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Clin Med2- Hematology > HIV - collins > Flashcards

HIV - collins Flashcards

1
Q

what year were routine HIV screenings recommended

A

2006

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2
Q

what year was PrEP(pre-exposure prophylaxis) approved

A

2012

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3
Q

what are the risk factors for HIV

A

concomitant STDs
alcohol and drug use
sexual intercourse (receptive anal intercourse»other modes)
Needles

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4
Q

what is the etiology of new HIV diagnoses

A

68% Male-to-male sexual contact
23% heterosexual contact
6% IVDU

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5
Q

What are the symptoms of HIV

A

often asymptomatic
can have acute retroviral syndrome (50-70%)
- mild=vague flu-like illness
- severe= meningitis, encephalitis, thrombocytopenia

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6
Q

what are HIV screenings and when are they done

A

CDC recommends at least one time screening for all pts 13-64
at least once yearly for high-risk patients
more frequently might be preferred for high risk patients

screening completed via “opt-out” testing
- pts notified HIV screen will be completed with routine blood work
- testing is the default - must elect NOT to be tested

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7
Q

what are HIV tests

A

Nucleic acid tests (NATs) - detect HIV RNA
Antigen/antibody testing - detects HIV p24 antigen AND HIV IgM and IgG
Antibody only testing - detects HIV IgM and IgG

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8
Q

what is the window period

A

time between acute infection and ‘detectable’ infection

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9
Q

What is the Nucleic Acid Test (NAT)

A

expensive
most acute HIV or indeterminate test - no HIV abx yet
Detectable 10 days post-exposure
positive = presence of HIV RNA

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10
Q

when are the treatments for HIV recommended

A

initiate in any pt age >18 regardless of CD4 count
initiate immediately on diagnosis(or ASAP)
should obtain baseline/screening labs on initiation of treatment

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11
Q

what baseline/screening labs should be obtained on the initiation of treatment for HIV

A

Viral load (HIV RNA)
CD4 count
HIV genotyping
BMP/CMP for baseline (liver and kidney function)
lipids
CBC
Glucose
Urinalysis
Pregnancy testing

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12
Q

what co-infections screening should be obtained for HIV

A

STI (syphilis, chlamydia, gonorrhea; + trichomonas in F)
Latent TB
Hep A and B
HCV
Coccidiodimycosis

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13
Q

What is the first line treatment for HIV

A

ART (anti-retroviral therapy)
generally a 3 drug combo (1InSTI + 2 NRTIs)

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14
Q

What is the second line treatment for HIV

A

2NRTIs+ 1 from another class (PI, NNRTI, II)

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15
Q

what is INSTI

A

integrase inhibitors

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16
Q

What is PI

A

Protease Inhibitors

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17
Q

what is NRTI

A

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors

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18
Q

What is NNRTI

A

Non-Nucleoside Reverse Transcriptase Inhibitors

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19
Q

What are the side effects of HIV treatments

A

N/V/D
Difficulty sleeping
Dry mouth
Headache
Rash
Dizziness
Fatigue
Fever
Osteopenia/osteoporosis
Peripheral neuropathy
Pancreatitis
Hepatitis
Anemia
Neutropenia
Nephrotoxicity

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20
Q

what is the goal of HIV treatment

A

virologic suppression
Defined as < 50 copies/mL
takes about 24 weeks to achieve

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21
Q

what should rise with Virologic suppression

A

CD4 count
check every 6 months for first 2 years
then, if suppressed, check yearly

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22
Q

What is Immune Reconstitution Inflammatory Syndrome (IRIS)

A

occurs after initiation of ART (higher risk if worse disease)
secondary to rapid increase in CD4 count - can now mount inflammatory response
appearance of worsening opportunistic infections
must rule out new or worsening opportunistic infections

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23
Q

what is the treatment of IRIS

A

supportive +/- steroids if severe

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24
Q

what are reasons to adjust ART

A

side effects
toxicity
simplify regimen for compliance
virologic failure (HIV RNA >200 on 2 consecutive occasions)

25
Q

what is the best way to prevent HIV

A

no vaccine available
prevention: cessation of IVDU/needle sharing, safe sex practices (regular screenings, condom use, limited partners, avoid concurrent ETOH/drug use), sex education, ART as prevention

26
Q

What is PrEP

A

pre-exposure prophylaxis
indicated for any high risk patients who request - inconsistent condom use, recent PEP or STI, HIV + partner, needle sharing

27
Q

how is PrEP taken

A

once daily oral (truvada or Descovy(not indicated in vaginal sex))
IM injection (cabotegravir) every 2 months
monitoring every 3 months for screenings

28
Q

what are the oral PrEP medications

A

Truvada (tenofovir DF and emtricitabine)
Descovy (tenofovir A and emtracitabine) - not indicated for receptive vaginal sex

29
Q

what are the IM injection PrEP medications

A

Cabotegravir (apretude) every 2 months - good option if patient preference and if troubles with adherence

30
Q

what needs to be monitored every 3 months with PrEP use

A

HIV screening
Pregnancy screening
ready for SUD treatment?
clean needle access
creatinine
STIs
Annual HCV screening

31
Q

What is PEP

A

Post-exposure prophylaxis
for prevention of HIV in negative pts AFTER EXPOSURE to HIV
must be started within 72 hours of exposure

32
Q

how is PEP adminitered

A

Orally for 28 days
Tenofovir DF + emtracitibine (truvada) daily
AND either Raltegravir (BID) or dolutegravir (daily

33
Q

What are screenings needed prior to the administration of PEP

A

HIV rapid test (if HIV + DONT start PEP)
pregnancy test
LFTs
BUN/creatinine
STI screen (if sex related exposure)
Hep B screen
HCV screen

requires repeat HIV screening at 30d and 90d to rule out seroconversion

34
Q

what are the complications of HIV

A

may have fever, weight loss, night sweats (can occur w/o OI)
wasting syndrome - loss of muscle > fat
neuropathy
arthritis, rhematologic diesases, osteopenia/osteoporosis
CAD
progression to AIDs - OI or Opportunistic diseases

35
Q

What is AIDS

A

acquired immunodeficiency syndrome
late-stage HIV (mean time of about 10 years between initial HIV infection and AIDS)

36
Q

what defines AIDS

A

CD4 count less than 200 cells/mcL

OR

Presence of an ‘AIDS defining’ infection/malignancy (OI)

37
Q

prior to ART, what was the most common OI in aids patients

A

Pneumocytis jirovecii (PCP)
CD4 < 200
symptoms are similar to pneumonias - cough, SOB, hypoxia, fever

38
Q

what is present of PCP pneumonia x-ray

A

diffuse or perihilar infiltrates on CXR
used to be called pneumocysitc carinii

39
Q

how is PCP pneumonia diagnosed

A

sputum testing

40
Q

how is PCP pneumonia treated

A

TMP-Sulfa (Bactrim) x 21 days

41
Q

what is toxoplasmosis

A

CNS infection
CD4 <100
ssx: HA, focal neuro deficits, seizures, AMS
Ring-enhancing lesion (Contrast enhancing) on CT
usually setting of + Serologic tests (IgM, IgG)

42
Q

what is the treatment of Toxoplasmosis

A

pyrimethamine + sulfadiazine X 6 weeks
+/- leucovorin
OR TMP-Sulfa (Bactrim) - prophylaxis

43
Q

What is Mycobacterium Avium Complex (MAC)

A

infection with Mycobacterium avium and Mycobacterium intracellular
CD4 <50 - rare since ART improvements
pulmonary infection in health individuals (elderly, pre-existing lung dz)
Disseminated MAC in HIV + patients (fever, night sweats, weight loss, fatigue, SOB, abd pain, diarrhea, anemia)

44
Q

how is MAC diagnosed

A

sputum culture (+ acid fast bacillus (AFB))

45
Q

how is MAC treated

A

clarithromycin (or azithromycin) + ethambutol + rifampin

46
Q

What is Cryptococcal Meningitis

A

Infection with Cryptococcus (usually neoformans)
fungal infection
sx: headache and fever (Meningeal irritation less likely)

47
Q

How is Crytococcal meningitis diagnosed

A

+ serum cryptococcal antigen (CRAG)
+ india ink stain CSF

48
Q

what is the treatment of cryptococcal meningitis

A

IV liposomal Amp B + flucytosine X 2 weeks
then Fluconazole 400mg X 8 weeks, then Fluconazole 200mg X 1 Year

49
Q

what is CMV retinitis

A

infection of the retina with cytomegalovirus
rule out all HIV + pts with visual changes
perivascular hemorrhages and white fluffy exudates - not cotton wool spots

50
Q

What are Opportunistic diseases in AIDS

A

HIV-related encephalopathy
Invasive cervical cancer
Kaposi’s sarcoma
Lymphomas
Progressive multifocal leukoencephalopathy(PML)
Wasting. syndrome

51
Q

What is Kaposi’s sarcoma

A

infection with Kaposi’s sarcoma herpes virus (KSHV) - aka HHV-8
most commonly CD4 < 200
purplish macules, papules or nodules
can present anywhere on skin/MM

52
Q

how is Kaposi’s sarcoma diagnosed

A

biopsy

53
Q

how is kaposi’s sarcoma treated

A

ART if not widespread
Add chemo if ART is widespread

54
Q

What are the typical first line HIV treatment regimens

A

Bictegravir + Tenofovir + emtricitabine (BIC/TAF/FTC)

Doultegravis + abacavir + lamivudine (DTG/ABC/3TC)

Doultegravir OR Raltegravir + tenofovir/emtricitabine (DTG/TAF/FTC or 3TC)

55
Q

what does the india ink stain test

A

Cryptococcus neoformans

56
Q

What is the prophylaxis treatment for TB

A

if not active disease (negative CXR) - start isoniazid (INH)

57
Q

what is the prophylaxis treatment for cocidiodomycosis

A

fluconazole if positive screening

58
Q

what is the prophylaxis treatment for PCP

A

trimethoprim-sulfamethoxazole (Bactrim) 80/400mg or 160/800mg

59
Q

what is the prophylaxis treatment for toxoplasmosis

A

Bactrim 160/800mg

Clin Med2- Hematology (8 decks)

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