HIV and AIDs

Question 1

Pathophysiology of HIV

Answer 1

• HIV induces defects in host-cell mediated and humoral responses
• – The person becomes susceptible to opportunistic infections and certain neoplasms
• AIDs is characterized by progressive immune suppression leading to opportunistic diseases
• HIV-1 is responsible for human HIV infections
• – Rapid dissemination into lymph system and organs after initial infection
• – Host immune response limits viral replication initially
• – Progression to AIDs in average 10 years if not treated
• HIV-2 is zoonosis
• –Lower transmission rate; less pathogenic
• Transmission: blood, sexual contact, and mother-to-child (vertical) transmission

Question 2

Stages of HIV

Answer 2

Symptomatic primary HIV infection approximately 2-4 weeks after infection
- Flu-like viral syndrome develops with fever, lymphadenopathy, pharyngitis, rash, and myalgias

Asymptomatic infection
- abnormal physical findings

Symptomatic HIV infection
- Development of common infections

Advanced HIV infection/AIDs
- Severe immunocompression, CD4 T lymphocytes (CD4 cells) count less than 200 cells/mm

Question 3

HIV: Goals of Treatment

Answer 3

1. Achieve maximal suppression of plasma viral load for as long as possible
2. Delay the development of medication resistance
3. Persevere CD4 T-cell numbers
4. Confer substantial clinical benefits, leading to reduction in morbidity and mortality

Question 4

Rationale for ART Medication Selection

Answer 4

There are more than 20 FDA approved ART drugs

Treatment of HIV infection is a dynamic, rapidly changing arena

HIV medications are always used in combination to reduce the amount of HIV in blood

Question 5

Principles of HIV Therapy

Answer 5

Ongoing HIV replication leads to immune system damage and progression to AIDs
- Plasma HIV ribonucleic acid (RNA) and CD4 T-cell levels must be regularly measured (every 3 to 6 months)

Treatment decisions should be individualized on the basis of risk of disease progression as indicated by plasma HIV RNA levels and CD4 measurements
- Goal of therapy should be the max achievable suppression of HIV replication

Most effective way to achieve sustained suppression of HIV replication is the combination of effective anti-HIV medications

Question 6

HIV: Initiating ART Medications

Answer 6

ART should be initiated in patients within 14 days of initial diagnosis
- Ideally the same day of diagnosis

Regardless of CD4+ T cell count, initiation of ART is strongly recommended for individuals with the following conditions:

• hx of AIDs defining illness,
• HIV/hepatitis B virus (HBV) co-infection
• HIV-associated nephropathy
• pregnancy

Question 7

Medications Used to Treat HIV

Answer 7

Six “families” of HIV antiretroviral drugs

• Nucleoside reverse transcriptase inhibitors
• Nonnucleoside reverse transcriptase inhibitors
• Protease inhibitors
• Fusion inhibitors
• Integrase strand transfer inhibitor
• C-chemokine receptor type 5 (CCR5) antagonists
• Post-attachment inhibitors

Question 8

HIV: Post-Exposure Prophylaxis

Answer 8

Effective if exposure occurred less than 72 hours earlier

Three drug regimen for adults and adolescents
- Tenofovir disoproxil fumarate 300 mg in fixed-dose combination with emtricitabine 200 mg daily with raltegravir 400 mg twice daily OR dolutegravir 50 mg once daily

Question 9

HIV: PrEP (Pre-Exposure Prophylaxis)

Answer 9

For persons at high risk of HIV

Tenofovir disoproxil fumarate 300 mg and emtricitabine 200 mg (Truvada) in fixed combination

Question 10

HIV- ART: Monitoring

Answer 10

Adherence to medications and medical visits 
Affective mental health problems 
Alterations in metabolism of lipids and glucose 
Cardiovascular risk 
Hepatitis B and C co-infection 
High-risk behaviors 
Immunization status 
Renal and hepatic function 
STIs 
Somatic signs and symptoms 
Tobacco, alcohol, and substance use