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HIV management Flashcards

1
Q

What is seen on P.E of a HIV patient?

A
  • kaposi sarcoma (painless purplish spots on the skin)
  • oral thrush (candidiasis- Painful swallowing)
  • CXR (pneumocystic pneumonia)
  • syphilis
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2
Q

What occurs with blockade of integrase? What do integrase inhibitor drugs end in?

A
  • virus can’t be inserted into host cell genome

- -gravir

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3
Q

What does the CCR5 inhibitors do?

A
  • blocks the HIV from “using” the CCR5 receptor to enter the cell
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4
Q

What is bad about monotherapy with ZIdovudine?

A
  • did not improve survival

- —-reduce viral load

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5
Q

How effective is Dual NRTI therapy?

A
  • improves survival by 33%
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6
Q

Define triple drug therapy

A

-combination of minimum 3 drugs from 2 classes of drugs from which the virus is susceptible.

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7
Q

What is the purpose of the anti-retroviral therapy ?

A
  • reduces viral load to UNDETECTABLE
  • restores immunocompetence
  • reduces morbidity and mortality
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8
Q

How to prevent drug resistance?

A
  • ADHERENCE to therapy (taking the drug every day!)
  • give drugs according to patient’s lifestyle, tolerability
  • depends on pharmacokinetics, drug-drug interaction, RX interruptions
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9
Q

CNS side effects of HAART?

A

mood, psychosis (efavirenz)

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10
Q

Skin S/E of HAART?

A

rash, hypersensitivity, Stevens-Johnsons (abacavir, nevirapine)

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11
Q

Bone s.e of HAART?

A
  • osteromalacia (tenofovir)
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12
Q

How may protease inhibitors affect drug-drug interactions?

A
  • these are potent Liver enzyme inhibitors
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13
Q

What does preventive medicine involve for HIV pts ?

A
  • STI screening
  • CVS risk and smoke cessation
  • Hep A/B, Flu, HPV vaccination
  • harm reduction (moving away from injecting drugs)
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14
Q

What psychosocial issues may a HIV pt face?

A
  • adjustment d.o
  • survivor’s guilt
  • feeling of isolation
  • relationships
  • spirtual
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15
Q

What does partner notification and disclosure (by the doctor) involve?

A
  • a voluntary process
  • —-required years of trust
  • Can be either: partner referral, provider referral and conditional referral
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16
Q

Barriers to partner notification?

A
  • fear of: REJECTION, ISOLATION, VIOLENCE
  • STIGMA > discrimination
  • CONFIDENTIALITY
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17
Q

How to prevent HIV transmission?

A
  • SEXUALLY TRANSMITTED: condom use is effective
  • not sexually transmitted when HIV pt is on HIV treatment
  • STI screening and RX
  • sero-adaptive sexual behaviour —-RISK IS MORE IF HE INSERTS
  • disclosure
  • post-exposure prophylaxis
  • pre- exposure prophylaxis
18
Q

Why is STI screening important for HIV prophylaxis?

A
  • HIV -ve pt exposed to STI is VULVNERABLE to HIV
19
Q

Conception options for : HIV+ male, HIV- female

A

(SEX as normal just PrEP for non-HIV pt) Treatment as prevention
(+/- timed condomless sex)
?HIV PrEP for female partner

20
Q

Conception option for

HIV+ female, HIV- male

A

Treatment as prevention
(+/- timed condomless sex)
? Self-insemination
?HIV PrEP for male partner

21
Q

How to prevent Mother to child transmission?

A
  • give PEP for 4 weeks after neonate is born
  • exclusive FORMULA feeding (unknown if breast feeding is infective)
  • if undetected Viral load—–then VAGINAL delivery
  • C-section if otherwise
  • HAART during preg.
22
Q

How effective is it to tell people to abstain?

A
  • not effective

- does not work

23
Q

BEST HIV strategies at an individual level?

A
  • condom programmes
  • behaviour change interventions (support people to have sex)
  • CONDOM program
  • PEPSE
  • circumcision (reduces HIV risk by 60 % )
  • PrEP
24
Q

Best HIV prevention strategies at a community level?

A
  • needle exchange
  • testing and rx of
    STIs
  • rx as prevention
25
Q 
What occurs with blockade of reverse transcriptase? 
What class of retroviral drugs block this?
A

NRTIs (nucleoside reverse transcriptase inhibitors) disrupt the construction of new piece proviral DNA

26
Q

Name 2 NRTIs.

A
  • Lamivudine

- Zidovudine

27
Q

What are the 2 types of entry inhibitors?

A
  1. Fusion

2. CCR5 Receptor

28
Q

What occurs with the blockade of the enzyme protease ?

A
  • HIV uses protease to break down LARGE glycoproteins to use smaller pieces for the assembly of new viral particles.
  • —–virus may still replicate with protease inhibitors but the resulting virions are immature
29
Q

When may dual therapy have little impact on survival?

A
  • when and if the patient was initially on monotherapy and then switched to dual
30
Q

Which HAART medications hold increased risk of MI?

A

Abacavir
Lopinavir
Maraviroc

31
Q

Which HAART med has hematological implication?

A
  • Zidovudine

d/t Anaemia

32
Q

Which medications may result in renal toxicity?

A
  • tenofovir (NRTI)
  • atazanavir (Protease Inhibit.)
    >proximal renal tubulopathies
33
Q

Which HAART drugs result in GI side effects?

A

protease inhibitors (NEVIRAPINE, most others)

34
Q

How may NNRTIs affect drug-drug interactions?

A
  • potent liver enzyme INDUCERS (ALSO the protease inhibitors)

—-therefore acts as pharmalogical boosting for drugs that need it

35
Q

Which BBV has the same treatment as HIV ?

A
  • Hepatitis B
36
Q

Who is in the multidisplinary team for managing HIV pts?

A
  • physicians
  • Nurse
  • paharmacists
  • secretaries
  • Virologists
  • Clinical psychologists
  • social workers
  • sexual health
37
Q

Who is eligible for PrEP ?

A

Those pts at HIGH risk of HIV:

  • HIV+ partner with DETECTABLE viral load
  • MSM/ Transwoman

Others eligible:

  • aged >16y.o
  • HIV negative
  • can commit 3/12’ly
  • scottish resident
  • willing to stop if eligibility no longer apply
38
Q

Which HAART drug is said to cause Anemia?

A

Zidovudine

39
Q

What effects may HAART rx have on the gut?

A

transaminitis

fulminant hepatitis

40
Q

What are common HIV co-infections?

A
  • Hep B
  • Hep C
  • Tuberculosis

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