HIV + drugs Flashcards
diagnosis of HIV
screening: ELISA high sensitivity (capture all positives) confirm: Western blot high specificity (identify true positives)
viral load
PCR test that quantifies how many copies of HIV RNA in blood sample
use viral load: copies of HIV RNA in blood
diagnosis:
acute infection (“window period”, 1-2 mo)
newborn of HIV+ mom was infected during peripartum
monitor effectiveness of drug therapy
ELISA and Western blot detect
antibodies to viral proteins: p24 + gp120
1-2 mo of HIV infection “window period”): asymptomatic + FN (low Ab levels) on ELISA + Western blot → use viral load
baby born to infected mother: FP (anti-gp120 crosses placenta) → determine if infected with viral load
AIDS diagnosis: immune system significantly affected by HIV
CD4 cell count
reason for cancer inHIV
immune system destroys neoplastic cells
interstitial infiltrates on CXR “ground-glass appearance on imaging”
CD4
pneumocystis jirovecii pneumonia (PCP)
mycobacterial pulmonary diseases in HIV+ patient
TB
mycobacterium avium intracellulare (MAC, MAI): CD4
pulmonary infections in HIV + patient
pneumocystis jirovecii pneumonia (PCP): CD4
neuro infections in HIV+ patient
cryptococcal meningitis toxoplasmosis 1° CNS lymphoma CMV retinintis progressive multifocal luekoencephalolpathy (PML): reactivation of latent JC virus AIDS dementia
AIDS patient with meningitis
cryptococcal meningitis
AIDS patient with ring-enhancing lesions on brain MRI
toxoplasmosis: MULTIPLE
1° CNS lymphoma: usually single
AIDS patient with CD4 count
CMV retinintis: cotton wool spots
“owl’s eye” nuclear inclusions, cells enlarged
CMV
GI infection in HIV + patient
cryptosporidiosis
HIV + patient with chronic, watery diarrhea
cryptosporidiosis
self-limited in immunocompotent
oral infections in HIV+ patient
oral thrush or esophageal candidiasis: c. albicans
oral hairy luekoplakia
HSV: oral herpes
CMV: oral infections
HIV+ patient with fluffy, cottage-cheese lesions on tongue
CAN SCRAPE OFF
c. albicans
hairy lesion SIDES of tongue
caused by EBV infection in HIV patient
CAN’T SCRAPE OFF
oral hairy leukoplakia
malignancies in HIV + patient (caused by viral infections)
kaposi sarcoma (caused by HHV-8)
Non-hodgkin lymphoma (caused by EBV co-infection): 1° CNS lymphoma, large B cell lymphoma
squamous cell carcinoma of cervix/anus from MSM (caused by HPV 16 and 18)
HIV + patient with ↑ blood vessel production (purple)
lesions on skin, mucous membrane, lungs
kaposi sarcoma (HHV-8)
NOT bacillary angiomatosis (bacillary henselae: superficial vascular lesions that look like cherry hemangiomas)
prophylactic Abs when CD4
PCP prophylaxis: TMP-SMX
if sulfa allergy:
dapsone (don’t use if G6PD deficiency)
aerosolized pentamidine
prophylactic Abs when CD4
prevent toxoplasmosis reactivation:
prophylaxis IF + IgG titer (previous infection): TMP-SMX
if sulfa allergy: dapsone + pentamidine + leucovorin
prophylactic Abs when CD4
MAC prophylaxis: azithromycin (1 dose/week)
prophylactic Abs when CD4
histoplasmosis prophylaxis IF in endemic area (MS river valley + Ohio river valley): itraconazole
HAART: highly active antiretroviral therapy
Know drugs in each category, MOA, common + life-threatening SEs
combo of at least 3 different drugs with different MOAs to prevent resistance
everyone HIV+ (regardless of CD4 count) should consider HAART
DEFINITELY if CD4
occupational exposure to HIV: post-exposure prophylaxis
3 drug regimen
continue for 4 weeks
treatment for pregnant women with HIV
zidovudine: if not on HAART during pregnancy and delivering
if already controlled on HAART during pregnancy: continue tx during delivery
