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finals y3s1 > HIV & AIDS > Flashcards

HIV & AIDS Flashcards

1
Q

progression of HIV to Aids

A

HIV destroy CD4+ -> hard for immune system to fight infection -> AIDS

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2
Q

who should be tested for HIV

A

1) IV drug user
2) unprotected sex w multiple partner
3) gay sex
4) person treated from STD
5) recipient of multiple blood transfusion
6) person who have been SAed
7) pregnant (prevent mother to child)

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3
Q

how to test for hIV

A

1) serum antibody detection

  • HIV EIA test

2) HIV RNA detection/quantification

  • PCR
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4
Q

stages of HIV infection

A

1) acute (primary) HIV infection
2) asymptomatic
3) persistent generalised lymphadenopathy
4) AIDs & related conditions

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5
Q

clinical presentation of acute HIV

A
  • soon after contracting
  • flu-like illness, swollen lymph nodes, fever, malaise, rash
  • 2-3 wk
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6
Q

clinical presentation of persistent ggeneralised lymphadenopathy

A

persistent unexplained lymph nodes enlargement in neck, underarm, groin > 3 months

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7
Q

clinical presentation of AIDS

A

1) CD4 < 200/mm^3, presence of AIDS-defining disease
2) advanced stage succumb to infections
3) GLENS (GI, lung, eye, nervous system, skin)
4) systemic symptom
5) rare cancer, candidiasis

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8
Q

monitoring parameters for anti-retroviral therapy (ART) - CD4

A
  • healthy: 500-1200 cells/mm^3
  • baseline, every 3-6 month after initiation, every 12 month after adequate response (increase by 50-100 cells/mm^3 during first year)
  • start prophylaxis for opportunistic infection when CD4 < certain number
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9
Q

monitoring parameter for ART - viral load

A
  • before initiation
  • within 2-4 wks after initiation/modification
  • 4-8 wks until viral load suppressed
  • 3-6 month after viral load suppression
  • ideally suppression by 8-24 wks
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10
Q

types of ART combination

A

1) 2 NRTI + 1 INSTI

  • tenofovir + emtricitabine + bictegravir
  • tenofovir + emtricitabine + dolutegravir
  • abacavir + lamivudine + dolutegravir

2) 1 NRTI + 1 INSTI

  • newly started on ART
  • emtricitabine + dolutegravir
  • X for individuals who
    ** HIV RNA > 500k copies/mL
    ** Hep B virus coinfection
    ** ART started before genotypic testing/HBV testing results
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11
Q

nucleoside reverse transcriptase inhibitor (NRTI) - AE

A

1) lamivudine

  • minimal tox
  • N/V/D

2) emtricitabine

  • minimal tox
  • hyperpigmentation, N/D

3) tenofovir

  • N/V/D
  • renal impairment
  • decrease in bone mineral density

4) abacavir

  • N/V/D
  • X use if high cardiovascular risk cuz of MI
  • hypersensitivity in pt w HLA-B*5701
    ** rash, fever, malaise/fatigue, loss of appetite, sore throat, cough, SOB
    ** fatal: discontinue
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12
Q

advantages and disadvantages of NRTI

A

advantage: renal elimination
disadvantage

  • mitochondrial toxicity
    ** lactic acidosis, hepatic steatosis
    ** lipoatrophy
  • require dose adjustment
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13
Q

advantages of non-nucleoside reverse transcriptase inhibitor (NNRTIs)

A
  • long t1/2
  • less metabolic tox (hyperlipidemia, insulin resistance)
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14
Q

disadvantages of non-nucleoside reverse transcriptase inhibitors (NNRTIs)

A
  • potential CYP450 DI
  • QTC prolongation
  • skin rash, SJS (rilpivirine > efavirenz)
  • efavirenz: neuropysch, increase LDL-C & TG, hepatotox
  • riflvipirine: depression, headache
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15
Q

INSTI advantages

A
  • bictegravir, dolutegravir good virologic effectiveness
  • higher genetic barrier to resistance
  • well tolerated
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16
Q

INSTI disadvantages

A

1) ADR

  • both: weight gain, N/D, headache
  • bictegravir, dolutegravir: inhibit tubular secretion = increase serum creatinine
  • raltegravir: pyrexia, creatinine kinase elevation (rhabdo)

2) DDI
- X polyvalent cation
- CYP3A4 substrates

17
Q

protease inhibitors disadvantages

A

1) metabolic complications
2) SE (N/V/D)
3) liver tox
4) CYP3A4 substrates
5) morphologic complications (lipohypertrophy)
6) increase risk for osteopenia/osteoporosis

(-navir)

18
Q

fusion inhibitor ADR

A

1) injection site reaction
2) rare hypersensitivity
3) increased bacterial pneumonia

(-virtide)

19
Q

CCR5 AE

A

abdominal pain, cough, dizziness, musculoskeletal sypmtoms, pyrexia, rash, URTI, hepatotox, orthostatic hypotension

finals y3s1 (10 decks)

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