HIV/AIDS Flashcards
Long term complications of ART
Insulin resistance, abnormal serum lipids, derangement of fat distribution (lipodystrophy syndrome)
Atherosclerosis
hyperlipidemia (mostly with PI and efavirenz regimens)
Most common symptoms in pts with AIDS
fatigue
weight loss
pain
anorexia
insomnia
cough
n/v
Treatable causes of fatigue in HIV
Fear of unknown
Anemia, adrenal or testosterone insufficiency
lactic acidosis, thyroid
Insomnia
infection
metabolic derangements
uncontrolled disease
malnourishment
anxiety/depression
Treatment for HIV fatigue
Tx underlying cause
methylphenidate
armodafinil
modafinil
testosterone
?blood transfusion
Causes of altered taste and dysphagia in pt with HIV
Oral or esophageal candidiasis
Azole-resistant candidiasis
Oral or esophageal candidiasis treatment
Fluconazole or Itraconazole
Azole-resistant Oral or esophageal candidiasis
Amphotericin B suspension or IV
OR capsofungin, anidulafungin, micafungin
Cause of pain in mouth and odynophagia in pt with HIV
Aphthous ulcers
Herpetic ulcers
CMV ulcers (no pain in mouth)
Tx aphthous ulcers
prednisone
OR thalidomide (se: rash, sedation, peripheral neuropathy)
tx herpetic ulcers
Famciclovir, valacyclovir or acyclovir
Tx CMV ulcers
Ganciclovir, valganciclovir or foscarnet (Used in biopsy diagnosed cases)
Tx for Diarrhea in HIV
r/o infection
empiric abx (metronidazole 250-500mg TID)
Antidiarrheals – Crofelemer
Rashes in HIV
Seborrheic dermatitis
Eosinophilic folliculitis
Causes of wasting and anorexia
hypogonadism
malnutrition
malabsorption
infection
Treatment for HIV/AIDS wasting and anorexia
ART
steroids
dronabinol
megestrol acetate
oxandrolone
testosterone
other anabolic steroids
recombinant growth hormone
thalidomide
Effect of anabolic agents and growth hormone used for wasting
greater effect on increasing lean muscle mass
Risk of hepatotoxicity
Growth hormone –> insulin resistance, swelling and joint pain
Effect of megestrol
Appetite stimulant
Primarily increases FAT (less helpful for pt on ART)
causes glucose intolerance and adrenal suppression
increased risk of VTE !!
potential benefit of ART in late-stage HIV
- 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
Potential risks of ART in late stage HIV
- Drug toxicity iso therapeutic futility
- Diminished QOL from demands of treatment regimen
- Therapeutic confusion
- Distraction from end of life and advanced care planning issues
When to stop prophylactic antibiotics
d/c iun last 3-4 weeks of life and restart if pt symptomatic
four stages of responding to multiple AIDS related deaths
Shock and denial
overload and confusion
facing of reality
reinvestment and recovery
External vs internal coping styles
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
