HIV adults Flashcards
Clinical manifestations of adult HIV: early signs
- generalized lymphadenopathy
- unexplained weight loss
- recurrent respiratory infections
- shingles
- oral sores
- angular cheilitis
- rashes such as pruritic papules, seborrhea, fungal nail infections
Overall clinical manifestations of adult HIV
- unexplained chronic diarrhea
- persistent fever
- persistent oral candidiasis
- oral hairy leukoplakia
- pulmonary tuberculosis
- joint infections
- unexplained anemia, neutropenia, chronic thrombocytopenia
AIDS-defining illnesses
- opportunistic infections such as kaposi’s sarcoma
- HIV encephalopathy
- lymphoma
- invasive cervical carcinoma
- nephropathy and cardiomyopathy
Determining treatment for HIV in adults
perform genotypic testing and drug resistance testing prior to onset of therapy and again when ready to start treatment
goals of HIV treatment in adults
- reduce HIV-related morbidity
- balance duration and QOL
- restore and preserve immunologic function
- suppress HIV viral load {maximal and durable}
- prevent HIV transmission
Tools to achieve treatment goals for HIV
- select antiretroviral regimen
2. maximize adherence {if cant comply completely then don’t treat because risk of resistance}
Improving adherence of antiretroviral meds
- support and reinforce
- creat simplified dosing strategies
- use reminders, alarms, timers, pillboxes, etc.
- provide ongoing pt education
- cultivate trust in PCP
when to start antiretroviral therapy
- no exact CD4 count dictates initiation of therapy
2. current recommendation is for ART for all
Recommendation for initiating ART
- give to all HIV-infected to reduce disease progression
2. for prevention of HIV transmission {especially in pregnant women
Benefits of early ART
- may prevent HIV-related end-organ-damage
- may potentially decrease risk of may complications
- prevention of perinatal and partner transmission
Complications of HIV
- HIV-associated nephropathy
- LIver disease progression from hep B or C
- cardiovascular disease
- malignancies (AIDS-defining and non-AIDS-defining)
- neurocognitive decline
- blunted immunological response
considerations of deferral of ART
- low CD4 count, consider deferral only in unusual situations and with close follow-up
- with significant barriers to adherence
- comorbidities that complicate or prohibit therapy
- subgroup of long-term nonprogressors
Current classes of ARV medications
- NRTI
- NNRTI
- PI
- Integrase Inhibitors (II)
- Fusion inhibitor
- CCR5 Antagonist
NRTI medications
- abacavir (ABC)
- didanosine (ddI)
- emtricitabine (FTC)
- lamivudine (3TC)
- Stavudine (d4T)
- tenofovir (TDF)
- zidovudine (AZT, ZDV)
NNRTI medications
- delavirdine (DLV)
- Efavirenz (EFV)
- Etravirine (ETR)
- Nevirapine (NVP)
- Rilpivirine (RPV)