HIV Prevention and Care Flashcards
What is an opportunistic infection?
Infection in an IC person caused by organisms that normally aren’t pathogenic
This immune cell is a marker of immune function and is the primary target for HIV infection
CD4 helper T cell
At what concentration is a vial load considered “undetectable” by ultra sensitive assay?
<20 copies/mL
Can HIV be transmitted by saliva?
No — only possible if visible blood
Only transmitted via:
Blood
Semen/vaginal fluids
Internal body fluids (CSF, synovial, peritoneal)
A pt presents to your clinic requesting HIV testing. They do no appear to have any risk factors for HIV. Should you administer the HIV test?
Yes
Pt request is enough to indicate testing
Other indications are those in which there is high risk of contact with blood, semen/vaginal fluids, or internal body fluids
How often should risk assessment be done for HIV?
Annual risk assessment
More frequently for MSM with multiple or anonymous partners, or those who use illicit drugs while engaging in sex
What is the goal of HIV treatment?
Prevent OI
Prolong duration and life quality
Prevent HIV transmission
Maximal virologic suppression (<20 c/mL)
Restore/preserve immune function (high as possible CD4 count — 50-150 cells/µL/yr)
How long does a person need to remain on ARVs after a HIV dx?
Need to be on ARV for life to keep viral load suppressed
When should ARV be started on a pt dx with HIV?
ASAP!
Tx OI simultaneously if possible — may not be possible if concern of drug interactions
What are the benefits of early tx of HIV?
Reduce disease progression
Prevent HIV transmission to others
Do pts die of HIV?
No
Death is a consequence of IC —> opportunistic infections or malignancies; ARV toxicities (old therapies)
When should OI prophylaxis by started on a pt with HIV?
When CD4 <200
What are some common OI with HIV infection? (11)
Thrush (candida albicans)
Oral hairy leukoplakia (EBV)
TB
Bacterial (S. Pneumoniae)
Pneumocystis jirovecii (fungus)
HSV
Candida esophagitis (candida albicans)
Toxoplasmosis (toxoplasmosis gondii)
Disseminated MAC (mycobacterium avium complex)
CMV
Cryptococcal meningitis (crytococcus neoformans)
PJP (p. Jiroveci pneumonia) is an OI in pts with HIV. When should primary prevention for this OI be done?
CD4 <200 or <14%
What is the preferred regimen for primary prevention of PJP (p. Jiroveci pneumonia)?
Cotrimoxazole I single strength or 3x/wk
T. gondii is an OI in pts with HIV. When should primary prevention for this OI be done?
When CD4 <100 and a positive serology (toxo IgG)
When should disseminated MAC be treated in a pt with HIV?
Only if pt not on fully suppressive ARV and CD4 <50
A pt with history of HIV presents to your clinic with the chief complaint of having non-tender, white patches on their tongue that cannot be removed with a toothbrush. They have a CD4 count of 238 cell/mm3. What is your ddx?
Thrush vs oral hairy leukoplakia
A pt with HIV presents to your clinic with a fever of 38.5C, non-productive cough, and difficulty breathing.
CXR reveals bilateral infiltrates
HRCT shows areas of ground glass attenuation and interloper septal thickening
What is your diagnosis?
PJP presentation
The HRCT is highly sensitive for PJP in HIV+ pts
What is the 1st line tx for PJP?
Oral or IV Septra (TMP-SMX) for 21 days
What adjunctive therapy can be given with Septra for tx of PJP?
Oral or IV steroids when PaO2 <70mmHg or an A-a gradient >36mmHg
When should adjunctive therapy be started for PJP?
Within 1st 72hrs
What are the benefits of adjunctive therapy for PJP?
Improves clinical outcomes by accelerating recovery, preventing resp failure, and death
How long does it take to see clinical improvement after starting therapy for PJP?
Improvement within 4-8d of tx on ABGs
What are the 3 interventions for reducing perinatal transmission of HIV?
Effective ARV therapy
Elective c-section if possible
Formula feeding
When should ARV therapy be started on HIV+ people?
Start ARV ASAP regardless of VL or CD4 count
Only stop taking if interferes with other medication indicated during pregnancy
When is HIV testing done on a pregnant person?
Upon dx of pregnancy
Repeat in 3rd trimester
Testing during labour if not done during prenatal care
At what viral load should a c-section be scheduled?
VL >1000c/mL
A pregnant individual had been on oral ART for 3 mo. her viral load at her 36wk check up is 1200 c/mL. What addition interventions are needed at time of delivery?
Scheduled c-section if possible
IV zidovudine during labour
Avoid forceps or vacuum delivery, PROM, fetal scalp electrode monitoring
Under what conditions should zidovudine monotherapy be administered to the neonate?
If mother on ART and VL <50 c/mL
Administer for 4 wks, start within 6-12hrs of birth
Under what conditions should triple HIV therapy be administered to the neonate?
If mother’s VL >50 c/mL
Administer for up to 6wks
Who is a candidate fro PrEP?
MSM at high risk (multiple partners, hx of STI)
Heterosexual men and women at high risk (multiple partners, hx of STI)
Ppl who inject drugs
HIV serodiscordant couples
Who does not need PrEP?
U=U
Ppl in a monogamous relationship with a person with undetectable viral load do not need to be on PrEP
What are the therapies approved for PrEP?
Oral TDF/emtricitabine
Oral TAF/emtricitabine
IM Cabotegravir
What therapy can be used “on-demand” for PrEP?
Oral TDF/emtricitabine
What is the dosing regimen for Cabotegravir?
Month 0, 1, then q2mo
Can PrEP be give in HIV+ pts?
No
HIV testing must be done every 3mo to confirm HIV- status
How soon after exposure does PEP need to be started?
Ideally less than 72hrs
How long is PEP taken for?
28 days
Is PEP mono or combo drug therapy?
Combo - 3 drugs
