HIV

Question 1

If a patient has a fourth-generation screening test positive for HIV and p24 Ag testing positive, what additional evaluation do you perform?

Answer 1

HIV-1/HIV-2 antibody differentiation immunoassay

Question 2

If the HIV-1/HIV-2 antibody differentiation immunoassay is positive, what is your next step in the evaluation of the patient?

Answer 2

HIV viral load

Question 3

If a patient is confirmed to be HIV-positive, what baseline laboratory evaluation do you perform?

Answer 3

Toxoplasmosis
CD4 count
HIV RNA viral load
CBC, chemistry, LFT, BUN/Cr, UA
Serology for Hepatitis A, B and C
HLAB5701 for abacavir resistance testing 
G6PD testing

Question 4

What immunizations are recommended for an HIV-positive pregnant woman?

Answer 4

Inactivated annual Influenza
H1N1
tetanus vaccines
Hepatitis A and B
Pneumococcal

Question 5

How do you counsel patients regarding the use of antiretroviral therapy during pregnancy?

Answer 5

can reduce perinatal transmission by several mechanisms, including lowering maternal antepartum viral load and preexposure and postexposure prophylaxis of the infant

Question 6

What are the two primary goals of antiretroviral therapy during pregnancy?

Answer 6

reduction of perinatal transmission and the treatment of maternal HIV disease

Question 7

What is the vertical transmission rate for patient with and without zidovudine?

Answer 7

w/o ziduvudine 25%

w/ zidovudine 5%

Question 8

What is the vertical transmission rate for patient with 1000 copies, 10,000 copies and 100,000 copies?

Answer 8

2%
11%
40%

Question 9

What is the risk of vertical transmission in a patient with undetectable HIV viral load in pregnancy?

Answer 9

0.1-0.3%

Question 10

When should antiretroviral therapy be started in the patient with a new diagnosis of HIV infection in pregnancy?

Answer 10

Immediately

Question 11

If a patient is already established on an antiretroviral regimen and presents with a new diagnosis of pregnancy, how will you manage her medications?

Answer 11

Choose anti-retrovirals that are safe in pregnancy -

NRTI (Emtricitabine/Lamivudine/Tenofovir), Integrase Inhibitor (Raltegravir, Dolutegravir), Protease Inhibitor

Question 12

How do you counsel an HIV-infected pregnant patient regarding recommended route of delivery?

Answer 12

If > 1000, schedule cs at 38w

Repeats < 1000, can be scheduled for 39w

Question 13

In an HIV infected pregnant woman with a high viral load, at what gestational age do you plan her delivery?

Answer 13

38 weeks

Question 14

How should you administer Zidovudine for women in labor?

Answer 14

1-hour loading dose of ZDV at 2 mg/kg followed by a continuous IV ZDV infusion of 1 mg/kg for 2 hours (minimum of 3 hours total)

Question 15

How do you manage a patient with preterm premature rupture of membranes who is HIV positive?

Answer 15

Deliver if spontaneous ROM occurs at >34 weeks gestation before labor or early in labor in women whose HIV RNA level is ≤1,000 copies/mL.

If less than 34 weeks and high viral load, shared decision making. An option is to start cART and continue pregnancy because transmission likely occurred already if PPROM and contractions are present.

Question 16

Describe your management of a patient with unknown HIV status who presents in labor at term.

Answer 16

Rapid screening

Question 17

Which patients do you consider to be candidates for a rapid HIV test?

Answer 17

women who were not tested earlier in pregnancy or whose HIV status is otherwise unknown

Question 18

How do you manage a pregnant woman in labor at term with a positive rapid HIV test?

Answer 18

Immediately administer antiretroviral prophylaxis for mother and neonate

Question 19

Which HIV-infected pregnant patients should receive zidovudine intrapartum?

Answer 19

Pregnant women infected with HIV whose viral loads are more than 1,000 copies/mL at or near delivery, independent of antepartum antiretroviral therapy, or whose levels are unknown

Question 20

Which neonates born to HIV-infected pregnant patients should zidovudine be given to in the neonatal period?

Answer 20

All newborns who were exposed perinatally to HIV should receive postpartum antiretroviral (ARV) drugs to reduce the risk of perinatal transmission of HIV

Question 21

Prophylaxis with CD4 at 250 but not lower than 200

Answer 21

Coccidiodomycosis treat with flucanozole

Question 22

Prophylaxis with CD4 at 200 but not lower than 150

Answer 22

Pneumocysitis pneumonia treat with Bactrim (alternative Dapsone)

Question 23

Prophylaxis with CD4 at 100 but not lower than 50

Answer 23

Toxoplasmosis treat with Bactrim (alternative Dapsone and pyrimethamine + leucovorin)

Talaromycosis, treat with itraconazole

Question 24

Prophylaxis with CD4 at 150 but not lower than 100

Answer 24

Histoplasmosis treat with itraconazole

Question 25

Prophylaxis with CD4 less 50

Answer 25

Mycobacterium avid complex treat with azithromycin

Question 26

What what CD4 count is it best to administer hepatitis B vaccine to a HIV patient?

Answer 26

Greater than 350

Question 27

How often should viral load be followed in pregnancy?

Answer 27

It should be followed every month unless new medication then follow every 2 weeks until you see viral load decreasing

Question 28

How often should CD4 be followed in pregnancy?

Answer 28

It should be followed every 3 months if CD4 is less than 200.
It should be followed every 6 months if CD4 is greater than 200.

Question 29

HIV is considered undetectable if the viral load is less than:

Answer 29

50 copies

Question 30

Examples of nucleoside reverse transcriptase inhibitor

Answer 30

• Emtricitabine
• Lamivudine
• Tenofovir

Question 31

Example of protease inhibitor:

Answer 31

Ritonavir (get early glucose screen and don’t use with methergine)

Question 32

Examples of integrase inhibitor:

Answer 32

Raltegravir
Dolutegravir (associated with neural tube defect)

Question 33

HIV RNA greater than 1,000 intrapartum with maternal ZDV resistance

Answer 33

1-hour loading dose of ZDV at 2 mg/kg followed by a continuous IV ZDV infusion of 1 mg/kg for 2 hours (minimum of 3 hours total)