HIV management Flashcards
What is seen on P.E of a HIV patient?
- kaposi sarcoma (painless purplish spots on the skin)
- oral thrush (candidiasis- Painful swallowing)
- CXR (pneumocystic pneumonia)
- syphilis
What occurs with blockade of integrase? What do integrase inhibitor drugs end in?
- virus can’t be inserted into host cell genome
- -gravir
What does the CCR5 inhibitors do?
- blocks the HIV from “using” the CCR5 receptor to enter the cell
What is bad about monotherapy with ZIdovudine?
- did not improve survival
- —-reduce viral load
How effective is Dual NRTI therapy?
- improves survival by 33%
Define triple drug therapy
-combination of minimum 3 drugs from 2 classes of drugs from which the virus is susceptible.
What is the purpose of the anti-retroviral therapy ?
- reduces viral load to UNDETECTABLE
- restores immunocompetence
- reduces morbidity and mortality
How to prevent drug resistance?
- ADHERENCE to therapy (taking the drug every day!)
- give drugs according to patient’s lifestyle, tolerability
- depends on pharmacokinetics, drug-drug interaction, RX interruptions
CNS side effects of HAART?
mood, psychosis (efavirenz)
Skin S/E of HAART?
rash, hypersensitivity, Stevens-Johnsons (abacavir, nevirapine)
Bone s.e of HAART?
- osteromalacia (tenofovir)
How may protease inhibitors affect drug-drug interactions?
- these are potent Liver enzyme inhibitors
What does preventive medicine involve for HIV pts ?
- STI screening
- CVS risk and smoke cessation
- Hep A/B, Flu, HPV vaccination
- harm reduction (moving away from injecting drugs)
What psychosocial issues may a HIV pt face?
- adjustment d.o
- survivor’s guilt
- feeling of isolation
- relationships
- spirtual
What does partner notification and disclosure (by the doctor) involve?
- a voluntary process
- —-required years of trust
- Can be either: partner referral, provider referral and conditional referral
Barriers to partner notification?
- fear of: REJECTION, ISOLATION, VIOLENCE
- STIGMA > discrimination
- CONFIDENTIALITY
How to prevent HIV transmission?
- 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
Why is STI screening important for HIV prophylaxis?
- HIV -ve pt exposed to STI is VULVNERABLE to HIV
Conception options for : HIV+ male, HIV- female
(SEX as normal just PrEP for non-HIV pt) Treatment as prevention
(+/- timed condomless sex)
?HIV PrEP for female partner
Conception option for
HIV+ female, HIV- male
Treatment as prevention
(+/- timed condomless sex)
? Self-insemination
?HIV PrEP for male partner
How to prevent Mother to child transmission?
- 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.
How effective is it to tell people to abstain?
- not effective
- does not work
BEST HIV strategies at an individual level?
- condom programmes
- behaviour change interventions (support people to have sex)
- CONDOM program
- PEPSE
- circumcision (reduces HIV risk by 60 % )
- PrEP
Best HIV prevention strategies at a community level?
- needle exchange
- testing and rx of
STIs - rx as prevention
What occurs with blockade of reverse transcriptase? What class of retroviral drugs block this?
NRTIs (nucleoside reverse transcriptase inhibitors) disrupt the construction of new piece proviral DNA
Name 2 NRTIs.
- Lamivudine
- Zidovudine
What are the 2 types of entry inhibitors?
- Fusion
2. CCR5 Receptor
What occurs with the blockade of the enzyme protease ?
- 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
When may dual therapy have little impact on survival?
- when and if the patient was initially on monotherapy and then switched to dual
Which HAART medications hold increased risk of MI?
Abacavir
Lopinavir
Maraviroc
Which HAART med has hematological implication?
- Zidovudine
d/t Anaemia
Which medications may result in renal toxicity?
- tenofovir (NRTI)
- atazanavir (Protease Inhibit.)
>proximal renal tubulopathies
Which HAART drugs result in GI side effects?
protease inhibitors (NEVIRAPINE, most others)
How may NNRTIs affect drug-drug interactions?
- potent liver enzyme INDUCERS (ALSO the protease inhibitors)
—-therefore acts as pharmalogical boosting for drugs that need it
Which BBV has the same treatment as HIV ?
- Hepatitis B
Who is in the multidisplinary team for managing HIV pts?
- physicians
- Nurse
- paharmacists
- secretaries
- Virologists
- Clinical psychologists
- social workers
- sexual health
Who is eligible for PrEP ?
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
Which HAART drug is said to cause Anemia?
Zidovudine
What effects may HAART rx have on the gut?
transaminitis
fulminant hepatitis
What are common HIV co-infections?
- Hep B
- Hep C
- Tuberculosis
