HIV / AIDS Flashcards
Which gender is more commonly effected by HIV
Men
Which ethnicity is more commonly effected by HIV
African American
What is the etiology of new HIV dx
Mostly male to male sexual contact
23% heterosexual contact
minimal IVDU
What mode of intercourse puts someone at highest risk for HIV
Receptive anal intercourse
Which forms of HIV are human pathogens
HIV 1
HIV 2
What are the symptoms of HIV
Often asymptomatic
*Can have acute retroviral syndrome
When will an acute retroviral syndrome present
3-6 weeks post infection and will last 1-2 weeks
What is occurring in the body during an acute retroviral syndrome
Rapid surge in viral load and a drop in CD4
What symptoms will someone with mild retroviral syndrome show
Vague
flu like
What symptoms will someone with severe retroviral syndrome show
Meningitis
encephalitis
thrombocytopenia
When are HIV screenings done
CDC recommends 1x screening for all patients 13-64
1x/year for high risk patients
What diagnostic tests are available for HIV testing
Nucleic acid tests
Antigen/antibody testing
Antibody only testing
What does the nucleic acid test show
HIV RNA
What does the antigen/ antibody HIV test show
Detects HIV p24 antigen and HIV IgM and IgG
What does the antibody only testing show for HIV
HIV IgM & IgG
When is nucleic acid most beneficial
Acute HIV or indeterminate test
*No HIV antibodies yet
Detectable 10 days post exposure
Which HIV test is considered a rapid test
HIV 1/2 antigen/antibody immunoassay
What can you start to receive HIV treatment if positive
> 18y/o
*regardless of CD4 count
Can pregnant women receive HIV treatment
Yes (Avoid TDF)
How soon do you initiate HIV treatment after infection
As immediately as possible
What baseline labs should be done before first HIV treatment
Viral load
HUV genotyping
CD4 count
BMP/CMP
Lipids
CBC
Glucose
Urinalysis
Pregnancy testing
What is the first line treatment for HIV
ART
(Anti-retroviral therapy)
*3 drug combo
What does the 3 drug combo include with ART
1InSTI + 2NRTIs
What is the second line treatment for HIV
2 NRTIs and 1 from a different class (PI/II/NNRTI)
What are the main goals of HIV treatment
Virology suppression
*CD4 should rise with the viral suppression
What is IRIS HIV treatment
Immune reconstitution inflammatory syndrome
When is IRIS treatment given for HIV
After the initiation of ART
*Secondary to rapid increase in CD4
What must be ruled out before IRIS can be initiated
Worsening opportunistic infection… can make additive treatment higher risk
What are some reasons ART treatment can be adjusted
side effects
toxicity
simplify for regimen compliance
virologic failure
How can HIV be prevented
cessation of IV drug use / needle sharing
Safe sex practices
Sex education
ART as prevention
What are some harm reduction approaches for HIV prevention
Needle exchange programs
appropriate cleansing of needles
PrEP
PEP
what is PrEP
Pre-exposure prophylaxis
*prevention of HIV infection in HIV negative patients
Who can be given PrEP
Indicated for any high risk patient who requests it
What tests need to be done before administering PrEP
Negative HIV antibody
creatinine
Hep B/C
STD test
Pregnancy testing
How can PrEP be taken
Oral (Daily)
IM (every 2 months)
How often does one need to be monitored with PrEP
every 3 months
what is PEP
post exposure prophylaxis
*Prevention of HIV in negative patients after exposure to HIV (Includes potential exposure)
How soon must PEP be administered after exposure
within 72 hours
How long is PEP treatment
Orally for 28 days
What screening needs to be done before starting PEP
HIV rapid test
Pregnancy test
LFTs
BUN /creatinine
STI screen
Hep B/C screen
After PEP how frequently does HIV need to be screened for and why
at 30 / 90 days to rule out seroconversion
What are some complications of HIV
CAD
RA
osteoporosis
AIDS
What is the time period from the initial HIV infection and AIDS
roughly 10 years (without ARV treatment)
What properties must one have to be considered as having AIDS
CD4 count <200 cells
OR
AIDS defining infection / malignancy
(Opportunistic infection)
What is (was) the most common opportunistic infection in AIDS patients
PCP
Pneumocystitis jirovecii
What will be seen in someone with PCP
Diffuse or perihilar infiltrates on CXR
*DX with sputum testing
*TX: Bactrim x 21 days
How does Toxoplasmosis show up in AIDS patients
CNS infection
-seizures / AMS
- Ring enhancing lesion on CT
-CD<100
How do you treat toxoplasmosis with AIDS patients
Pyrimethamine + Sulfadiazine
If an AIDS patient has a CD4 count of <50 what are you looking for
MAC
Mycobacterium Avium Complex
How do you diagnose MAC in AIDS patients
Sputum culture
How do you treat MAC in AIDS patients
Clarithromycin (Azithromycin)
+ Ethambutol
+Rifampin
If someone with AIDS have cryptococcal meningitis, what sx will they have
headache
Fever
How do you diagnose cryptococcal meningitis in AIDS patients
CRAG (Serum cryptococcal antigen)
+India ink strain CSF
How do you treat cryptococcal meningitis
IV lysosome Amp B + Flucytosine x2 weeks
THEN
Fluconazole 400mg x 8weeks
THEN
Fluconazole 200mg x 1 year
What is CMV retinitis in AIDS patients
Infection of the retina with cytomegalovirus
Preivascular hemorrhages and white fluffy exudates
**NOT cotton wool spots
What are AIDS opportunistic diseases
HIV related encephalopathy
Invasive cervical cancer
Kaposis Sarcoma
Lymphomas
PML
Wasting syndrome
What is karposis sarcoma
Infection with kaposis sarcoma herpes virus (KSHV)
How does kaposis sarcoma look
Purplish macule / papule / nodules (CD4 <200)
How do you diagnose kaposis sarcoma
Biopsy
What is the tx for kaposis sarcoma
ART if not widespread
*Add chemo if widespread
