HIV/AIDS Flashcards
PrEP concepts
for people without HIV at high risk (sexually active men, transgender women, sexually active/IVDU)
2 meds from 2 different classes
descovy, Truvada
Cabotegravir - injection alternative or for kidney disease
HIV, STI, creatinine testing before and during therapy
PrEP AE
nephrotoxicity (use injectable if renal impair)
decrease in bone mineral density
increased cholesterol
altered fat metabolism
GI effects
PrEP drug interactions
statins, antivirals, anticonvulsants, aminoglycosides, NSAIDs, hep C meds
nPEP
nonoccupational post exposure prophylaxis
<72 hours after high risk exposure
28 day course of 3 drug antiretroviral regimen
HIV symptomatology
CD4 > 500 : oral/skin problems
CD4 200-499 : fever, diarrhea, weight loss, worsening derm/mucosal problems, shingles, candiasis, ITP, recurrent sinus/pulm infections
AIDS : CD4<200 or AIDS defining illness
HIV testing recommendation
age 13-64 test once, higher risk tested yearly
reportable disease
screening ELISA, followed by HIV differentiation assay
AIDS best case scenario labs
low viral load
high CD4
ART hospital mgmt
continue meds in hospital!
if suppressed viral load and CD4 >500 and is admitted for non-HIV reason, may not need ID
consult ID for: new dx, acute opportunistic infection, advanced HIV/AIDS w undifferentiated illness, need for ART modification
ART drug interactions
statins, FLUTICASONE (adrenal suppression), atypical antipsychotics, PPIs (some agents), St. Johns wort, antiarrhythmics, oral contraceptives
CYP 450 inhibitor
opportunistic infx for CD4 < 500
M. TB
candida, HSV, cutaneous zoster
opportunistic infx for CD4 < 200
PJP, candida, cryptococcal
AIDS-associated malignancies: Kaposi sarcoma, NHL
opportunistic infx for CD4 <50
disseminated Mycobacterium avian complex, CMV, toxoplasmosis
AIDS-associated wasting, AIDS-associated dementia
PJP prevention
for CD4 <200
TMP/SMZ QD or 3x/week first line
toxoplasmosis prevention
CD4<100
TMP-SMZ
disseminated mycobacterium avium complex (MAC) complex
CD4<50
azithromycin or clarithromycin
long term comorbidities of HIV
CV disease
renal disease
bone disease
cancer
liver disease
neurocognitive dysfunction
hypotestosteronism
DM (A1 not accurate)
lung disease
hearing impairment
statins CI in HIV
lovastatin, simvastatin
HIV - associated renal disease (HIVAN)
dx with biopsy
prone to ESRD and AKI
steroids & ACEI & cyclosporine (peds)
HIV - associated bone disease
vitamin D supplementation
DEXA scan @ 50
biphosphonates
older adult considerations
kidney, metabolic, CV, cognitive, liver health
monitor closely for toxicities, AE
most common resp pathogens in HIV
PJP
S. pneumoniae
H. flu
M. TB
