HIV infection and HIV treatment Flashcards
persistent sore throat and new onset rash and diarrhea with negative rapid strep and has headache and nausea and diarrhea
Acute HIV
acute HIV presentation
acute fever, headache, sore throat, nausea, diarrhea and enlarged lymph nodes. may be mistaken for other viral illnesses and seems like the flu
Gonoccocal pharyngitis infection
genitourinary symptoms that can occur by itself. Seen with joint or tendon pain or peripheral rash (not truncal) and varies from maculopapular to pustular.
EBV infectious mononucleus presentation
<21 yrs old and sore throat with malaise and LAD see rash if given antibiotics like amoxicillin
when does symptoms for an acute HIV infection occur?
2-4 weeks post exposure
mononucleosis like syndrome of fever lymphadenopathy, sore throat, and arthralgias and generalized macular rash and GI symptoms
acute HIV infection
what labs are seen on acute HIV infection?
presence of p24 antigen present.
HIV antibody testing may be negative (not yet seroconverted)
HIV1/2 antibody differentiation immunoassay will be positive. OR can have positive HIV RNA nucleic acid amplification testing shows viral load is elevated >100K
CD4 count may be normal
management of HIV infection
combination of anti-retroviral therapy partner notification consideration of secondary prophylaxis.
when to start ART therapy for patients with HIV?
even if newly diagnosed, start combination antiretroviral therapy.
offer treatment regardless of CD4 count as this can fall precipituously with HIV infection.
DO NOT NEED resistance testing to be done at time of initiation of ART. must be done eventually but this does not delay starting ART.
infectious mononucleosis presentation
malaise myaglia, generalized rash (maculopapular, urticarial and petechial) but rash is only seen after amoxicillin. they also have fever, pharyngitis and LAD and atypical lymphocytes.
bone lucency, marked body cavity LAD and uncontrolled HIV need to consider
lymphoma 4% of HIV pts have lymphoma at time of diagnosis.
risk factors for developing lymphoma and HIV
HIV direct effects when CD4 count <100, immunosuppressive state, coinfection with oncogenic viruses (EBV)
most common lymphoma related to HIV
Burkett’s lymphoma and diffuse large non hodgkin lymphoma
Pre exposure prophylaxis or PrEP consists of:
2 drug antiretroviral therapy with tenofovir + emtricitabine.
why do we like PrEP therapy?
helps decrease risk for HIV acquisition by >90% and is offered to those with substantial risk for new HIV infections
who gets PrEP?
sexual behaviors - HIV positive partner with detectable viral load,
men who have sex with men,
individuals with high prevalence areas (sub Saharan Africa) with recent bacterial sexually transmitted infection,
sex exchange for money,
inconsistent condom use,
higher number of partners
IV drug abuse - HIV positive injecting partner or sharing of injecting equipment
how to monitor PrEP therapy?
need required follow up every 3 months with HIV testing, risk reduction counseling, medication adherence and side effect assessment. Need lipid panel, CMP (cr level) every 6 months. check urine GC/chlaymydia/trichonella, test for hepatitis, urine testing and PCR. Need to check for pregnancy q3 months.
how to qualify for PrEP therapy?
negative fourth generation HIV testing, no manifestations of acute HIV, normal renal function and documented Hep B infection or Hep B vaccination status. needs pregnancy test.
Pt presents with new skin changes when HIV presentation and CD4 coutns are less than 400. What are those skin changes
new seborrheic dermatitis. Can also need to screen for HIV when they have recurrent herpes zoster infections and sudden severe psoriasis
guidelines for starting treatment with pregnant women who have HIV And why?
start ART as soon as possible regardless of initial viral load or CD4 counts to minimize maternal risks of HIV infection and reduce risk for perinatal transmission
when is drug resistance testing done for pregnant women with HIV?
done after ART is started. ART can be modified based on drug resistance results.
Often are HIV RNA viral load is checked? CD4 cell count checked?
check HIV RNA load at initial visit, every 2-4 weeks after initiation or change of therapy until undetectable and t_hen every 3 months_
check CD4 count every 3-6 months
Resistance testing is done once if not previously performed
post exposure prophylaxis is:
PEP must be started within 72 hrs** of exposure **otherwise not recommended.
3 drugs for 28 days tenofovir, emtricitabine, and raltegravir.
Test pt at baseline, then at 4-6 weeks and then 3 months post exposure
how do we test for HIV? screening is with:
initial ELISA- this screens serum for HIV antibodies + antigen screening at the same time as initial ELISA test
Basically looking at HIV antibodies (ELISA for HIV1/HIV2) and HIV p24 antigen
rationale: pts in window period where they are infected but not producing antibodies at high enough level to be detected will be missed. The antigen/antibody combination had a low false positive rate.
confirmatory testing is: with a HIV1/2 antibody differentiation immunoassay - if intermediate, then get HIV RNA testing by PCR.
if HIV1/HIV2 antibody differentiation immunoassay is positive- confirms infection.
If negative HIV1/HIV2 antibody differentiation get HIV RNA testing by PCR. If that is positive, then it confirms HIV infection.
How do we confirm HIV testing is positive if HIVp24 antigen or initial ELISA HIV antibody is positive?
confirmatory testing: with a HIV1/2 antibody differentiation immunoassay - if intermediate then get HIV RNA testing (by PCR).
if HIV1/HIV2 antibody differentiation immunoassay is positive = infection.
If negative or intermediate, HIV1/HIV2 antibody differentiation get HIV RNA testing by nucleic acid amplification testing.
If positive, then it confirms HIV infection,
