HIV Flashcards
If a patient has a fourth-generation screening test positive for HIV and p24 Ag testing positive, what additional evaluation do you perform?
HIV-1/HIV-2 antibody differentiation immunoassay
If the HIV-1/HIV-2 antibody differentiation immunoassay is positive, what is your next step in the evaluation of the patient?
HIV viral load
If a patient is confirmed to be HIV-positive, what baseline laboratory evaluation do you perform?
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
What immunizations are recommended for an HIV-positive pregnant woman?
Inactivated annual Influenza H1N1 tetanus vaccines Hepatitis A and B Pneumococcal
How do you counsel patients regarding the use of antiretroviral therapy during pregnancy?
can reduce perinatal transmission by several mechanisms, including lowering maternal antepartum viral load and preexposure and postexposure prophylaxis of the infant
What are the two primary goals of antiretroviral therapy during pregnancy?
reduction of perinatal transmission and the treatment of maternal HIV disease
What is the vertical transmission rate for patient with and without zidovudine?
w/o ziduvudine 25%
w/ zidovudine 5%
What is the vertical transmission rate for patient with 1000 copies, 10,000 copies and 100,000 copies?
2%
11%
40%
What is the risk of vertical transmission in a patient with undetectable HIV viral load in pregnancy?
0.1-0.3%
When should antiretroviral therapy be started in the patient with a new diagnosis of HIV infection in pregnancy?
Immediately
If a patient is already established on an antiretroviral regimen and presents with a new diagnosis of pregnancy, how will you manage her medications?
Choose anti-retrovirals that are safe in pregnancy -
NRTI (Emtricitabine/Lamivudine/Tenofovir), Integrase Inhibitor (Raltegravir, Dolutegravir), Protease Inhibitor
How do you counsel an HIV-infected pregnant patient regarding recommended route of delivery?
If > 1000, schedule cs at 38w
Repeats < 1000, can be scheduled for 39w
In an HIV infected pregnant woman with a high viral load, at what gestational age do you plan her delivery?
38 weeks
How should you administer Zidovudine for women in labor?
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)
How do you manage a patient with preterm premature rupture of membranes who is HIV positive?
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.
Describe your management of a patient with unknown HIV status who presents in labor at term.
Rapid screening
Which patients do you consider to be candidates for a rapid HIV test?
women who were not tested earlier in pregnancy or whose HIV status is otherwise unknown
How do you manage a pregnant woman in labor at term with a positive rapid HIV test?
Immediately administer antiretroviral prophylaxis for mother and neonate
Which HIV-infected pregnant patients should receive zidovudine intrapartum?
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
Which neonates born to HIV-infected pregnant patients should zidovudine be given to in the neonatal period?
All newborns who were exposed perinatally to HIV should receive postpartum antiretroviral (ARV) drugs to reduce the risk of perinatal transmission of HIV
Prophylaxis with CD4 at 250 but not lower than 200
Coccidiodomycosis treat with flucanozole
Prophylaxis with CD4 at 200 but not lower than 150
Pneumocysitis pneumonia treat with Bactrim (alternative Dapsone)
Prophylaxis with CD4 at 100 but not lower than 50
Toxoplasmosis treat with Bactrim (alternative Dapsone and pyrimethamine + leucovorin)
Talaromycosis, treat with itraconazole
Prophylaxis with CD4 at 150 but not lower than 100
Histoplasmosis treat with itraconazole
Prophylaxis with CD4 less 50
Mycobacterium avid complex treat with azithromycin
What what CD4 count is it best to administer hepatitis B vaccine to a HIV patient?
Greater than 350
How often should viral load be followed in pregnancy?
It should be followed every month unless new medication then follow every 2 weeks until you see viral load decreasing
How often should CD4 be followed in pregnancy?
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.
HIV is considered undetectable if the viral load is less than:
50 copies
Examples of nucleoside reverse transcriptase inhibitor
- Emtricitabine
- Lamivudine
- Tenofovir
Example of protease inhibitor:
Ritonavir (get early glucose screen and don’t use with methergine)
Examples of integrase inhibitor:
Raltegravir Dolutegravir (associated with neural tube defect)
HIV RNA greater than 1,000 intrapartum with maternal ZDV resistance
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)
