HIV/AIDS

Question 1

HIV

what cells are attacked?

Answer 1

CD4 cells

Question 2

HIV

when is it AIDS?

Answer 2

CD4 less than 200

Question 3

HIV

Which HIV strain is the most common?

Answer 3

HIV-1, it also progresses faster

Question 4

HIV

what ages are most likely affected?

Answer 4

25-34y

Question 5

HIV

How is HIV transmitted?

Answer 5

~75% sexually

Question 6

HIV

Who is most likely to contract infection?

Answer 6

Those who have receptive anal sex, men who have sex with men

Question 7

HIV

what is the risk of accidental needle stick?

Answer 7

1:300

Question 8

HIV

What factors increase risk from needle stick?

Answer 8

depth of penetration
hollow bore needles
visible blood on needle
advanced stage of disease in source patient

Question 9

HIV

How is HIV spread to chiildren from mother?

Answer 9

placenta, delivery, breast milk

Question 10

HIV

What body fluids are considered non infectious

Answer 10

Saliva, sweat, stool, tears not considered infectious.

Question 11

HIV

Increased risk of HIV transmission

Answer 11

ulcerative or inflammatory STIs
trauma
menses
lack of male circumcision

Question 12

HIV

when does acute Infection start? (Incubation period)

Answer 12

2-6 weeks post-infection

Question 13

What are Sx of acute HIV

Answer 13

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

Question 14

HIV

skin manifestations

Answer 14

Zoster: may be present at normal CD4 counts
HSV 1 and 2
HPV
Staph aureus skin infections/ folliculitis

Question 15

HIV

AIDS non specific Sx

Answer 15

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

Question 16

AIDS

defining conditions

Answer 16

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)

Question 17

HIV

Neuro manifestations

Answer 17

HIV meningitis
HIV dementia / HIV-associated neurocognitive disorders
Cryptococcosis

Question 18

HIV

Dx

Answer 18

Antibody/antigen test
Looks for antibodies against HIV and HIV itself (antigens)
*Recommended first test

Question 19

HIV

Confirming Dx tests

Answer 19

1. RNA/DNA test (preferred for peds)
2. Antibody test (aka immunoassay or ELISA test)

Question 20

HIV

Work up for new pt

Answer 20

1. CBC, CD4 count, viral load, comprehensive metabolic panel
2. CMV IgG and toxoplasmosis IgG: risk for reactivation in immunosuppression
3. If no history of varicella zoster infection or vaccination, screen with IgG; offer vaccination if CD4 >200
4. Screening for other STDs; HPV vaccination
5. Hepatitis A, B, C screening
6. PPD

Question 21

Peds HIV

Clinical manifestations

Answer 21

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.

Question 22

Peds HIV

Most common AIDs defining conditions

Answer 22

Pneumocystis jiroveciipneumonia (PCP)
Recurrent bacterial infections
Wasting syndrome
Esophageal candidiasis
HIV encephalopathy
Cytomegalovirus pneumonia, colitis, encephalitis, or retinitis

Question 23

HIV

Screening recomendations

Answer 23

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

Question 24

HIV/AIDS

Tx

Answer 24

ART – using anti-HIV drugs
HAART – combination of drugs (highly active antiretroviral therapy)

No cure, helps live longer healthier lives.

Question 25

HIV

Drug Classes

Answer 25

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

Question 26

HIV/AIDS

Issues with Tx compliance

Answer 26

Adherence
General side effects include: nausea, fatigue, diarrhea, headaches, rashes, and hepatic impairment
tolerance, cross-resistance, be mindful of opportunistic

Question 27

HIV/AIDS

First Line of defense

Answer 27

Protease inhibitor

Question 28

HIV

Pre-Exposure Prophylaxis (PrEP)

Answer 28

Tenofovir & emtricitabine
For those in high-risk categories
Ongoing relationship with HIV+ partner, risky sexual behavior without protection
Injection drug use

Question 29

HIV

Post-exposure prophylaxis (PEP)

Answer 29

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