HIV Infection Flashcards
What is the difference between HIV and AIDS?
HIV refers to infection with the HIV retrovirus that causes immunodeficiency by infecting and destroying CD4 cells (in addition to other immune cells)
AIDS (Acquired Immunodeficiency Syndrome) refers to the syndrome that occurs when the CD4 cell count falls below 200 cells/microliter, leading to opportunistic infections and malignancies
What are the aims of HIV treatment? (5)
- Achieve an undetectable viral load
- Preserve immune function
- Reduce mortality and morbidity associated with chronic infection
- Reduce onward transmission
- Improve physical and psychological well-being of infected individuals
(Whilst minimizing drug toxicity)
When should treatment be initiated in patients with HIV?
As soon as diagnosis is made, regardless of CD4 cell count
*all patients with suspected or diagnosed HIV should be reviewed promptly by a HIV specialist
What outcomes are associated with poor treatment adherence to HAART? (3)
- Drug resistance
- Progression to AIDS
- Death
What is the treatment of HIV in treatment-naive patients?
3-drug treatment with TWO NRTIs (nucleoside reverse transcriptase inhibitors) plus ONE of the following:
- integrase inhibitor (IH)
- non-nucleoside reverse transcriptase inhibitor (NNRTI)
- protease inhibitor (PI)
What are the 7 NRTIs?
- Emtricitabine (FTC)
- Tenofovir (TAF or TDF)
- Abacavir (ABC)
- Lamivudine (3TC)
- Didanosine
- Stavudine
- Zidovudine (AZT)
**All but didanosine and stavudine are licensed for use in the UK
What are the preferred NRTI “backbone” regimens for initiating ART in a patient with HIV?
FIRST LINE:
- Emtricitabine and tenofovir
SECOND LINE:
- Abacavir and lamivudine
(Plus third drug)
What are the options for the third drug added to the NRTI backbone of ART therapy?
FIRST LINE:
- ritonavir-boosted atazanavir (PI)
- ritonavir-boosted daruvavir (PI)
- dolutegravir (PI)
- cobicistat-boosted elvitegravir (PI)
- raltegravir (PI)
- rilpivirine (NNRTI)
SECOND LINE:
- Efavirenz (NNRTI)
(Remember, ART initiation therapy utilizes two NRTIs and ONE of either an integrase inhibitor an NNRTI, or a boosted protease inhibitor)
What is the treatment of choice for patients with HIV and Hep B?
Antivirals that have activity against both HIV and Hep B
FIRST LINE:
- tenofovir + emtricitabine
When should changing therapy be considered for patients being treated for HIV?
Deterioration of condition: clinical, virological, CD4 count
What factors should be taken into consideration when choosing an alternative regimen for ART? (4)
- Response to previous treatment
- Tolerability
- Drug-drug interactions
- Possibility of drug resistance
What is the aim of ART in pregnancy?
Maximal suppression of viral replication as early as possible (if possible before conception) in order to minimise vertical transmission
What is the regimen of choice for treating pregnant women with HIV?
FIRST LINE:
- NRTI backbone of tenofovir or abacavir + emtricitabine or lamivudine
- Third drug should be either efavirenz or ritonavir-boosted atazanavir
** all pregnant women living with HIV who conceive whilst on effective ART should continue this treatment throughout their pregnancy; all other women should start ART during their pregnancy
What is the recommendation for breast-feeding during pregnancy in HIV-positive mothers?
Should be avoided to prevent vertical transmission of HIV
What are the risk factors for acquiring HIV? (3)
- Men or transgender individuals who have unprotected anal intercourse with men
- Sexual partners of people who are HIV-positive with a detectable viral load
- HIV-negative heterosexual individuals who have unprotected intercourse with a HIV-positive person, and are likely to repeat this with the same person or another person with a similar status
