HIV/AIDS - Sandkovsky Flashcards
What type of virus is HIV
A retrovirus: RNA virus, infects cell, forms DNA, makes more RNA
T/F: HIV is able to replicate continuously in their host cells despite a competent host immune response
True
Major cellular targets for HIV-1
Lymphocytes
mononuclear phagocytes
HIV transmission factors
AIDS Active STD presence of genital lesions frequency and type of unprotected sex circumcision viral load
How is HIV transmitted
Bodily fluids: blood, semen, breast milk
Needles
HIV pathogenesis and progression to AIDS
CD4 depletion in GALT in the acute phase of HIV. Selective loss of Th17, polyclonal B cell activation, increased CD4 and CD8 turnover with decreased half lives
T/F: Shingles is suggestive of HIV infection
True- also several other indications
AIDS indicators
CD4 count <14% of total lymphocytes
Diagnostic testing for HIV
Oral fluid testing, urine testing, home test kit, rapid HIV testing
Screening highest sensitivity for HIV
ELISA- detecting antibodies to HIV-1 and HIV-2
Confirmation- highest specificity for HIV
Western Blot
Acute HIV infection you should perform
HIV RNA by PCR
Specific tests used in HIV infection
Quantitative HIV RNA, CD4 cell count/percentage, Total lymphocyte count, HLA B5701 (always before abacavir), Resistance testing
Definition of success for HIV
HIV RNA <50 copies/mL
A 55 y.o. women has HIV with CD4 count of 344 cells.mm and viral load of 34000 copies/mL. What is treatment
2 nucleoside reverse transcriptase inhibitors and 1 non-nucleoside reverse transcriptase inhibitor
OR
2 nucleoside reverse transcriptase inhibitors and 1 protease inhibitor OR
2 nucleoside reverse transcriptase inhibitors and an integrase inhibitor
What drug is used with all PIs to exploit CYP3A4 inhibition to allow for smaller doses
Ritonavir
Preferred initial treatments
1) Tenofovir (TDF)/ Emtricitabine (FTC) + Efavirenz
2) Abacavir/lamivudine + dolutegravir
Why is anti retrovirus treatment (ART) necessary?
Prevent transmission by lowering viral load
HIV in pregnancy- recommended regimen: All infected should be treated regardless of CD4 count with…
ZDV/#TC/lopinavir/ritonavir or TDF/FTC+Atazanavir/ritonavir
Protease inhibitors are associated with
Metabolic syndrome
Side effects of HIV medication:
Lipodystrophy, Bone disorders, etc…
HIV RNA in plasma: HIV RNA should be greater than
10,000 copies
Oral complications of HIV
Apthous ulcer oral hairy leukoplakia candidiasis Kaposi's sarcoma HSV
Frequent Dermatologic complications in HIV patients
Herpes zoster (More than 1 dermatome suggests HIV infection) Eosinophilic folliculitis MRSA related Seborrheic dermatitis purigo nodularis herpes simplex bacillary angiomatosis molluscum contagiosum cryptococcus scabies
Cardiovascular complications of HIV
Dilated cardiomyopathy
pulmonary HTN
Tricuspid valve endocarditis
Chronic diarrhea in HIV patients is associated with a CD4<____
100
Two big neurologic complications in HIV patients
Cryptococcus and Bacterial Meningitis
T/F: CMV retinitis the CD4 count is usually less than 50 and fundoscopic exam looks like cottage cheese and ketchup
True
What type of pneumonia is associated with HIV patients
Pneumocystitis jirovecci pneumonia
What fungal infection is associated with HIV
Coccidioides immitis and Histoplasmosa Capsulatum (<150 CD4)
Pneumocytitis pneumonia prophylaxis should be started at CD4+ t cell count less than
200 cell/mm
Prophylaxis for toxoplasmosis in HIV patients. What drug and CD4 count?
Bactrim at CD4 <100
Definition of virologic management failure
HIV RNA> 200 copies/mL
Patients who cannot get HIV have what type of mutation
CCR5 mutation
