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ID Exam 4 > HIV/AIDS > Flashcards

HIV/AIDS Flashcards

1
Q

Human Immunodeficiency Virus

A

single stranded RNA retrovirus
Targets a key part of our immune system; the CD4 helper T-cells

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2
Q

Acquired Immune Deficiency Syndrome (AIDS)

A

acquired syndrome caused by HIV as the virus depletes the immune system
The person becomes immunodeficient
For most, death occurs from an opportunistic infection

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3
Q

Treatment for HIV consists of _____

A

lifetime antiretrovirals which suppress viral activity
No cure

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4
Q

Where does AIDS virus come from?

A

Derived from primate lentivirus
a subgroup of retroviruses (RNA integrates into host DNA)

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5
Q

When wat HIV-1 isolated?

A

1985

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6
Q

Two types of HIV, both cause AIDS

A

HIV 1- more common worldwide
HIV 2- predominantly west africa, less transmissible

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7
Q

Transmission of HIV

A

Blood exposure or sexually transmitted

Mother to neonate
Vertical transmission
Via placenta, birth or breast milk

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8
Q

Exposure Risks for HIV

A

Heterosexual contact
Male to male sexual contact
IV drug use
Transactional sex
Prior skin lesions from other sexually transmitted infections
Hemophilia and the use of unscreened blood for transfusions

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9
Q

What is a cancer that HIV patients are more susceptible to getting?

A

Kaposi’s sarcoma

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10
Q

gp120’s role in fusion/entry

A

gp120 which protrudes from viral surface attaches to CD4 receptors on cell surface
gp120 then interacts with CCR5 and CXCR4

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11
Q

what does gp41 do?

A

gp41 mediates fusion to the viral membrane to the cell membrane

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12
Q

How Viral replication begins

A

Host DNA mechanism is then used to make viral copies
Viral mRNA is transcribed from the integrated DNA via RNA polymerase
Then made into large proteins via host ribosomes

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13
Q

Clinical features of HIV stage 1

A

Stage 1 - Early acute
Onset after 2-3 wks of exposure, fever, lethargy, sore throat, diarrhea, lymphadenopathy, maculopapular rash trunk and arms, high viral count.
Virus is transmissible

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14
Q

Clinical features of Stage 2 HIV - Middle latent stage

A

Early symptoms resolve around 2 months, the viral load drops and levels off for about 7-11 years. Patient is asymptomatic

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15
Q

Clinical features of Stage 3 HIV - Late immunodeficient stage

A

CD4 drops → onset of AIDS, and death in about 2 yrs if untreated

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16
Q

False-negative “window” of HIV infection occurs _____

A

until the antibodies become present

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17
Q

Old School HIV testing

A

ELISA with a western blot for confirmation (ELISA still used as a rapid HIV test)

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18
Q

Current HIV Testing guidelines

A

p24 antigen- detection earlier in the “window” period
HIV1 / HIV2 antibodies- wks 2-4

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19
Q

Seroconversion occurs when _____

A

when the antibodies form (weeks 2-4)

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20
Q

CD4 count for an increase in opportunistic infections

A

<200

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21
Q

Additional testing for HIV

A

CD4 count- increase in opportunistic infections < 500
CD4 lymphocyte percentage- compared to all WBCs
Viral Load (via PCR)
HIV subtyping and order a resistance profile

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22
Q

______, occurring as a patient becomes immunodeficient, indicates they have progressed into AIDS

A

Detection of an AIDS defining illness

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23
Q

Neurologic symptoms with AIDS

A

Dementia, Subacute encephalopathy

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24
Q

Opportunistic infections with AIDS

A

Pneumonia- Pneumocystis jirovec
CMV
Kaposi Sarcoma- Herpesvirus 8
Non-Hodgkin’s B cell lymphoma- EBV
Meningitis- Cryptococcus neoformans
Brain abscess- Toxoplasma gondii
Shingles-zoster

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25
Q

As CD4 count drops, triggers prophylaxis, including

A

Pneumocystis pneumonia and Toxoplasmosis - TMP-SMX
Cryptococcal meningitis- Fluconazole
CMV retinitis- Ganciclovir
Oral candidiasis- Clotrimazole
Azithromycin- MAC complex

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26
Q

Cancers caused by ____ are common in AIDS patients

A

HPV

27
Q

____% of patients with AIDS will get TB

A

4

28
Q

Herpes in HIV

A

HSV 1 and 2
In AIDS, more severe and more likely disseminated
Can also cause ocular herpes infections

29
Q

You should treat all Herpes outbreaks in HIV patients with

A

Oral acyclovir
HSV Prophylaxis with daily oral acyclovir, etc.
Zoster is treated with famciclovir or valacyclovir
Vaccine-Shingrix

30
Q

Candidiasis in HIV

A

Oral candidiasis
Unpleasant taste, dryness
Can be scraped off, unlike hairy leukoplakia
Esophageal candidiasis
Common AIDS complication, suggest AIDS onset
KOH prep

31
Q

Treatment of candidiasis in HIV

A

Clotrimazole troches
Oral fluconazole for oral or esophageal
Ketoconazole for angular cheilitis

32
Q

Kaposi Sarcoma Clinical features in HIV patients

A

HHV-8
Vascular tumor
Rare cancer, but ↑↑in HIV and AIDS
- Not just AIDS patients
Skin, GI tract, mucosal surfaces, pulmonary

33
Q

Treatment of Karposi sarcoma in HIV patients

A

Localized chemotherapy or radiation
Cryotherapy or laser therapy
Intralesional injections

34
Q

Clinical features of hairy leukoplakia in HIV

A

Epstein-Barr Virus (EBV)
Lateral border of the tongue
Leukoplakic area with a corrugated or what sometimes appears “hairy”

35
Q

Pneumocystis Pneumonia clinical featrures in HIV

A

P.jirovecii
A common opportunistic fungal infection
Cough, fever, shortness of breath
CT scan or Chest X-ray
PCR sputum or bronchial lavage

36
Q

Treatment of Pneumocystis Pneumonia in HIV

A

TMP-SMX
Prednisone- decrease alveolar inflammation

37
Q

Mycobacterium Avium Complex (MAC) in HIV

A

Sputum sample renders acid-fast bacilli
Sputum culture used distinguish between TB

38
Q

Prophylaxis of _____ is no longer recommended in most patients initiating ART (HIV) due to low incidence among those on ART

A

Mycobacterium Avium Complex (MAC)

39
Q

Toxoplasmosis clinical features in HIV

A

Common space occupying lesion
Headache, neurologic Sx, seizures and AMS
Ring-enhancing lesions on brain CT w/ positive toxoplasma IgG

40
Q

Prophylactic treatment of Toxoplasmosis in HIV?

A

With CD4 count < 100 cells/µL
Cross cover PJP with Trimethoprim-sulfamethoxazole (TMP-SMX)
DC prophylaxis if > 200 cells/µL for 3 months
Treatment with pyrimethamine and sulfadiazine

41
Q

Cytomegalovirus (CMV) Retinitis clinical features in HIV

A

Visual changes must be worked up for HIV patients
Blind spots, blurred vision and floaters
Immediate consultation with ophthalmology
Perivascular changes with white fluffy exudate
Common retinal infection w/ CD4 count < 50 cells/µL
Watch for herpes or other retinal infections

42
Q

Cytomegalovirus (CMV) Retinitis Treatment in HIV

A

Intravitreal Ganciclovir
IV Foscarnet + Valganciclovir
Prophylaxis- Valganciclovir, and DC when > 100 cells/µL for at least 6 months

43
Q

HIV Associated CNS Lymphoma Clinical features

A

Common CNS lesion in people with HIV
Symptoms similar to toxoplasmosis, Order toxoplasma titers
Rule out abscess, toxoplasmosis, crtyptocomma
May require a brain biopsy
PCR of EBV DNA in CSF
Associated with Epstein-Barr virus

44
Q

Cryptococcal Meningitis clinical features in HIV

A

As you imagine a headache in an HIV patient should never be taken lightly
Common opportunistic infection in new HIV diagnosis
With meningitis- fever, headache, yet with HIV, less meningismus
Cryptococcal antigen serology or positive CSF culture for cryptococcal

45
Q

T/F a headache in an HIV patient should never be taken lightly

A

T

46
Q

Cryptococcal Meningitis Treatment in HIV

A

Manage elevated CSF pressure- Therapeutic LP
Amphotericin with flucytosine, followed by fluconazole
Secondary prophylaxis fluconazole- DC when ART effective for 3 mons

47
Q

Goals in HIV treatment

A

Reduce viral load, thus preventing advancement to AIDS
Reducing viral load also reduces transmissibility
Monitor patients response to therapy- CD4 count and Viral load
Prophylaxis and treatment of opportunistic infections and cancer
With effective treatment, life expectancy is near same to those without HIV

48
Q

_____ is key to avoiding resistance in HIV Patients

A

Adherence (to treatment)

49
Q

HAART

A

Highly Active Antiretroviral Therapy

50
Q

IRIS

A

Immune Reconstitution Inflammatory Syndrome

51
Q

IRIS in HIV

A

The patient will have an inflammatory response to current infections
Simply stated, your body restores its inflammatory response
Thus, symptoms can flare when starting antiretrovirals

52
Q

Nucleoside/ Nucleotide Reverse Transcriptase Inhibitors (NRTIs) MOA

A

Inhibits DNA synthesis via the viral reverse transcriptase

53
Q

Examples of NRTIs

A

Abacavir (Ziagen)- only HLA-B5701 allele negative patients, possible hypersensitivity reaction
Lamivudine (Epivir)
Emtricitabine (Emtriva)
Zidovudine (AZT, or ZDV)- First drug ever approved
Tenofovir (TAF or TDF)
(TAF) alafenamide or (TDF) disoproxil fumarate
Emtricitabine/Tenofovir disoproxil fumarate (Truvada)

54
Q

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) MOA

A

Inhibit reverse transcriptase at a different site then NRTIs

55
Q

Examples of NNRTIs

A

Efavirenz (Sustiva)
Nevirapine (Viramune)
Rilpivirine (Edurant)
Doravirine (Pifeltro)
Etravirine (Intelence)

56
Q

Integrase Inhibitors MOA

A

Blocks replicated viral DNA from “integrating” into host DNA
Used in preferred regimes- efficacious and well tolerated

57
Q

Examples of Integrase Inhibitors

A

Raltegravir (Isentress)
Dolutegravir (Tivicay)
Elvitegravir- only available as a combination (Stribild or Genvoya)
Cabotegravir (Vocabria)- oral and injectable; given with rilpivirine

58
Q

Protease Inhibitors Examples

A

Darunavir (Prezista)
Atazanavir (Reyataz)
Ritonavir (Novir)

59
Q

BBW for Protease Inhibitors

A

Common DDI due to metabolism via P450 system-

60
Q

Entry Inhibitors examples

A

Enfuvirtide (Fuzeon)
Maraviroc (Selzentry)
Fostemsavir (Rukobia)
Ibalizumab (Trogarzo)

61
Q

Prevention and Education: Post HIV exposure

A

Tenofovir/ Emtricitabine (Truvada) and Dolutegravir- ASAP (< 72 hrs) for 28 days

62
Q

Pre exposure prophalaxis in HIV (PrEP)

A

Tenofovir and Emtricitabine (Truvada) for high risk of exposure
Cabotegravir q2 months- New FDA approval

63
Q

HIV Screening Recommendations

A
  • Screening asymptomatic and high risk individuals for HIV
  • USPSTF 2019 Recommends screening all pregnant persons

ID Exam 4 (3 decks)

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