HIV and AIDS Flashcards
What area does HIV-2 hit the hardest?
Sub-Saharan Africa
HIV is a member of what group of viruses?
Retroviridae
HIV binds to what?
Specific cell surface receptor molecules (CD4) = degree of individual susceptibility
What is the MC mode of HIV infection?
Sexual transmission across an exposed mucosal epithelium
Who should be tested for HIV?
- Age 15-65 at least once regardless of risk
- All pregnant women prior to childbirth
- Younger or older individuals w/increased risk factors
What should you do if you test a pt for HIV and it comes back non-reactive or reactive?
Repeat testing!!
- if reactive: repeat to differentiate which form
- if non-reactive: test with HIV nucleic acid test
What is the MC way HIV is transmitted to healthcare workers?
Needlestick
What does HIV serology CD4 cell count measure?
The status of the immune system and disease progression
Demonstrates the risk of opportunistic infections
(how are out defenses holding up?)
What does HIV serology Viral load (HIV-1 RNA levels measure?
The response to and efficacy of HAART
- gives corresponding predictive information to the CD4 count
(how many enemies do we have?)
What should you do if the viral load is still >50 after 4 months?
Therapy regimen modification may be needed
What are some clinical manifestations of acute HIV infection?
Initially appears w/ a syndrome similar to mono
fever, malaise, lethargy, LAD, truncal maculopapular rash
When do we start seeing clinical manifestations of acute HIV infection?
Occurs 2-4 wks after exposure to HIV
What are some clinical manifestations of asymptomatic/latent HIV infection?
Seropositive
No S/Sxs of HIV infection
How long is the asymptomatic/latent phase?
The longest phase - typically lasts 4 to 7 yrs.
What are some clinical manifestations of symptomatic HIV infection?
Localized fungal infxn
Molluscum contagiosum
Hairy leukoplakia
Mucocutaneous ulceration
What are clinical manifestations of AIDS?
- Marked immune suppression
- Onset of disseminated opportunistic and malignancies
- CD4 count < 200/mm3
What is the highest risk of sexual transmission of HIV?
Unprotected anal receptive intercourse
What may decrease the risk of sexual transmission of HIV?
Latex condoms (70-80%)
Can HIV be transmitted from saliva or tears?
No cases have been documented
What is the MC mode of transmission of HIV?
Sexual transmission
Why does crack cocaine use increase your risk for transmission of HIV?
Needle sharing with infected individuals
How is HIV perinatally transmitted?
Vertical transmission - in utero, during childbirth, breast-feeding.
- 50% risk with prolonged breast-feeding
What is the MC method of transmission of HIV to children?
Perinatal transmission- transplacental
What is the recommended therapy regimen of postexposure prophylaxis?
Emtricitabine \+ Tenofovir \+ Raltegravir
What do you do for nonoccupational postexposure prophylaxis?
CBC
Start ART asap (48-72 hr of exposure) and cont. for 28 days
What is a toxicity associated with Efavirenz (NNRTI)?
CNS sxs - psychosis and depression
-contraindicated in pregnancy
What is a toxicity associated with Indinavir (protease inhibitor)?
Crystal-induced nephropathy (nephrolithiasis)
What is the goal of antiviral therapy?
Improve efficacy of other antiretroviral agents in a cART regimen; can do so by adding a PK enhancer
Truvada for AIDS pre-exposure prophylaxis is made up of which two medications?
Emtricitabine and Tenofovir DF
The discussion involved in the initiation of therapy should include what three things?
- Advantages of cART
- Potential toxicities
- The complexity of monitoring treatment
Deferral of therapy may be considered if…?
- High CD4 count >500 cells/mcL
- Diff or inability to adhere to therapy (ie homeless)
- Presence of comorbidities that would complicate or contradict antiviral therapy (ie pregnancy)
- Pt considered a long-term non-progressor
HIV positive pt who is co-infected with tuberculosis have a greater risk for developing what?
Active tuberculosis and subsequent infectious state compared with HIV negative pts
What medication should be given to pt with TB and advanced HIV disease?
Rifabutin at least TID per week
What are some treatment options for oral candidiasis?
Nystatin swish and swallow 4-5 x a day x 1-2 wks
Kaposi sarcoma is caused by what?
It is a cancer caused by human herpes virus (HHV-8)
- presents as red, purple, brown or black papular lesions on skin or mucous membrane
What the cause of pneumocystis pneumonia?
AIDS-defining illness
Caused by yeast-like fungus - pneumocystis jiroveci
<200 CD4 count
S/Sx of pneumocystis pneumonia?
fever, chills, non-productive cough, pleuritic chest pain, dyspnea
What is seen on an CXR in a pt with pneumocystis pneumonia?
bilateral ground-glass interstitial infiltrates
- pattern of butterfly or batwing
What is the prophylaxis treatment of pneumocystis pneumonia?
TMP/SMX (initiated when CD4 count < 200)
Esophageal candidiasis commonly occurs concurrently with what?
Oropharyngeal candidiasis
S/Sxs of Esophageal candidiasis?
Retroseternal chest pain and odynophagia
Tx for Esophageal candidiasis?
Fluconazole (PO or IV) or itraconazole (PO) x 2-3 wks
- improvement within days of initiation of tx
Preferred tx for a pt with Toxoplasmosis?
Pyrimethamine
S/Sx of Toxoplasmosis?
Neurological deficit - hemiparesis, speech defect, altered mental status, seizure, coma
Cryptococcosis often presents as what?
Meningoencephalitis or meningitis
Cryptosporidiosis is associated with?
Profuse watery, non-bloody diarrhea w/ fever and abdominal pain
What is the MC presentation of cytomegalovirus infection?
Retinitis
- usually unilateral
- vision changes, peripheral vision loss, scotoma and/or floaters
Cytomegalovirus infection esophagitis presents with what sxs?
Chest pain, Odynophagia, nausea
What do you see on the EGD in a pt with cytomegalovirus infection
Ulceration in distal esophagus
- bx to confirm dx
What is age group of women who die from AIDS?
35-44 yrs old
- 9th leading cause in US
- 4th leading cause in African American
What appears to be more effective in preventing opportunistic infections and HIV disease progression in women and pregnancy women?
cART
What is an increased likelihood in women vs men in regards to HIV infection?
Toxicities
What are some specific findings in women with HIV infection?
- Irregular mensuration
- recurrent vulvovaginal candidiasis
- HPV related cervical dysplasia
- Invasive cervical cancer
What age group is seen in elderly people with HIV?
> 50 yrs old
Why/how are elderly people infected with HIV?
- Divorces and death of a spouse
- Erectile dysfunction meds
- Contraception no longer a concern - postmenopausal
- Vaginal atrophy = small cuts/tears = increased blood exposure
- Less discussion during encounters with PCP
What is the medication for HIV pre-exposure prophylaxis?
Truvada —> intially for 90 days
- Emtricitabine/Tenofovir DF
What pts should be considered for PrEP for HIV prevention?
- Sexually active homosexual/bisexual men
- Male-to-female transgender persons
- Heterosexual and bisexual women who are likely to have partners with HIV risks
- IV drug users
What are some factors that increase the likelihood that PrEP is a good option?
- Pt has receptive anal intercourse
- Pt w/ known HIV infected partner
- Pt w/ hx of STIs
- Pt w/ high # sex partners
- Prostitutes
- No condom use
- Sharing needles
What test is used to confirm HIV status?
HIV antibody test
- symptom review to exclude HIV infection
How often is HIV antibody testing done?
Every 3 mos
What is the ultimate goal of AIDS vaccine?
Prevent infection
What is the goal of therapeutic HIV/AIDS vaccines
Boost the immune response to and better control existing HIV infection
What is the “idea” behind Topical Microbicides used for AIDS prevention?
a chemical barrier to impede viral transmission or inactive the virus before it crossed vaginal or rectal membranes
What is the “current topical contender” for AIDs prevention?
1% vaginal gel containing Tenofovir
