HIV/AIDS Flashcards
HIV
what cells are attacked?
CD4 cells
HIV
when is it AIDS?
CD4 less than 200
HIV
Which HIV strain is the most common?
HIV-1, it also progresses faster
HIV
what ages are most likely affected?
25-34y
HIV
How is HIV transmitted?
~75% sexually
HIV
Who is most likely to contract infection?
Those who have receptive anal sex, men who have sex with men
HIV
what is the risk of accidental needle stick?
1:300
HIV
What factors increase risk from needle stick?
depth of penetration
hollow bore needles
visible blood on needle
advanced stage of disease in source patient
HIV
How is HIV spread to chiildren from mother?
placenta, delivery, breast milk
HIV
What body fluids are considered non infectious
Saliva, sweat, stool, tears not considered infectious.
HIV
Increased risk of HIV transmission
ulcerative or inflammatory STIs
trauma
menses
lack of male circumcision
HIV
when does acute Infection start? (Incubation period)
2-6 weeks post-infection
What are Sx of acute HIV
80% of patients have nonspecific symptoms
Self limited,
Mono/flu-like illness
“Acute retroviral syndrome”
opportunistic oral/esophageal candidiasis
Low-grade fever +/- chills
*Fatigue
Night sweats**
Myalgia/arthralgia
Painful mucocutaneous ulceration
Rash +/- yeast infection
Headaches
Pharyngitis
Diarrhea
**Weight loss (unintentional)
*Lymphadenopathy
*Oral hairy leukoplakia – caused by Epstein Barr; can’t be scraped off
HIV
skin manifestations
Zoster: may be present at normal CD4 counts
HSV 1 and 2
HPV
Staph aureus skin infections/ folliculitis
HIV
AIDS non specific Sx
Blurred vision
Dry cough
Night sweats
Fatigue
Unintentional weight loss (due to anorexia, nausea, vomiting)
White spots on tongue
SOB
Lymphadenopathy
Chronic diarrhea
Temperature over 100.5F
AIDS
defining conditions
Candidiasis, PJP, Kaposi sarcom (skin lesions), CNS lymphoma,
Non-Hodgkin lymphoma, Toxoplasmosis of brain,
Recurrent Salmonella septicemia,
CMV disease, Disseminated histoplasmosis, Recurrent bacterial pneumonias most common (S pneumoniae, Haemophilus)
HIV
Neuro manifestations
HIV meningitis
HIV dementia / HIV-associated neurocognitive disorders
Cryptococcosis
HIV
Dx
Antibody/antigen test
Looks for antibodies against HIV and HIV itself (antigens)
*Recommended first test
HIV
Confirming Dx tests
- RNA/DNA test (preferred for peds)
- Antibody test (aka immunoassay or ELISA test)
HIV
Work up for new pt
- CBC, CD4 count, viral load, comprehensive metabolic panel
- CMV IgG and toxoplasmosis IgG: risk for reactivation in immunosuppression
- If no history of varicella zoster infection or vaccination, screen with IgG; offer vaccination if CD4 >200
- Screening for other STDs; HPV vaccination
- Hepatitis A, B, C screening
- PPD
Peds HIV
Clinical manifestations
varied/nonspecific.
Lymphadenopathy with hepatosplenomegaly can be early sign of infection.
During the first year of life, oral candidiasis, failure to thrive, and developmental delay are common presenting features.
Peds HIV
Most common AIDs defining conditions
Pneumocystis jiroveciipneumonia (PCP)
Recurrent bacterial infections
Wasting syndrome
Esophageal candidiasis
HIV encephalopathy
Cytomegalovirus pneumonia, colitis, encephalitis, or retinitis
HIV
Screening recomendations
CDC: everyone 13-64 should be tested at least once as part of routine health care
High risk - screen annually (MSM, sex workers, IV drug use)
routine pregnancy screening
HIV/AIDS
Tx
ART – using anti-HIV drugs
HAART – combination of drugs (highly active antiretroviral therapy)
No cure, helps live longer healthier lives.
HIV
Drug Classes
1.Nucleoside reverse transcriptase inhibits (NRTI) - Interferes with HIV as it tries to replicate
2. Non-nucleoside reverse transcriptase inhibits (NNRTI) – not as common
3. Protease inhibitors (PI) – inhibits replication of virus
4. CCR4 antagonists (CCR5)
5. Fusion inhibitors (FI)
6. Integrase inhibitors– inhibits infections of T cells; often first line of therapy
HIV/AIDS
Issues with Tx compliance
Adherence
General side effects include: nausea, fatigue, diarrhea, headaches, rashes, and hepatic impairment
tolerance, cross-resistance, be mindful of opportunistic
HIV/AIDS
First Line of defense
Protease inhibitor
HIV
Pre-Exposure Prophylaxis (PrEP)
Tenofovir & emtricitabine
For those in high-risk categories
Ongoing relationship with HIV+ partner, risky sexual behavior without protection
Injection drug use
HIV
Post-exposure prophylaxis (PEP)
Given 48 to 72 hours after known exposure (ideally within 2 hours)
Three drug regimen
tenofovir + emtricitibine (NRTIs) PLUS raltegravir or dolutegravir
Follow up testing recommended
Not 100% effective
