Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

BCPS > HIV & Opportunistic Infections > Flashcards

HIV & Opportunistic Infections Flashcards

1
Q

HIV 4th generation test

A

First step to diagnosing HIV inpatient.

If positive, then will need HIV-1/2 Ab differentiation immunoassay

If negative, then no HIV.

> 99% sensitivity and specificity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

HIV-1/2 Ab Immunassay

A

Administer if 4th generation test positive

Differentiates HIV 1 from HIV 2

If positive, diagnosis made

If negative, administer HIV-1 nucleic acid test

> 99% sensitivity and specificity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

HIV-1 nucleic acid test

A

Administer if 4th gen HIV test +, HIV-1/2 Ab immunassay negative

Tests for HIV-1

If positive, diagnosis made
If negative, no HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Rapid HIV test

A

Can have result in 20 minutes after oral swab or fingerstick

If positive, repeat with another manufacturer test. IF that is positive, then positive . If negative, repeat with another manufacturer’s test.

If negative, no need to retest.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

HIV RNA Viral suppression

A

Goal of ART

HIV RNA <20-75 (level of detection of assay)

HIV RNA <200 prevents HIV transmission to sexual partners

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

HIV RNA testing - when to test

A
  1. Baseline
  2. If not on therapy, every 3-6 months
  3. 2-4 weeks after starting or changing therapy
  4. Then, every 3-4 months while on treatment. Can go to q6 months if suppressed >1yr
  5. Clinical event or decrease in CD4 count
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PrEP options

A

Anyone who wants it and recently tested negative for HIV

  1. Tenofovir disoproxil fumarate 300mg + emtricitabine 200mg (truvada)
  2. Tenofovir alafenamide 25mg + emtricitabine 300mg (descovy)
  3. Cabotegravir 600mg months 1 & 2, then q8w
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

On demand PrEP

A

for MSM, infrequently, can anticipate when. Not FDA approved.

Truvada (tenofovir disoproxil fumarate/emtricitabine):
2 doses 24hrs before sex, 1 dose 24 hrs after first dose, 1 dose 48 hours after first dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Monitoring parameters for PrEP

A

Baseline:
1. HIV test
2. Renal function (for tenofovir)
3. STI
4. Lipids

Repeat HIV test q3months (or 2 months on cabotegravir)

Repeat renal fxn, STI, lipids q6-12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

HIV in Pregnancy

A

ALL WOMEN SHOULD BE ON COMBINATION ART ASAP EVEN IN FIRST TRIMESTER

Regimens:
1. A dual nucleoside reverse transcriptase inhibitor (NRTI) combo: abacavair/lamivudine; tenofovir/emtricitabine; tenofovir/lamivudine

  1. Ritonavir-boosted protease inhibitor: darunavir/ritonavir
  2. Integrase strand transfer inhibitor (INSTI): dolutegravir
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

HIV in labor with HIV RNA >1000

A

Zidovudine IV should be given

Or if HIV RNA unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Infant born to HIV + mom, low risk transmission

A

Zidovudine 4mg/kg/dose q12H for 4 weeks.

Start within 6 hours of delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Infant born to HIV + mom, high risk of transmission

A

Zidovudine, lamivudine and nevirapine

OR

Zidovudine, lamivudine, and raltegravir

6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Nonoccupational post-exposure prophylaxis HIV

A

Begin with 72 hours of coming in contact with blood, semen, vaginal secretion, breast milk

Raltegravir twice daily OR dolutegravir daily
+
Tenofovir disoproxil fumarate/emtricitabine daily

Alt: darunavir/ritonavir + tenofovir disoproxil fumarate/emtricitabine

Treat 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Occupational PEP HIV

A

Begin ASAP

Raltegravir BID
+
Tenofovir disoproxil fumarate/emtricitabine

Several alts

Continue 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nucleoside/nucleotide reverse transcriptase inhibitors

A

LATTEZ

Lamivurdine
Abacavir
Tenofovir disoproxil fumarate
Tenofovir alafenamide
Emtricitabine
Zidovudine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

TAF vs TDF

A

TDF more favorable on lipids

TAF more favorable on bones and kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

NRTI renal adjustment needed

A

Emtricitabine
Lamivudine
Zidovudine

TDF do not use <50-70 ml/min
TAF do not use <15 ml/min

TAF has way more drug interactions, mainly with the 3A4 strong inducers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

NRTI hepatic adjustment needed

A

Abacavir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Genetic test before abacavir

A

HLA B*5701 to determine if risk for hypersensitivity reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Nonnucleoside Reverse Transcriptase Inhibitors (v’s)

A

ENDER of hiv

Efavirenz
Nevirapine
Doravirine
Etravirine
Rilpivirine

ALL metabolized by CYP 3A4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

NNRTI with renal adjustment & hepatic adjustment

A

Nevirapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Protease inhibitors (-navirs)

A

LARD get this hiv outta me

Lopinavir/ritonavir
Atazanavir
Ritonavir
Darunavir

TAKE ALL WITH FOOD

All metabolized by CYP3A4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Endocrine disturbances with protease inhibitors

A

T2DM
Peripheral fat loss & central fat accumulation
Lipid abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Protease inhibitor renal adjustment
Atazanavir
25
Protease inhibitor hepatic adjustment
Atazanavir Darunavir
26
Integrase Strand Transfer Inhibitors (-gravirs)
C BRED (can take with food) Cabotegravir (PO and IM) Bictegravir Raltegravir Elvitegravir Dolutegravir
27
INSTIs with renal adjustment
Bictegravir Elvitegravir
28
INSTIs with hepatic adjustment
Bictegravir Dolutegravir Elvitegravir
29
Entry Inhibitors
FILME at the entry Fostemsavir Ibalizumab (IV) Lenacapavir (PO and SC) Maraviroc Enfuvirtide (SC)
30
Entry inhibitors renal adjustment
Maraviroc
31
Recommended initial ART therapy
2 NRTIs (LATTEZ) + INSTI (-gravirs)
32
Pneumocystitis jiroveci pneumonia (PJP) Preferred Treatment
Mod-severe: Bactrim 15-20mg/kg/day TMP dividied q6-8h x21 days - may use IV Mild-mod: 2 bactrim DS tabs TID Add steroid taper if severe (A-a gradient >35 or Po2 <70): pred 40mg BID x5d, then 40mg x5d, then 20mg daily for remainder of therapy *steroids decrease mortality*
33
PJP prophylaxis
Use if CD4 < 200. May D/C if CD4 > 200 for 3 months Bactrim SS or DS daily Alt: Bactrim DS 3x/week Alt: Atovaquone 1500mg daily Alt: Pentamidine monthly inhalation Alt: Dapsone 100mg daily or combine with pyrimethamine & leucovorin
34
PJP Alterantive regimens
1. Clindamycin and primaquine 2. Atovaquone 3. Pentamidine (IV) 4. Trimethoprim & Dapsone
35
Pyrimethamine + leucovorin purpose
Leucovorin helps prevent myelosuppression. Must be given with pyrimethamine
36
Toxoplasmosis preferred therapy
Pyrimethamine 50-75mg/day + Sulfadiazine 1000-1500mg q6h Add leucovorin 10-25mg/day to reduce bone marrow suppression effect of pyrimethamine 6 weeks at least Can be used for chronic maintenance
37
Toxoplasmosis alternative therapy
1. Clindamycin + pyrimethamine 2. Bactrim 3. Atovaquone + pyrimethamine/leucovorin 4. Atovaquone + sulfasalazine 5. Atovaquone alone Similarly can be used for chronic maintenance therapy, different dosing
38
Toxoplasmosis prophylaxis
CD4 <100. Can d/c if CD4 >200 for 3 months 1. Bactrim DS daily 2. Dapsone/pyrimethamine/leucovorin 3. Atovaquone +/- pyrimethamine
39
Oropharyngeal candidiasis treatment
Fluconazole 100mg daily Alt: Itraconazole 200mg solution daily Alt: Posaconazole suspension 400mg daily Alt: Miconazole buccal tabs Alt: Clotrimazole troches Alt: Nystatin 5ml 4-5x daily Treat 7-14 days
40
Esophageal candidiasis treatment
Fluconazole 100-400mg daily PO or IV Itraconazole 200mg PO daily Several alts Treat 14-21 days
41
Vulvovaginal candidiasis treatment
Fluconazole 150mg x1 Topical azoles Alt: itraconazole 200mg solution daily Treat 3-7 days
42
Cryptococcal meningitis induction therapy
Preferred: ****1. Liposomal amphotericin B 3-4 mg/kg/day PLUS flucytosine 25mg/kg q6h 2. Amphotericin B deoxycholate 0.7-1 mg/kg/day PLUS flucytosine 25mg/kg q6h (renal toxicity) Several alts. Pick liposomal amp B. Induction is 2 weeks
43
Cryptococcal meningitis consolidation therapy
Fluconazole 800mg daily (may decrease to 400mg if CSF negative, ART started) At least 8 weeks
44
Cryptococcal meningitis maintenance therapy
Fluconazole 200mg daily x1 year. May d/c after a minimum of a year if CD4 > 100 for 3 months
45
When to start ART with cryptococcal meningitis
AFter 2-10 weeks of treatment. Risk of IRIS
46
Cryptococcal meningitis prophylaxis
Not indicated
47
MAC preferred therapy
Clarithromycin 500mg BID PLUS ethambutol 15mg/kg/day Can use azithromycin 500-600mg in place of clarithromycin if drug interactions or intolerance Treat for 12 months minimum
48
Add on therapy to MAC preferred therapy
If CD4 <50, high mycobaterial load, or no ART 1. Rifabutin 300mg/day 2. FQ (levo 500, moxi 400) 3. Aminoglycoside (amikacin 10-15 mg/kg IV or streptomycin 1g IV/IM)
49
MAC prophylaxis
CD4 <50 and not on ART. If immediately started on ART, not needed. Use a macrolide
50
Cytomegalovirus retinitis, sight threatening lesions
Can progress to blindness or retinal detachment Valganciclovir 900mg BID x14-21 days, then 900mg daily. May add on intravitreal injections of ganciclovir or foscarnet Alt: ganciclovir IV Alt: Foscarnet IV Alt: Cidofovir IV
51
Cytomegalovirus retinitis, peripheral lesions
Valganciclovir 900mg BID x14-21 days, then 900mg daily for 3-6 months until ART induced immunity
52
Cytomegalovirus esophagitis, colitis, pneumonitis, neuro
Use ganciclovir, foscarnet, or valganciclovir
53
CMV prophylaxis
Not indicated
54
Positive TB skin test
Ranges from >=5 to >=15 depending on risk factors
55
Latent TB regimens, non HIV
1. Rifapentine 900mg + isoniazid 900mg weekly for 12 weeks 2. Rifampin 600mg daily x4 months 3. Rifampin 600mg daily + isoniazid 300mg daily x3 months 4. Isoniazid 300mg daily or 900mg twice weekly for 6-9 months
56
Latent TB treatment, with HIV
1. Rifapentine 900mg daily + isoniazid 15mg/kg + pyridoxine 50mg daily weekly for 12 weeks 2. Isoniazid 300mg + rifampin 600mg + pyridoxine 25-50mg daily x3 months Can still do rifampin 600mg daily x4 months If rifampin drug interactions concerning, then isoniazid 300mg daily + pyridoxine 25-50mg daily x6-9 months
57
First line active TB agents
Rifampin Isoniazid Pyrazinamide Ethambutol
58
Intensive & continuation phase for TB, no HIV
Intensive: RIPE x2 months (daily or 5x weekly) Continuation: isoniazid + rifampin x4 months (daily or 5x weekly) If TB isolate susceptible to isoniazid, rifampin, then can exclude ethambutol
59
Intensive, continuation phase for TB, HIV +
Intensive: RIPE daily x2 months (may use rifabutin instead of rifampin) Continuation: isoniazid + rifampin or rifabutin daily x4 months
60
When to extend continuation phase of TB treatment
nonHIV: positive sputum and xray after intensive phase HIV: if not on ART increase from 4 to 7 months
61
Purpose of pyridoxine in RIPE therapy
Prevent neuropathy caused from isoniazid
62
When to use rifabutin over rifampin for HIV + on ART
ART contains protease inhibitor ART contains TAF Dose adjustment to ART needed if contain INSTIs Need washout period after rifampin of 2 weeks before restarting PIs, elvitegravir, or NNRTI
63
Rifabutin + ART
May need to increase dose to 450-600mg daily if in combo with NRTI and NNRTIs Do not give with TAF If PI boosted with ritonavir, decrease rifabutin dose Avoid elvitegravir and bictegravir with rifabutin

BCPS (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions