HIV/AIDS

Question 1

Long term complications of ART

Answer 1

Insulin resistance, abnormal serum lipids, derangement of fat distribution (lipodystrophy syndrome)
Atherosclerosis
hyperlipidemia (mostly with PI and efavirenz regimens)

Question 2

Most common symptoms in pts with AIDS

Answer 2

fatigue
weight loss
pain
anorexia
insomnia
cough
n/v

Question 3

Treatable causes of fatigue in HIV

Answer 3

Fear of unknown
Anemia, adrenal or testosterone insufficiency
lactic acidosis, thyroid
Insomnia
infection
metabolic derangements
uncontrolled disease
malnourishment
anxiety/depression

Question 4

Treatment for HIV fatigue

Answer 4

Tx underlying cause
methylphenidate
armodafinil
modafinil
testosterone
?blood transfusion

Question 5

Causes of altered taste and dysphagia in pt with HIV

Answer 5

Oral or esophageal candidiasis
Azole-resistant candidiasis

Question 6

Oral or esophageal candidiasis treatment

Answer 6

Fluconazole or Itraconazole

Question 7

Azole-resistant Oral or esophageal candidiasis

Answer 7

Amphotericin B suspension or IV
OR capsofungin, anidulafungin, micafungin

Question 8

Cause of pain in mouth and odynophagia in pt with HIV

Answer 8

Aphthous ulcers
Herpetic ulcers
CMV ulcers (no pain in mouth)

Question 9

Tx aphthous ulcers

Answer 9

prednisone
OR thalidomide (se: rash, sedation, peripheral neuropathy)

Question 10

tx herpetic ulcers

Answer 10

Famciclovir, valacyclovir or acyclovir

Question 11

Tx CMV ulcers

Answer 11

Ganciclovir, valganciclovir or foscarnet (Used in biopsy diagnosed cases)

Question 12

Tx for Diarrhea in HIV

Answer 12

r/o infection
empiric abx (metronidazole 250-500mg TID)
Antidiarrheals – Crofelemer

Question 13

Rashes in HIV

Answer 13

Seborrheic dermatitis
Eosinophilic folliculitis

Question 14

Causes of wasting and anorexia

Answer 14

hypogonadism
malnutrition
malabsorption
infection

Question 15

Treatment for HIV/AIDS wasting and anorexia

Answer 15

ART
steroids
dronabinol
megestrol acetate
oxandrolone
testosterone
other anabolic steroids
recombinant growth hormone
thalidomide

Question 16

Effect of anabolic agents and growth hormone used for wasting

Answer 16

greater effect on increasing lean muscle mass
Risk of hepatotoxicity
Growth hormone –> insulin resistance, swelling and joint pain

Question 17

Effect of megestrol

Answer 17

Appetite stimulant
Primarily increases FAT (less helpful for pt on ART)
causes glucose intolerance and adrenal suppression
increased risk of VTE !!

Question 18

potential benefit of ART in late-stage HIV

Answer 18

• Selection of “less fit” virus
• Protection against HIV encephalopathy and dementia
• relief or easing of sx associated with high viral loads (lack of evidence)
• Continued therapeutic effect
• Psych and emotional benefits

Question 19

Potential risks of ART in late stage HIV

Answer 19

• Drug toxicity iso therapeutic futility
• Diminished QOL from demands of treatment regimen
• Therapeutic confusion
• Distraction from end of life and advanced care planning issues

Question 20

When to stop prophylactic antibiotics

Answer 20

d/c iun last 3-4 weeks of life and restart if pt symptomatic

Question 21

four stages of responding to multiple AIDS related deaths

Answer 21

Shock and denial
overload and confusion
facing of reality
reinvestment and recovery

Question 22

External vs internal coping styles

Answer 22

External– No control so just have to accept what is happening (denial as coping)
Internal - control in each person–express emotions and feel more in control of their own fate