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Infectious Disease > HIV > Flashcards

HIV Flashcards

1
Q

What investigations do you order to stage HIV?

A
  1. CD4 count
  2. Opportunistic Infection Screen
  3. Viral Load (RNA)
  4. Genotype (Resistance)
  5. Tropism Testing (CCR5)
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2
Q

What does tropism testing identify in patients with HIV?

A

HIV requires both the CD4 receptor and a coreceptor in order to enter CD4+ T-cells. A tropism test identifies which co-receptor (CCR5 or CXCR4) the patient’s HIV strain uses. There are specific treatments that target against CCR5 (CCR5 antoagonist - macaviroc) which can be used in the treatment of HIV.

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3
Q

What serological should you order in HIV patients upon initial diagnosis?

A

CMV IgG
Toxoplasmosis IgG
Hepatitis B/C Serology

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4
Q

What is the recommend anti-retroviral regimen for HIV?

A

2 Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
PLUS
1 INSTI (integrase stand transfer inhibitor)
OR
1 NNRTI (non-nucleoside reverse transcriptase inhibitor)
OR
1 PI (protease inhibitor)

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5
Q

What is the initial recommended regimen for HIV in most patients?

A
  1. Bictegravir + tenofovir alfenamide + emtricitabine
    OR
  2. Dolutegravir + one of:
    - tenofovir alafenamide + emtricitabine
    - tenofovir disoproxil fumarate + emtricitabine
    - tenofovir disoproxil fumarate + lamivudine
    OR
  3. Dolutegravir + lamivudine w/caveats
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6
Q

What are examples of nucleoside reverse transcriptase inhibitors (5)?

A
  • tenofovir
  • emtricitabine
  • lamivudine
  • zidovudine
  • abacavir
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7
Q

What are examples INSTI (integrase strand transfer inhibitors)?

A
  • Bictegravir
  • Dolutegravir
  • Elvitegravir
  • Rastegravir
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8
Q

At what CD4 count is PCP prophylaxis recommended in HIV patients?

A

CD4 < 200

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9
Q

What is the preferred PCP prophylaxis in patients with HIV?

A

TMP/SMX 1 DS Tab PO Daily

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10
Q

Which other medications (besides Septra) can be used for PCP prophylaxis?

A
  • Dapsone (OK if Sulfa allergy BUT NOT if previous SJS/TEN from Septra)
  • Atovaquone 1500 mg PO daily
  • INH pentamidine monthly
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11
Q

How long do you continue PCP prophylaxis for in patient you begin treating for HIV?

A

Continue prophylaxis until CD4 count stabilized > 200 for at least 3 months

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12
Q

When is MAC prophylaxis recommended in HIV patients?

A

When CD4 < 50 AND the patient is either not starting ART therapy or not on fully suppressive therapy. DO NOT need to give prophylaxis if the patient is starting regular ART therapy.

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13
Q

What is the prophylactic therapy for MAC in HIV patients?

A

Azithromycin 1200 mg PO weekly

Can also use clarithromycin

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14
Q

Which infection do HIV patients require prophylaxis for once CD4 count drops < 100?

A

Toxoplasmosis if the patient is toxoplasmosis IgG positive.

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15
Q

What is the recommended regimen for toxoplasmosis prophylaxis in HIV patients?

A

TMP/SMX 1 DS Tab PO Daily

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16
Q

What would you use for prophylaxis of PCP in pregnancy, if needed?

A

You would treat with Septra, but supplement with folic acid during the first trimester to prevent neural tube defects.

17
Q

What are the treatment options for infection with PCP in HIV patients?

A

(1) TMP-SMX 15-20 mg/kg IV x 21d

Alternatives for moderate-severe disease:
(A) Primaquine + clindamycin IV
(B) Pentamidine IV

Alternatives for mild to moderate disease:
(A) Dapsone + TMP
(B) Primaquine + clindamycin PO
(C) Atovaquone 750 mg PO BID

18
Q

What qualifies as severe PCP infection, warranting treatment with steroids?

A

If PaO2 < 70% OR A-a gradient > or = 35 mmHg:

Treat with tapering steroid regimen for 21 days:

Prednisone 40 mg PO BID x 5d, then
20 mg PO BID x 5d, then
20 mg PO daily x 11d

19
Q

What is the preferred treatment for MAC infection in the setting of HIV?

A

Clarithromycin + ethambutol OR
Azithromycin + ethambutol

12 months of treatment

20
Q

What are the preferred treatments (2) for toxoplasmosis infection in patients with HIV?

A

(1) Sulfadiaxine + pyrimethamine

(2) Pyrimethamine + clindamycin

21
Q

What CD4 count cutoff puts you at risk for PML in HIV?

A

< 100

22
Q

What CD4 count puts you at risk for CNS lymphoma in patients with HIV?

A

< 50

23
Q

What CD4 count cutoff puts you at risk for CMV infection in patients with HIV?

A

< 50

24
Q

At what HIV viral load would you recommend a mother undergo a scheduled C/S rather than spontaneous vaginal delivery?

A

VL > 1000

25
Q

What is the preferred treatment for HIV in pregnancy?

A

Dolutegravir

Infectious Disease (13 decks)

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