HIV/AIDS Flashcards
1
Q
___ is a disease that is often found alongside HIV and AIDS
A
Hepatitis C
1
Q
HIV is known as a ___virus
A
Retro
2
Q
HIV uses the enzyme ____ to replicate itself
A
Reverse transcriptase
3
Q
AIDS - diagnosis/definition
A
HIV positive plus an AIDS-defining illness:
- CD4 count < 200
- 26 different diagnoses: eg. PJP, TB, Cancers (such as cervical, Kaposi’s sarcoma, lymphomas), extrampulmonary coccidiomycosis
4
Q
___% of individuals will show antibodies to HIV at __ to __ weeks. It should not take more than ___ months for antibodies to develop.
A
- 95%
- 4 to 6 weeks
- 6 months
5
Q
Window period - definition
A
The period which antibodies have not developed but patient may still be infectious
6
Q
HIV - Blood testing
A
- HIV Ag/AB Combo Assay (11days-1month detection, 99.9% conclusive at 6 weeks)
- Secondary testing: Western blot: 99.9% at 6 - 8 weeks
- EIA Rapid test (results in 5-30minutes)
7
Q
What are CD4 cells?
A
Immune cells found in the blood, lymph nodes, and other places in the body which fight infection
8
Q
HIV - Pathophysiology
A
HIV enters CD4 cells to multiply or make copies of itself.
CD4 counts drops while viral load increases.
9
Q
HIV - Seroconversion reaction
A
Following initial infection, patients experience a viral like illness(>90%) characterized by fever, swollen lymph glands, sore throat, rash, muscle aches, headache, fatigue. Caused by immune system producing antibodies in response to the illness.
Characterized by sharp drop in CD4 count, this is the window period as the body hasn’t made a sufficient number of HIV antibodies yet.
10
Q
HIV - What happens after seroconversion usually?
A
Often followed by a long period(years) of no symptoms.
CD4 levels initially rise up a bit but slowly decreases over time with viral load gradually increasing.
11
Q
General symptoms of HIV (6)
A
L. DUFFY:
- Lymph nodes @ neck, groin, axilla swollen and tender
- Diarrhea (persistent)
- Unexplained weight loss
- Fever (persistent)
- Fatigue
- Yeast infections, thrush
12
Q
HIV can be found in varying amounts in these bodily fluids
A
(Most body fluids)
- Blood
- Breast milk
- Semen
- Saliva
- Vaginal fluid
- Tears
13
Q
HIV can be transmitted by __ (5)
A
ONIUM:
- Occupational exposure risk
- Needles used for tattoos, acupuncture
- IV Drug use
- Unprotected sex through linings of penis, vagina, vulva, rectum (rarely via mouth)
- Mother to baby during delivery and breastfeeding
14
Q
HIV - If mom is not on ARV therapy, there is a ___% vertical transmission risk from mother to baby. If treated, drops to almost 0%.
A
25%
15
Q
Which has more efficient HIV transfer? Female to male transmission or male to female?
A
Males to female.
2-2.5 times more efficient.
16
Q
Younger women(up to 20 years of age) have an increased risk of HIV contraction due to ___.
A
Immature genital mucosa.
Less reliable mucous production.
17
Q
You cannot contract HIV from the following situations
A
- Sharing cups
- Kissing/Hugging
- Coughing
- Sneezing
- Swimming pools
18
Q
Highest risk activity for contracting HIV is ___.
A
Anal intercourse
- Males having sex with males(MSM)
19
Q
6 classes of ARVs
A
F’N PINE:
- Fusion inhibitors
- NRTI
- Protease inhibitor
- Integrase strand transfer inhibitor
- NNRTI
- Entry inhibitor (CCR5 inhibitor)
20
Q
HIV - When to start treatment. The ___ (earlier / later) the better.
A
Earlier
21
Q
HIV treatment - Reasons to start early (4)
A
- HIV viremia harmful regardless of CD4 count
- Resistance decreased
- Cost savings ( as in associated costs with treating later)
- Transmission decreased
22
Q
HIV - Goals of therapy (5)
A
- HIV associated mortality (reduction)
- Immunologic function (restore/preserve)
- Maximal, sustained viral load suppression
- Disease progression (prevent/slow)
- Life expectancy and QOL(increase)
- Prevent HIV transmission(includes mother to child)
23
Q
HIV eradication is not possible with the current ARV treaments because of ___.
A
Sanctuary sites in brain, lymph nodes, genitals.
They harbor latently infected CD4 cells(established in acute phase of infection)
24
Name the HIV treatment that is very aggressive - designed to hit HIV hard, suppress viral replication and prevent progression(and resistance) of the disease - What therapy is this? What are the component combinations?
- HAART - highly active antiretroviral therapy which consists of:
- 2 NRTI's and a PI
or
-2 NRTI's and a NonNRTI
25
Average CD4 count in healthy individuals is \_\_\_
1000 (range is 800-1600)
26
\_\_\_ is a better indicator of the state of the immune system than CD4 count. Normal range for that is \_\_\_.
CD4 fraction %.
Normal range is **above 15%**(27-60%).
27
HIV therapy - With treatment, CD4 cell count is expected to rise ___ per year.
100 - 150 cells/mm3
28
HIV therapy - When should one check CD4 counts?
- At **baseline**
- Then every **3-6 months** (if viral load stable then q6-12months)
29
What is the target viral load for HIV therapy? When should you attain it?
- **\<40 - 50 copies/mL** (ie. undetectable)
- **Within 8 weeks** of starting therapy(Rx Files says **6 months**)
30
HIV treatment - When should one initiate treatment?
- Depends on CD4 cell count, but generally ASAP
If \< 350 cells/mm3 then should start immediately (A1 grade evidence)
- 350 - 500 cells/mm3 then A2 evidence
- \>500 cells/mm3 then B3 evidence
OR if have one of following conditions HPAN:
1) Hep B virus coinfection
2) Pregnant
3) AIDS defining illness Hx (eg. TB, PJP)
4) Nephropathy that is HIV associate
31
HIV treatment should generally start right away except for when you have \_\_\_
**Cryptococcal meningitis** (associated with higher mortality if on ARV regimen)
32
Genotyping the HIV virus is how one can check for resistance. When is it usually done?
- Prior to starting therapy
- Whenever viral load \> 500 without an obvious cause
33
Minimum viral load for HIV genotyping is \_\_\_.
500 copies/mL
34
Must be on ARV therapy for at least ___ weeks (or stopped within) to get accurate genotyping/resistance testing.
4 weeks
35
Gene that you must check prior to starting Abacavir. What is the reason for doing so?
- HLA-B\*5701
- To prevent hypersensitivity reaction (serious and life threatening): Occurs in 1st 2 weeks, Rash, Joint pain, Fever, Respiratory Sx
- DO NOT RE-CHALLENGE (death due to liver failure), Stop Abacavir immediately
36
Which drug do you have to check for the CCR5 receptor? What is the alternate receptor analogous to CCR5(that this drug does not work on)?
Maraviroc.
CXCR4. If the person has both receptor types then maraviroc is NOT a good choice.
37
Regimen to start in ARV naiive patients - NNRTIs
_Viral load \> 100,000_:
ATRIPLA : Efavirenz(NonNRTI) plus Tenofovir(NRTI) and Emtricitabine(NRTI)
_Viral load \< 100,000 and HLA-B\*5701 negative_: Efavirenz(NonNRTI) plus Abacavir(NRTI) plus Lamuvidine(NRTI)
38
An alternative to the NonNRTI Efavirenz(not Rilpivirine) is \_\_\_. What to look out for with that is \_\_\_(SE).
Nevirapine.
Rash, Steven Johnsons Syndrome, Hepatitis (frequency higher with CD4 counts \> 250 for females, \>400 for males)
39
Complera (a third NonNRTI regimen) is used when..
Viral load \> 100,000 and **must be taken with a 500+ calorie meal**.
Similar to Atripla except Efavirenz switched to Rilpivirine.
40
\_\_\_% adherence is required for effective viral load suppression
95%
41
Name the NonNRTIs (3)
NER: (they have VIR in middle of word)
- NeVIRapine
- EfaVIRenz
- RilpiVIRine
45
Of the NRTIs, the only nucleotide one is \_\_\_. The rest are nucleoside.
Tenofovir
46
This drug you need to test the HLA-B\*5701 gene beforehand prior to use
Abacavir
47
Name the NRTIs (5)
STEALZ:
- Stavudine
- Tenofovir
- Emtricitabine
- Abacavir
- Lamivudine
- Zidovudine
48
ATRIPLA (2 NRTIs + NonNRTI) is comprised of:
TEE:
- Tenofovir
- Emtricitabine
- Efavirenz
49
COMPLERA (2 NRTIs + NonNRTI) is comprised of:
TER:
- Tenofovir
- Emtricitabine
- Rilpivirine
50
Protease Inhibitors are boosted with ___ (Drug). How and why?
Ritonavir.
CYP inhibitor.
To decrease total dose and allow for once daily dosing.
51
Name some common Protease Inhibitors (3)
"The LAD likes to eat PI"
LAD:
(All agents ending in AVIR" are PI except abacavir, rategravir and elvitegravir)
- LopinAVIR
- AtazanAVIR
- DarunAVIR
55
Name the components of NRTI fixed dose TRUVADA and KIVEXA.
TRUVADA: Tenofavir, Emtricitabine (starts with a T) KIVEXA: Abacavir, Lamivudine
56
Name the InteGRase Inhibitors (2)
"GRavir":
- Raltegravir
- Elvitegravir
57
Stribild is known as the ___ tablet. It contains \_\_\_.
QUAD
Elvitegravir, cobicistat, emtricitabine, tenofavir
58
Cobicistat is not a ARV but is there to \_\_\_
Limit liver enzymes which break down **elvitegravir**, therefore boosting the dose.
59
Raltegravir is given (OD / BID).
BID
60
HIV therapy - Treatments during pregnancy
- _NRTI_: Combivir: Lamvudine and zidovudine 1 tab BID
- _PI_: Atazanivir 300mg and Ritonavir 100mg OD
61
Why do patients feel worse after starting ARV treatment?
- **IRIS** - Immune Response Inflammatory Syndrome
- Previously immune system was repressed so cannot recognize TB, MAC, PCP, herpes.
- Immune system is boosted and recognizes them and overcompensates. Can be FATAL.
62
HIV therapy - Vaccinations, which to get and does it work? Can only give vaccination if CD4 count is greater than \_\_\_.
- No live vaccines as weakened immune system
- **Pneumococcal vaccine, Hep A, Hep B, Flu**
- CD4 count \> 200.
- Vaccinations may increase viral load in next 4 weeks. Do not measure viral load after 4 weeks post vaccination.
63
What are the general classes of medications that can potentially cause a DI with HIV meds? (6)
MANIAS:
- Methadone
- Antidepressants
- Nutritional supplements (eg st johns)
- Illicit drugs and alcohol
- Anticonvulsants
- Sedatives/Hypnotics
64
What is the main herbal that interacts with PIs?
St. John's Wort.
Decreases PI by 50%.
65
What HIV treatment drug classes are CYP metabolized? (2)
PI and NonNRTI
66
Which anticonvulsants should be avoided with HIV medication?
- Carbamezepine
- Oxcarbazepine
- Phenytoin
- Phenobarbital
- Primidone
- Felbamate
All are enzyme inducers.
Use 2nd line like Gabapentin or Lamotrigine.
67
HIV therapy - Methadone DI?
Efavirenz is an inducer of CYP which will increase methadone metabolism.
May need to increase methadone dose
68
HIV therapy - OCPs DI?
- Most ARVs decrease levels of estrogen and effectiveness in body.
- Use alternative forms of birth control.
69
Which drug used in TB/MAC treatment greatly decreases Efavirenz efficacy?
Rifampin
70
Which statins greatly increase PI levels? What is the result? Preferred alternatives?
**Lovastatin, Simvastatin**.
Increase in LFTs, liver toxicity/death.
Rhabdomyolysis.
**Rosuvastatin, Pravastatin** preferred.
71
Which BZD has a DI with HIV meds?
Triazolam.
2000% increase in AUC.
72
HIV therapy - What is the point which is considered virologic treatment failure?
Unable to maintain less than 200 copies/mL
73
What is immunologic failure?
Unable to increase CD4 count to over 150 cells/mm3 in 1st year
74
With virologic failure, what should be done?
Change to a new regimen of at least 2 or 3 active drugs.
75
HIV therapy - If pt develops a rash, should they discontinue their medication?
- Not necessarily. Maybe if it was an angry red rash.
- Only stop if rash is accompanied by fever, flu like symptoms, swollen throat.
76
What are the expected body changes with HIV?
- Bone loss
- Increased cholesterol
- Increased blood sugars
77
Which HIV drug can cause **hepatic steatosis** and/or life threatening **lactic acidosis**?
_Zidovudine_.
Stop NRTIs. May need IV fluids.
Drug affects mitochondrial function so cannot process lactate.
78
Zidovudine - What are the signs/symptoms of lactic acidosis? (7)
_VW NASAL_:
- Vomiting (persistent)
- Weight loss
- Nausea (persistent)
- Abdominal pain
- SOB
- Abnormal heart rate
- Liver tenderness increased
79
What is one means of measuring compliance with a lab test?
Zidovudine(AZT) and Stavudine both increase MCV.
This is not due to folic acid or B12 deficiency but a normal response of using these meds. Don't treat.
80
HIV drug side effects generally improve in ___ weeks. What can be done to manage them?
_3 - 4 weeks_.
Use OTCs to manage SE.
Gravol.
Use Boost/Ensure for weight loss.
The usuals for diarrhea, headache, rash.
81
Nevirapine dosing
200mg OD for first few weeks then 200mg BID.
May see **rash** **if not initiated at lower dose**.
82
HIV complications - Symptoms of PCP (Pneumocystis Jiroveci Pneumonia)
W SCOFF:
- Weight Loss
- SOB
- Cough
- O2 desaturation
- Fever
- Fatigue
83
PCP treatment and prophylaxis
**Co-trimoxazole (SMX-TMP)** IV or Oral, 15mg/kg/day divided q6-8h.
Prophylaxis if CD4 \< 200: 1 tab Septra regular strength every day of week until CD4 \>200 for 3months.
OR
Double strength tablet 3 times a week (MWF) x 3 months
