HIV/AIDS Flashcards

Question

What is pooled NAT?

Answer 1

Targeted to clinics with a large MSM population Has a diagnostic gain of 6.4% over 4th generation ELISA 25 of 54 MSM who got pooled NAAAT had a negative 3rd generation ELISA

Answer 2

To improve and facilitate partner notification To provide public health the opportunity to be directly involved with index cases and thus to add to case management resources To enhance epidemiological surveillance

Answer 3

Emphasize confidentiality and ensure understanding of non-nominal testing Review transmission risks and prevention strategies Describe partner notification process Explore psychological preparedness, coping and support mechanisms Emphasize need to return for result

Answer 4

Interpret: Means either no infection or too early to test Risks within the past 3-6 months dictate need for retesting, as necessary, 3 months after the last possible exposure Reinforce: Reduction of risks (avoid high risk activities, avoid sharing needles or other drug use equipment, use safer sex practises)

Answer 5

Clarify difference between HIV and AIDS Verify client’s understanding of test result Emphasize importance of regular followup with primary care provider Review what client should expect in terms of follow-up care (vaccines, lab tests, etc.) Discuss partner notification process Review transmission prevention strategies Emphasize importance of finding support (friends, family, ASO, etc.)

Answer 6

In BC, testing will be offered to all low risk adults once every five years – high risk adults once a year Testing is also offered for all hospital admits at SPH, VGH, MSJ and UBC – this will also be expanded

Answer 7

``` AIDS is a chronic disease. It fits a chronic disease trajectory: Pre-trajectory Asymptomatic Symptomatic AIDS defining illness Downward and dying ```

Answer 8

HIV is different Highly stigmatized Uncertain trajectory Patients often not well supported by family

Answer 9

``` Anxiety Isolation Loss Stigma Anger Decisional conflict Depression Hopelessness Uncertainty ```

Answer 10

HIV diagnosis - anxiety, panic, depression, suicidal ideation and attempts AIDS diagnosis - fear, anger, impulsive behavior, suicidal ideation Treatment - depression, weakness, alienation, dysphoria, disability, pain Treatment termination - anxiety, fear New symptoms - anxiety, demanding/dependent behavior Recurrence and relapse - depression, apathy, isolation, suicidal ideation, fear of abandonment Awareness of dying - deterioration, decline, ambivalence, dependence, disinterest, resolution

Answer 11

``` On the continuum of care: Suicide assessment Crisis intervention Pharmacotherapy Education Stress reduction techniques Support groups Support assistance Spiritual support Legal assistance - estate planning ```

Answer 12

Fear of contagion Guilt re: transmission Anxiety, fear & depression > fatal maturity Balance of relationship upset Conflict regarding treatment decisions Conflicts between family and/or care team Anticipatory grief

Answer 13

``` Individual Loss of income Housing Social status Social network HIV is a disease of poverty, of the marginalised, and the vulnerable ```

Answer 14

``` Highly Active Anti Retroviral Therapy ```

Answer 15

Maximal and durable suppression of viral load Restore/preserve immune function Improve quality of life Reduce HIV related morbidity/mortality Treatment has led to a 94% drop in AIDS related deaths in Canada

Answer 16

Reduced transmission of virus – has led to treatment as prevention program in BC New positive rate in BC declining across all populations including IDU Higher rate of averted HIV cases than anywhere else in Canada

Answer 17

ART is recommended and should be offered regardless of CD4 cell count The strength of the recommendation increases as the CD4 count decreases ART should be offered to all persons in the acute phase of primary HIV infection Pregnant women, persons with chronic Hep B or Hep C infection, persons over the age of 60 and persons with HIV associated nepropathy should all be started on ART ART should be started ASAP in persons with opportunistic infections ART is recommended in all HIV infected persons with TB

Answer 18

It has become clear that a normal life span can only be expected if CD4 cells recover to > 500 A partial reconstitution (between 350 and 500) is associated with non-HIV health problems (CV, renal, hepatic, cancers) CD4s below 200 are associated with a lower probability of achieving optimal counts

Answer 19

Average CD4 when HAART is started in Canada is 184 – CD4s below 200 are associated with a lower probability of achieving optimal counts

Answer 20

Above 50 000 - 100 000 copies/mL

Answer 21

3 year risk of aids is 40%

Answer 22

Viral load is closely monitored for people on ART - goal is undetectable

Answer 23

Nucleoside reverse transcriptase inhibitors (NRTI) Non-nucleoside reverse transcriptase inhibitors (NNRTI) Protease inhibitors (PI) Integrase inhibitors Entry inhibitors

Answer 24

``` GENERALISED LIVER TOXICITY GI DISTURBANCES MEDICATION INTERACTIONS CNS DISTURBANCES PERIPHERAL NEUROPATHY RENAL DYSFUNCTION ```

Answer 25

Dyslipidemias - increased triglycerides, total cholesterol Risk of CAD increases by 25% with each year of exposure Lipodystrophy Osteoporosis Torsades de Pointes (type of VT with prolonged QT interval)

Answer 26

Stevens-Johnson syndrome

Answer 27

``` Impact on daily activities Potential for unplanned disclosure Psychological impacts Changes in perception of health status Treatment focused care - failure to see the whole person ```

Answer 28

Take with a meal or snack Ensure orders for gravol etc. are available Time permitting - check in 2-3 hours after dose to see if they need any PRNs Try pre-medicating 30 to 60 mins prior to antiretrovirals with gravol or metoclopramide etc. if persisting Reassure will subside within several weeks

Answer 29

Try taking at bedtime or vice versa

Answer 30

The HIV virus will develop resistance to these medications.

Answer 31

Targeted at high risk populations - MSM who engage in unprotected anal intercourse, IV drug users who share and inject multiple times a day, sex trade workers. Consists of tenofovir or truvada once a day as a preventative measure for HIV negative individuals.

Answer 32

Because virus persists in resting CD4 T cells and other body tissues As soon as HAART is stopped this latent virus begins to replicate A cure could be possible if you could eliminate the reservoir There are trials looking at latency reversing agents that could achieve this

Answer 33

Nearly a fifth of patients diagnosed very late in the course of their illness

Answer 34

HIV testing should be offered to all patients engaging with the health care system who had ever had sex and had not been tested in the last year.

Answer 35

Phenotype and Genotype

Answer 36

Measures growth of the virus in various concentrations of antiretroviral therapies. Similar to bacteria antibiotic sensitivity testing.

Answer 37

Detects drug resistant viral mutations present in reverse transcriptase and protease genes. Usually done before first treatment is commenced.

Answer 38

Start on 3 drugs from different classes - usual first line treatment is two NRTIs and a boosted PI or two NRTIs and an NNRTI or two NRTIs and an integrase inhibitor.

Answer 39

Avoid resistance | Use combination of drugs to inhibit the virus in several ways

Answer 40

Potency Adherence*** Tolerance

Answer 41

CNS side effects GI side effects Lipid issues Renal impairment

Answer 42

``` Oropharyngeal candidiasis Candida esophagitis Vulvovaginal candidiasis Cryptococcus - meningitis/pneumonia Pneumocystis pneumonia (PCP aka PJP) ```