HIV and Immunization Drugs

Question 1

Anti-retroviral Therapy

Answer 1

Drugs:

• enfuvirtide - subQ
• maraviroc - PO
• zidovudine - PO/IV
• delavirdine - PO
• raltegravir - PO
• ritonavir - PO

Indication:

• HIV infected
• HIV infected pregnant
• Hx of aids-defining illness (inflammatory, infectious, cancer)
• serodiscordant couples

AE:

• hepatotoxicity
• Nephrotoxicity
• Osteopenia (early onset of osteoporosis and fractures)
• dyslipidemia (early onset coronary vascular disease - angina, MI)
• Fat redistribution (lipodystrophy)
• • lipoatrophy: arms, legs, face, butt
• • lipohypertrophy: abdomen, breasts, buffalo hump
• • body image issues
• Insulin resistance

Adherence:

• viral rebound, immune decommpensation, clinical deterioration
• neurocognitive impairment
• depression, denial
• nondisclosure of HIV serostatus, stigma
• low health literacy, low social support, stressful life
• homelessness, poverty, access to healthcare
• SAD

Question 2

Inactivated Influenza vaccine (IIV)

Answer 2

Indication:
- everyone older than 6mo and pregnant

Route:
- IV/subQ

Contraindication

• < 6mo
• severe egg allergy
• guillain-barre syndrome

Question 3

Live attenuated influenza vaccine (LAIV)

Answer 3

Indication:
- 2-49 years healthy and nonpregnant

Route:
- nasal spray

Contraindication:

• pregnancy
• with antiviral
• with aspirin
• egg allergy
• guillain-barre syndrome
• chronic diseases and asthma
• immunosuppressed
• working with at risk population
• acute phase disease (stuffy)
• other vaccines in the last 4 weeks

Question 4

Pneumococcal polysaccharide vaccine (PPSV23)

Answer 4

Route: IM/subQ

Indication:

• > 19yo and if immunocompromised, chronic disease, smokers, living in long-term facility
• > 65yo - one dose; needs booster

Contraindication
- pregnancy, children < 2

SE: local inflammatory reaction at site, fever, drowsiness, anorexia

Question 5

Pneumococcal conjugate vaccine (PCV13)

Answer 5

IM/subQ

Indication:

• > 19yo and if immunocompromised, chronic disease, smokers, living in long-term facility
• > 65yo - one dose; needs booster
• children < 2

Contraindication:
- children < 6mo

SE: local inflammatory reaction at site, fever, drowsiness, anorexia