HIV adults Flashcards

1
Q

Clinical manifestations of adult HIV: early signs

A
  1. generalized lymphadenopathy
  2. unexplained weight loss
  3. recurrent respiratory infections
  4. shingles
  5. oral sores
  6. angular cheilitis
  7. rashes such as pruritic papules, seborrhea, fungal nail infections
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2
Q

Overall clinical manifestations of adult HIV

A
  1. unexplained chronic diarrhea
  2. persistent fever
  3. persistent oral candidiasis
  4. oral hairy leukoplakia
  5. pulmonary tuberculosis
  6. joint infections
  7. unexplained anemia, neutropenia, chronic thrombocytopenia
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3
Q

AIDS-defining illnesses

A
  1. opportunistic infections such as kaposi’s sarcoma
  2. HIV encephalopathy
  3. lymphoma
  4. invasive cervical carcinoma
  5. nephropathy and cardiomyopathy
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4
Q

Determining treatment for HIV in adults

A

perform genotypic testing and drug resistance testing prior to onset of therapy and again when ready to start treatment

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5
Q

goals of HIV treatment in adults

A
  1. reduce HIV-related morbidity
  2. balance duration and QOL
  3. restore and preserve immunologic function
  4. suppress HIV viral load {maximal and durable}
  5. prevent HIV transmission
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6
Q

Tools to achieve treatment goals for HIV

A
  1. select antiretroviral regimen

2. maximize adherence {if cant comply completely then don’t treat because risk of resistance}

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7
Q

Improving adherence of antiretroviral meds

A
  1. support and reinforce
  2. creat simplified dosing strategies
  3. use reminders, alarms, timers, pillboxes, etc.
  4. provide ongoing pt education
  5. cultivate trust in PCP
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8
Q

when to start antiretroviral therapy

A
  1. no exact CD4 count dictates initiation of therapy

2. current recommendation is for ART for all

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9
Q

Recommendation for initiating ART

A
  1. give to all HIV-infected to reduce disease progression

2. for prevention of HIV transmission {especially in pregnant women

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10
Q

Benefits of early ART

A
  1. may prevent HIV-related end-organ-damage
  2. may potentially decrease risk of may complications
  3. prevention of perinatal and partner transmission
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11
Q

Complications of HIV

A
  1. HIV-associated nephropathy
  2. LIver disease progression from hep B or C
  3. cardiovascular disease
  4. malignancies (AIDS-defining and non-AIDS-defining)
  5. neurocognitive decline
  6. blunted immunological response
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12
Q

considerations of deferral of ART

A
  1. low CD4 count, consider deferral only in unusual situations and with close follow-up
  2. with significant barriers to adherence
  3. comorbidities that complicate or prohibit therapy
  4. subgroup of long-term nonprogressors
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13
Q

Current classes of ARV medications

A
  1. NRTI
  2. NNRTI
  3. PI
  4. Integrase Inhibitors (II)
  5. Fusion inhibitor
  6. CCR5 Antagonist
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14
Q

NRTI medications

A
  1. abacavir (ABC)
  2. didanosine (ddI)
  3. emtricitabine (FTC)
  4. lamivudine (3TC)
  5. Stavudine (d4T)
  6. tenofovir (TDF)
  7. zidovudine (AZT, ZDV)
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15
Q

NNRTI medications

A
  1. delavirdine (DLV)
  2. Efavirenz (EFV)
  3. Etravirine (ETR)
  4. Nevirapine (NVP)
  5. Rilpivirine (RPV)
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16
Q

PI medications

A
  1. Atazanavir (ATV)
  2. Darunavir (DRV)
  3. Fosamprenavir (FPV)
  4. Indinavir (IDV)
  5. Lopinavir (LPV)
  6. Nelfinavir (NFV)
  7. Ritonavir (RTV)
  8. Saquinavir (SQV)
  9. Tipranavir (TPV)
17
Q

Integrase inhibitors (II) medications

A
  1. Dolutegravir (DTG)
  2. Elvitegravir (EVG)
  3. Raltegravir (RAL)
18
Q

Fusion inhibitor meds

A

Enfuviritide (ENF, T-20)

19
Q

CCR5 antagonist medication

A

Maraviroc (MVC)

20
Q

Initial treatment med combinations

A
  1. one NNRTI + 2 NRTIs
  2. one PI + 2 NRTIs
  3. one II + 2 NRTIs
    * *there are advantages and disadvantages to each type of regimen
21
Q

Postexposure prophylaxis for HIV

A

Example: people who have occupational contact, experience sexual assault - use of ART recommended for few days

22
Q

Preexposure prophylaxis for HIV

A

Example: people who exhibit or plan to exhibit risky behavior

23
Q

HIV treatment guidelines are available wher

A
  1. National AIDS Education Training Center
  2. HIV ATIS
  3. CDC