HIV Clinical Care

Question 1

What is approach to new diagnosis of HIV?

Answer 1

Staging of infection, check for opportunistic infections, treatment, psychological support, education, partner notification

Question 2

Screening for which epidemiologically linked conditions are carried out on diagnosis of HIV? (6)

Answer 2

Hep B, 
hep C, 
syphillis, 
STI, 
(schistosomiasis), 
(TB)

Question 3

List 4 targets of anti-retroviral drugs available

Answer 3

Reverse transcriptase inhibitor, integrase inhibitor, protease inhibitor, entry inhibitors (prevents fusion or CCR5 receptor)

Question 4

What is highly active anti-retroviral therapy? (HAART)

Answer 4

Combo of 3 drugs from at least 2 drug classes to which the virus is susceptible

Question 5

Why are there a lot of polymorphisms in the viral replications made in HIV?

Answer 5

Because reverse transcriptase makes a lot of mistakes

Question 6

How does HAART work? (Basic)

Answer 6

It suppresses viral load and helps immune system function

Question 7

What is key to preventing drug resistance in HIV? And why?

Answer 7

Adherence!!! If patient takes drug break then viral load can increase, polymorphism can occur, viral load can increase again with new dominant HIV that is resistant

Question 8

If HIV+ve patient wants to stop their type of tablet, why is another drug that covers resistance e.g. protease inhibitor taken for a while?

Answer 8

Because in a tablet there are often 3 drugs joined together and the levels of one drug might take longer to clear from the body and so then patient is basically on monotherapy which can lead to polymorphisms and resistance so cover drug helps stop this

Question 9

What do NRTI and NNRTI stand for

Answer 9

nuscleoside or non-nucleoside reverse transcriptase inhibitor

Question 10

What is prognosis of HIV today?

Answer 10

Life expectancy normal (although depends on duration of immunosuppression and viraemia) but fewer good health years

Question 11

List some examples of HAART toxicity

Answer 11

skin, CNS (mood & psychosis), renal toxicity (proximal tubulopathies and nephrolithiasis), osteomalacia, increased MI risk, anaemia, GI (transaminitis and fulminant hepatitis)

Question 12

In terms of drug-drug interactions, protease inihibitors and NNRTIs affect other drugs how? (I.e. how do they bully other drugs)

Answer 12

Protease inhibitors are liver enzyme inhibitors and NNRTIs are liver enzyme inducers so can affect how good other drugs are

Question 13

The treatment for Hep B is the same as for HIV. True/false?

Answer 13

True - hep B is also retroviral

Question 14

What is the difference between primary and secondary HIV prevention?

Answer 14

Primary - prevent acquiring HIV and secondary - prevent transmitting HIV

Question 15

List 8 methods of primary prevention of HIV

Answer 15

Condoms, regular testing, behaviour change, PREP, PEP, PMTCT, circumcision, needle exchange/drug treatment

Question 16

List 7 methods of secondary HIV prevention

Answer 16

Condoms, regular HIV testing, behaviour change, anti-retroviral treatment, disclosure, PMTCT and needle exchange/drug treatment

Question 17

HIV treatment with ART does not prevent onwards transmission. True/false?

Answer 17

False - it does, really effectively - 0 transmission when viral load really low

Question 18

What is PrEP?

Answer 18

Pre-exposure prophylaxis - 2 ART drugs

Question 19

PrEP is 86% effective at risk reduction of HIV. True/false?

Answer 19

True

Question 20

What drugs are given for PrEP?

Answer 20

Tenofovir/emtricitabine combined

Question 21

What are 3 considerations for PrEP?

Answer 21

Renal health, drug-drug interactions and regular monitoring

Question 22

What are dosing options with PrEP?

Answer 22

Daily drug or on-demand (for when maybe exposed)

Question 23

PEP should be taken within how long after high risk exposure?

Answer 23

72hrs

Question 24

How is PEP taken?

Answer 24

Combination ART taken for 4 weeks

Question 25

What are the drugs taken for PEP?

Answer 25

Tenofovir/emtricitabine and raltegavir

Question 26

What is approximate reduction in HIV acquisition with PEP?

Answer 26

Approx. 80%

Question 27

What are 3 methods of PMTCT? (Prevention of mother to child transmission)

Answer 27

HAART during pregnancy, 2-4/52 PEP for neonate and exclusive formula feeding

Question 28

How should baby be delivered in HIV+ve mother?

Answer 28

Vaginal fine if undetected viral load but need C-section if detected viral load

Question 29

<1% risk of MTCT in UK/Ireland - true/false?

Answer 29

True

Question 30

What is so important for primary and secondary prevention of HIV?

Answer 30

HIV testing!!