HIV Flashcards by Olivia Galante | Brainscape

Q

How does HIV attach to and enter human cells?

A

Uses glycoprotein 120 and glycoprotein 41 to attach to CD4 molecules and coreceptor CCR5 or CXCR4

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Q

How was a patient with HIV cured?

A

Received a bone marrow transplant for leukaemia from a donor who was homozygous for a CCR5 mutation

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Q

What causes the seroconversion illness in HIV?

A

Killing of infected CD4 lymphocytes by CD8 lymphocytes at around 3-4 weeks after infection

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Q

Why are there different clones of virus in HIV patients?

A

Because the virus replicates via a reverse transcriptase that is error prone which means that there can be clones that are poorly recognised by the cytotoxic lymphocytes

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Q

Why do people with HLA-B*57.01 have more effective cytotoxic responses against HIV?

A

Because this HLA type binds a peptide from the HIV core protein that is essential for replication therefore won’t be mutated

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Q

What is the mechanism of action of tenofovir?

A

Nucleoside reverse transcriptase inhibitor

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Q

What are the common mechanisms for HIV medications?

A

Reverse transcriptase inhibitors
Integrase inhibitors
Protease inhibitors

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Q

What is the mechanism of action of zidovudine?

A

Nucleoside reverse transcriptase inhibitor

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Q

What are the side effects of zidovudine?

A

Lipodystrophy, metabolic effects, GI side effects

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Q

What is the mechanism of action of lamivudine?

A

Nucleoside reverse transcriptase inhibitor

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Q

What is the mechanism of action of emtricitabine?

A

Nucleoside reverse transcriptase inhibitor

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Q

What is the mechanism of action of abacavir?

A

Nucleoside reverse transcriptase inhibitor

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Q

Which patients will have hypersensitivity to abacavir?

A

HLA-B57*01

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Q

What is the side effect of tenofovir disoproxil fumarate?

A

Nephrotoxicity, reduced bone mineral density

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Q

What monitoring needs to be done for tenofovir disoproxil fumarate?

A

6 monthly creatinine, phosphate, urine protein

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Q

What is the difference between tenofovir alafenamide and tenofovir disoproxil fumarate?

A

Tenofovir alafenamide has a longer plasma half life so less renal exposure so reduces nephrotoxicity

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Q

What is the mechanism of action of nevirapine?

A

Non nucleoside reverse transcriptase inhibitor

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Q

What is the mechanism of action of efavirenz?

A

Non nucleoside reverse transcriptase inhibitor

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Q

What is the mechanism of action of rilpiverine?

A

Non nucleoside reverse transcriptase inhibitor

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Q

What is the mechanism of action of delaverdine?

A

Non nucleoside reverse transcriptase inhibitor

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Q

What is the mechanism of action of etravirine?

A

Non nucleoside reverse transcriptase inhibitor

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Q

What is the mechanism of action of doravirine?

A

Non nucleoside reverse transcriptase inhibitor

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Q

What are the side effects of nevirapine?

A

Hypersensitivity reactions including hepatitis (stop if rash)

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Q

What are the side effects of efavirenz?

A

Sedation/insomnia, vivid dreams, neuropsych symptoms, deranged LFTs, rash

Q

What are the side effects of rilpiverine?

A

Prolonged QTc

Q

What are the side effects of delaverdine?

A

Rash, headache

Q

What are the side effects of etravirine?

A

Rash, GI side effects

Q

Why is ritonavir used in HIV?

A

It inhibits CYP3A4 so will increase the effect of other protease inhibitors

Q

What is the mechanism of action of lopinavir?

A

Protease inhibitor

Q

What is the mechanism of action of atazanavir?

A

Protease inhibitor

Q

What is the mechanism of action of darunavir?

A

Protease inhibitor

Q

What are the side effects of atazanavir?

A

Elevated bilirubin, renal stones

Q

What are the side effects of darunavir?

A

Rash

Q

What is the mechanism of action of raltegravir?

A

Integrase inhibitor

Q

What is the mechanism of action of elvitegravir?

A

Integrase inhibitor

Q

What is the mechanism of action of dolutegravir?

A

Integrase inhibitor

Q

What is the mechanism of action of bictegravir?

A

Integrase inhibitor

Q

What are the side effects of raltegravir?

A

Elevated CK/rhabdo

Q

What are the side effects of dolutegravir?

A

Headache, depression/anxiety, neural tube defects

Q

What are the side effects of bictegravir?

A

Headache, GI side effects

Q

What PEP should be offered to someone who has sexual exposure to a known HIV positive case when the viral load of the source is unknown?

A

3 drug PEP

Q

What PEP should be offered to someone who has sexual exposure to a known HIV positive case when the viral load of the source is undetectable?

A

None

Q

What PEP should be offered to someone who has occupational exposure to a known HIV positive case and the source has unknown viral load?

A

3 drug PEP

Q

What PEP should be offered to someone who has occupational exposure to a known HIV positive case and the source has a known undetectable viral load?

A

Consider 2 drug PEP

Q

What PEP should be offered to someone who has sexual exposure to a source with unknown HIV status?

A

2 drug PEP if source MSM or from high prevalence country (risk <1/1000 and >1/10000)

Q

What drugs are used for PrEP?

A

Tenofovir and emtricitabine

Q

When does PEP need to be started?

A

Within 72 hours

Q

How long is the course of PEP?

A

28 days

Q

What drugs are used for 2 drug PEP?

A

Tenofovir AND emtricitabine OR lamivudine

Q

What drugs are used for 3 drug PEP?

A

Tenofovir AND emtricitabine OR lamivudine AND EITHER dolutegavir OR raltegavir OR rilpivirine

Q

Who should get PrEP?

A

All people with behaviour that poses high risk of HIV acquisition

Q

What is the efficacy of PrEP?

A

90-99%

Q

What is the usual clinical presentation for PJP?

A

Progressive exertional dyspnoea, fever, non productive cough, desaturating on mobilising

Q

What is the treatment for PJP?

A

Cotrimoxazole

Q

Who should get primary prophylaxis for PJP?

A

Patients with newly diagnosed HIV or CD4 count < 200

Q

What is the usual clinical presentation for Cryptococcus meningitis?

A

Sub acute headache and fever, may have behavioural changes or confusion, meningeal features are late

Q

What is seen on LP for cryptococcal meningitis?

A

Raised opening pressure, slightly raised WCC and protein, low glucose, india ink and CRAG positive

Q

What is the treatment for cryptococcal meningitis?

A

Therapeutic LP

Amphotericin plus fluctyosine for 2 weeks followed by 8 weeks of fluconazole