HIV Course

Question 1

Which gender is more likely to be infected with HIV? There are more _____ infected than _______

Answer 1

Females; males, females

Question 2

Which group is more likely to acquire HIV?

Answer 2

Male-to-male sexual contact, at least 75% new infections(over heterosexual, injection drug use, MSM and injection drug use combined)

Question 3

In the time course of the HIV infection, when could anti-HIV Abs appear? What happens during the clinical latency period? When can we see constitutional symptoms? Can you make a diagnosis of HIV based on the CD4 count?

Answer 3

3-12 weeks;
Virus is proliferating in CD4 cells that have been infected, maybe creating syncytia and creating virions;
when CD4 cells and immune system lose control and viremia recurs, perhaps at 8 years after primary HIV infection;
NOOOOOO

Question 4

What do you begin to see at a certain CD4 count? What is that count?

Answer 4

Kaposi’s sarcoma (HIV in conjunction with HHV)
1. Pneumocystitis jirovecii pneumonia (classified as fungus and can respond to bactrim, a sulfa drug)
2. Non-Hodgkin’s lymphoma (could see lymphadenopathy)
3. Esophageal candida (AIDS defining diagnosis!!!: thrush, oral hairy leukoplakia)
4. Crypcosporidiosis
5. Chronic herpes (face)
6. Cerebral toxoplasmosis (mass effect, multiple ring-enhancing lesions on MRI/CT, typically involves basal ganglia)
7. Progressive Multifocal Leukoencephalopathy (JC virus)
8. CMV retinitis
9. Mycobacterium avium complex (straight pink things that fill up the macrophages);
around 200

Question 5

At around 500 CD4 T cells, what do you see? What would you try to target?

Answer 5

Skin disease (seborrheic dermatitis) and nodular prurigo (papulopruitic eruptions centered around hair follicles);
target the HIV

Question 6

At around which CD4 count do you see pulmonary TB? How does the TB typically arise?

Answer 6

300-400; typically is reactivated with a low enough CD4 count

Question 7

What are some goals of antiretroviral therapy?

Answer 7

1. Suppress HIV-1 replication (lower viral load and impede HIV spread)
2. Prevent/delay destruction of immune system
3. Achieve normal survival while maintaining a tolerable life

Question 8

When is it indicated to initiate therapy of chronic infection?

Answer 8

If symp, with CD4 T cell count and plasma HIV RNA at any value, TREAT;
if asymp with AIDS, CD4 less than 350, TREAT;
if asymp, >350 CD4, >100,000 copies of plasma HIV RNA, some clinicians might treat;
if asymp, >350, <100,000, DEFER THERAPY

Question 9

Benefits to treating someone with CD4 > 500 cells/ul?

Answer 9

At the very least, DISCUSS treatment with the patient

Question 10

List concerns of early therapy?

Answer 10

1. ARV-related toxicities
2. Non-adherence to ART
3. Drug resistance
4. Cost

Question 11

What are the different types of ARV medications (6)?

Answer 11

1. NRTI’s
2. NNRTI’s
3. PI’s
4. II’s
5. Fusion inhibitors
6. CCR5 antagonist

Question 12

What are the PREFERRED initial regimens?

Answer 12

1. Combination of 2 NRTI’s with NNRTI
2. Combo of 2 NRTI’s with PI
3. Combo of 2 NRTI’s with II