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CDM I > HIV Pt 2 > Flashcards

HIV Pt 2 Flashcards

1
Q

HIV: What is the action of HIV?

A
  • A retrovirus that depends on reverse transcriptase (RNA dependent DNA polymerase) to replicate.
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2
Q

HIV: Which is the most prevalent in the US, HIV 1 or 2?

A
  • HIV 1
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3
Q

HIV: How does this virus enter a CD4+ T helper cell?

A

Via chemokine receptors (CCR5 and CXCR4)

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4
Q

HIV: What genetic deletion tends to favorably prevent or suppress HIV?

A
  • CCR5 deletion
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5
Q

HIV: Why would a CCR5 deletion suppress or prevent HIV?

A
  • HIV relies on this receptor to enter CD4+ T helper cells. - If HIV cannot enter this cell the virus cannot replicate.
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6
Q

HIV: Once HIV replicates within a CD4+ T helper cell, what is the fate of the cell?

A
  • cell fusion or death
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7
Q

HIV: Once HIV has replicated and destroyed the host CD4+ T helper cell, what does it do next?

A
  • Adheres to the next CD4+ T helper cell and enters that cell for replication and cell destruction.
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8
Q

HIV: (T/F) Replication of HIV is dependent of the cell death and fusion of the CD4+ T helper cell it has infiltrated.

A
  • TRUE
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9
Q

HIV: What is the pathophysiology that is occuring during the “latent stage” of the infection?

A
  • Integration of HIV genome into cell genome.
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10
Q

HIV: (T/F) Without ART, CD4 count continues to decline with increasing length of infection.

A
  • TRUE
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11
Q

HIV life cycle: How many steps are there in the HIV life cycle?

A
  • Five steps
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12
Q

HIV life cycle: What are each of the five steps of the HIV life cycle?

A
  • Step 1: Viral entry
  • Step 2: Reverse transcription
  • Step 3: Integration
  • Step 4: Transcription and translation
  • Step 5: Assembly and budding
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13
Q

HIV: Clinical signs and symptoms?

A
  • Asymptomatic - Fever, night sweats, and weight loss - Presence of opportunistic infection - Kaposi’s sarcoma - Lymphoma - Oral lesions such as hairy leukoplakia
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14
Q

HIV timeline: Within the first 12 weeks the CD4 count dips and rises again (though not quite back to baseline) before dropping. Why is that?

A
  • During the initial drop the body recognizes A decreased amount of CD4+ T helper cells and tries to make up for it but cannot produce enough to compete against the exponentially growing HIV.
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15
Q

HIV timeline: (T/F) Most patients will acquire Acute retroviral syndrome.

A
  • FALSE - Most patients are asymptomatic.
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16
Q

HIV timeline: At what point in the timeline is a patient most likely to develop acute retroviral syndrome?

A
  • During the initial CD4+ T helper cell count dip and rise.
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17
Q

HIV timeline: What is the cause of the Acute retroviral syndrome?

A
  • The peak in viral load that accompanies the immediate dip in CD4+ T helper cells prior to the body’s reaction to produce more of these cells.
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18
Q

HIV timeline: Clinical latency occurs around what time period?

A

6-10 years

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19
Q

HIV timeline: Following clinical latency the CD4+ T helper cell count begins to drop at a faster rate as the viral load increases and surpasses the CD4+ T helper cell count. What does the graph look like from that point on? What syndrome develops as a result?

A
  • Viral load exponentially increases. - CD4+ T helper cell count continues to decline drastically. - AIDS
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20
Q

Acute HIV infection: S/Sx?

A

Non-specific “flu like” symptoms: - Fever - Fatigue - Pharyngitis - Lymphadenopathy - Rash

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21
Q

Acute HIV infection: It is important to remember that patients experiencing acute retroviral syndrome have very high viral loads and as a result are highly ___.

A

infectious.

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22
Q

Acute HIV infection: Patients experiencing acute retroviral syndrome are so contagious that it is suspected that up to ___% of new HIV transmissions in sub-Saharan Africa are believed to occur during the acute phase of infection

A

50% (thus driving the pandemic)

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23
Q

HIV: While the CDC recommends opt out testing for HIV, who should be tested?

A
  • Anyone between 13 and 64 - IVDU and their sex partners - Persons who exchange sex for money or drugs - Sex partners of HIV infected persons - MSM - Heterosexual partners if either have had more than one previous sex partner
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24
Q

HIV lab tests: What are the two lab tests associated with screening for HIV?

A
  • ELISA

- EIA

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25
Q

HIV lab test: If you have a positive ELISA result, what do you have to confirm that result with?

A
  • A Western blot confirmation.
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26
Q

HIV lab test: If you have a positive EIA test, what do you confirm that test with?

A
  • NAT- (HIV RNA by PCR)
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27
Q

HIV lab tests: Which of the screening tests has been available the longest? Which test is now recommended over the other?

A
  • ELISA: historic test. - EIA: Recommended over ELISA for screening.
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28
Q

HIV lab tests: What does ELISA testing look for?

A
  • Looks for antibody only.
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29
Q

HIV lab tests: How long does it take for enough of the HIV antibodies to develop before the ELISA test can detect the antibodies?

A
  • 4-12 weeks for antibody to develop.
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30
Q

HIV lab tests: EIA is also known by what names?

A
  • The combination or 4th generation test.
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31
Q

HIV lab tests: What does EIA testing detect?

A
  • HIV antibody [and] - p 24 antigen
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32
Q

HIV lab tests: How long does it take for enough of the HIV antibodies to develop before the EIA test can detect the antibodies?

A
  • 2-6 weeks from exposure to positivity
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33
Q

HIV lab tests: You have screened a patient for HIV using an EIA lab test and it has come back positive. What are the baseline tests you will order next?

A
  • CD4+ T cell count

- VL

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34
Q

HIV lab tests: While older tests were able to detect viral load only if it was greater than 1000, newer tests can detect viral load greater than what value?

A

> 500

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35
Q

HIV lab tests: You have collected your CD4+ T cell count and viral load (which is above 500). What testing do you do next?

A
  • Assess the nature of the virus.
  • Phenotyping and genotyping.
  • Drug resistance testing.
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36
Q

HIV lab tests: When considering the overall health of a recently diagnosed HIV patient, what are some of the baseline tests you would order for the patient (non-specific to CD4+ T-cell count, VL, and drug resistance of HIV)?

A
  • Chemical screen - CBC - LFTs - STI testing - Hepatitis testing - opportunistic infection tests (e.g. toxoplasmosis, TB) - Pap test (consider anal Pap test for men and women who participate in anal sex)
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37
Q

HIV lab tests: Which forms of hepatitis should you have a higher index of suspicion of in an HIV patient due to their bloodborne natures?

A
  • HBV - HCV
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38
Q

HIV Tx: What is the general goal of HIV Tx?

A
  • Increase CD4+ T-cell count.
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39
Q

HIV Tx: At what CD4+ T-cell count do you initiate therapy?

A
  • At ANY CD4+ T-cell count.
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40
Q

HIV Tx: At what CD4+ T-cell count is typically the threshold for seeing infections like thrush?

A

< 350 cells/mm^3

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41
Q

HIV Tx: What is the historic name for the type of therapy used for HIV Tx?

A
  • HAART - Highly active antiretroviral therapy
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42
Q

HIV Tx: The term HAART has gone by the wayside. What is the current name for HIV therapy?

A
  • antiretroviral therapy (ART)
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43
Q

HIV Tx: What kind of medications make up standard medication categories of ART?

A
  • Protease inhibitors (PIs) - Nucleoside reverse transcriptase inhibitors (NRTIs) - Non-Nucleoside reverse transcriptase inhibitors (NNRTIs) - Integrase strand transfer inhibitors (INSTIs)
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44
Q

HIV Tx: What does “PIs” stand for?

A
  • Protease inhibitors
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45
Q

HIV Tx: What does “NRTIs” stand for?

A
  • Nucleoside reverse transcriptase inhibitors
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46
Q

HIV Tx: What does “NNRTIs” stand for?

A
  • Non-Nucleoside reverse transcriptase inhibitors
47
Q

HIV Tx: What does “INSTIs” stand for?

A
  • Integrase strand transfer inhibitors
48
Q

HIV Tx: What are the goals of HIV therapy?

A
  • Suppression of Viral load
  • Restoration of immune function
  • Prevention of HIV transmission
  • Prevention of Drug resistance
  • Improvement in quality of live.
49
Q

HIV Tx: What is the quantitative goal associated with our intent to suppress viral load via pharmacotherapy?

A
  • Suppression of viral load to < 50 copies per mL
50
Q

HIV Tx: How do we measure immune function in HIV patients?

A
  • CD4+ T-cell count
51
Q

Principles of therapy: HIV treatment regimens typically have two components. What are those two components referred to as?

A
  • the backbone and the base.
52
Q

Principles of therapy: Describe the “backbone” of an HIV regimen.

A
  • Typically consists of two Nucleoside reverse transcriptase inhibitors (NRTIs)
53
Q

Principles of therapy: Describe the “base” of an HIV regimen.

A

Traditionally included either a… - NNRTI [or] - PI [or] - INSTI

54
Q

Principles of therapy: In December 2019, this medication was added to guidelines for treatment as a base.

A
  • Integrase inhibitor: Reltegravir
55
Q

Principles of therapy: What is an appropriate website to refer patients to to serve as a comprehensive HIV patient-friendly website?

A

www.poz.com

56
Q

HIV Med Chart: What do the generic names of all protease inhibitors (PI) have in common?

A
  • They end in “-navir”
57
Q

HIV Med Chart: What are two newer NRTIs that have become more common in treatment plans?

A
  • Emtricitabine (FTC) - Tenofovir (TAF)
58
Q

HIV Med Chart: Atripla is a commonly used combined medication consisting of three medications. What are these medications?

A
  • Emtricitabine (FTC) [NRTI] - Tenofovir (TAF) [NRTI] - Efavirenz (EFV) [NNRTI]
59
Q

HIV Med Chart: Efavirenz (EFV) is a ___ generation NNRTI medication.

A
  • First
60
Q

HIV Med Chart: Tenofovir (TAF) has two formulations: an old and a new. Which formulation is old?

A
  • Tenofovir disoproxil
61
Q

HIV Med Chart: Tenofovir (TAF) has two formulations: an old and a new. Which formulation is new?

A
  • Tenofovir alafenamide
62
Q

HIV Med Chart: Tenofovir (TAF) has two formulations: an old and a new. The older formulation has a higher risk of what complications?

A
  • Renal failure - Osteoporosis
63
Q

HIV Med Chart: (T/F) Tenofovir alafenamide has a decresased risk of causing renal failure and osteoporosis than tenofovir disoproxil.

A
  • TRUE * Tenofovir alafenamide is the newer formula.
64
Q

HIV Med Chart: Which formulation of tenofovir is in the medication Truvada?

A
  • Tenofovir disoproxil (the older formulation)
65
Q

HIV Med Chart: The PIs are the drugs that end in “-navir”. What is the one PI drug you want to remember?

A
  • Darunavir (DRV)
66
Q

HIV Med Chart: Why is it important to remember darunavir (DRV) as a PI medication?

A
  • It is on the treatment guidelines - You can use it with tenofovir[TAF] / emtricitabine(FTC)[NRTI] backbone
67
Q

HIV Med Chart: Integrase Strand Transfer Inhibitors (INSTIs) end in what?

A
  • “-egravir”
68
Q

HIV Med Chart: What are the three main INSTIs to know?

A
  • Raltegravir (RAL) - Eltegravir (EVG) - Dolutegravir (DTG)
69
Q

HIV Med Chart: Which INSTI medication is the oldest and is generally regarded as the cheaper option of the INSTIs?

A
  • Raltegravir (RAL)
70
Q

HIV Med Chart: Combination medications have what benefit in terms of administration frequency?

A
  • You can have once daily dosing.
71
Q

HIV Med Chart: What are the brand names of the common combination meds?

A
  • Atripla - Stribild - Genvoya - Complera - Odefsey
72
Q

HIV Med Chart: Atripla is a combination medication composed of what?

A
  • Tenofovir disoproxil (TAF) [NRTI] - Emtricitabine (FTC) [NRTI] - Efavirenz (EFV) [NNRTI]
73
Q

HIV Med Chart: Stribild is a combination medication composed of what?

A
  • elvitegravir (EVG) [INSTI] - cobicistat (pharmacokinetic enhancer) - emtricitabine (FTC) [NRTI] - tenofovir disoproxil (TDF) [NRTI]
74
Q

HIV Med Chart: Genvoya is a combination medication composed of what?

A
  • elvitegravir (EVG) [INSTI] - cobicistat (pharmacokinetic enhancer) - emtricitabine (FTC) [NRTI] - tenofovir alafenamide (TAF) [NRTI]
75
Q

HIV Med Chart: Cobicistat is a pharmacokinetic enhancer found in combination medications. What medication(s) does it boost?

A
  • elvitegravir (EVG) [INSTI]
76
Q

HIV Med Chart: Complera is a combination medication composed of what?

A
  • emtricitabine (FTC) [NRTI] - rilpivirine (RPV) [NNRTI] - tenofovir disoproxil fumarate (TDF) [NRTI]
77
Q

HIV Med Chart: Odefsey is a combination medication composed of what?

A
  • emtricitabine (FTC) [NRTI] - rilpivirine (RPV) [NNRTI] - tenofovir alafenamide (TAF) [NRTI]
78
Q

Initiating Tx: Historically, decision on when to treat HIV was based off of what lab finding?

A
  • CD4+ T-cell count
79
Q

Initiating Tx: Based on the most recent guideline (January 2020), when should you initiate treatment?

A
  • All HIV positive patients should be considered for initiation of treatment.
80
Q

Initiating Tx: When choosing an initial treatment plan, there are three main categories. What are they?

A

1) 1 INSTIs + 2 NRTIs 2) 1 PK-boosted PI + 2 NRTIs 3) NNRTI + 2 NRTIs

81
Q

Initiating Tx: What do all of the three main categories of initial treatment plans have in common?

A

Base and backbone: - 1 base medication - 2 backbone medications

82
Q

Initiating Tx: When choosing a regimen, one of the two NRTIs should be which medications?

A
  • lamivudine (Epivir) (3TC) [or] - emtricitabine (Emtriva) (FTC)
83
Q

HIV Tx - Bottom line: What is the common/historic formula for initiating treatment?

A

1) 2 NRTIs (FTC+TAF) + 1 NNRTI (ex.EFV) 2) 2 NRTIs + 1 INSTI (ex. RAL) 3) 2 NRTIs + “boosted” PI (DRV)

84
Q

HIV Tx - Bottom line: PIs can be boosted by which two pharmacokinetic enhancer drugs?

A
  • cobicistat - ritonavir
85
Q

Benefits of early therapy: Untreated HIV is associated with the development of what condition(s) (general)?

A
  • AIDS - Non-AIDS-defining conditions
86
Q

Benefits of early therapy: Earlier ART may prevent what HIV-related complication?

A
  • end-organ damage
87
Q

Benefits of early therapy: (T/F) Deferred ART reliably repairs HIV-related damage acquired earlier.

A
  • FALSE - Deferred ART may not reliably repair HIV-related damage acquired earlier.
88
Q

Benefits of early therapy: (T/F) End-organ damage occurs at all stages of HIV infection.

A
  • TRUE
89
Q

Benefits of early therapy: What renal pathologies may benefit from early therapy?

A
  • HIV-associated nephropathy
90
Q

Benefits of early therapy: (T/F) Early therapy may decrease the risk of neurocognitive decline.

A
  • TRUE
91
Q

Benefits of early therapy: (T/F) Early therapy has not shown to decrease the risk of cardiovascular disease and malignancies.

A
  • False - Decreases risk of CV dz and malignancies (AIDS defining and non-AIDS defining)
92
Q

Benefits of early therapy: What hepatic pathologies may benefit from early therapy?

A
  • Liver disease progression from hepatitis B or C
93
Q

Benefits of early therapy: What are common legitimate concerns surrounding initiating early therapy?

A
  • ARV-related toxicities - Non-adherence to ART - Drug resistance - Cost * Truvada, without insurance, costs ~$2,000 per month
94
Q

CD4 levels: How often do you get a CD4+ T-helper cell count?

A
  • Check at baseline (x2) - At least every 3-6 months - Immediately before initiating ART
95
Q

CD4 levels: How often are you checking CD4+ T-helper cell counts if you’ve initiated ART?

A
  • Every 3-6 months during first 2 years of ART [OR] - if CD4+ T-cells are < 300 cells/uL
96
Q

CD4 levels: After 2 years on ART with HIV RNA consistently suppressed, how often are you checking the patient’s CD4+ T-cell levels if they have historically been in the 300 to 500 cells/uL range?

A
  • Every 12 months
97
Q

CD4 levels: After 2 years on ART with HIV RNA consistently suppressed, how often are you checking the patient’s CD4+ T-cell levels if their previous lab results have been > 500 cells/uL?

A
  • Optional
98
Q

CD4 levels: What are common scenarios in which you would want to test a patient more frequently?

A
  • If also on A medication that may lower CD4 count - Clinical decline
99
Q

Other monitoring studies: If you want to start a patient on abacavir (ABC) [NRTI], what screening should you consider?

A
  • HLA-B*5701 screening
100
Q

Other monitoring studies: Patients who test positive for HLA-B*5701 are at risk of developing what if they take abacavir (ABC) [NRTI]?

A
  • Hypersensitivity reaction
101
Q

Other monitoring studies: (T/F) A patient is screened for HLA-B*5701 which comes back positive. A trial of abacavir (ABC) [NRTI] should at least be attempted prior to listing the medication as an allergy on the patient’s chart.

A
  • False - If they have a positive HLA-N*5701, then the patient should automatically considered to have an abacavir (ABC) [NRTI] allergy.
102
Q

Other monitoring studies: (T/F) If HLA-B*5701 testing is not available, abacavir (ABC) may be initiated after counseling and with appropriate monitoring for a hypersensitivity reaction.

A
  • TRUE
103
Q

HIV life cycle & Txs: At what stage of the HIV life cycle do NRTIs and NNRTIs intervene?

A
  • Step 2: Reverse transcriptase
104
Q

HIV life cycle & Txs: At what stage of the HIV life cycle do PIs intervene?

A
  • Step 5: Assembly and building
105
Q

HIV life cycle & Txs: At what stage of the HIV life cycle do INSTIs intervene?

A
  • Step 3: Integration
106
Q

ART: (T/F) There is a high potential for adverse effects with ART.

A
  • TRUE
107
Q

ART: What are the MC adverse effects associated with ART?

A
  • Rash - Diarrhea - Pancreatitis - Hyperlipidemia and lipodystrophy - Increased cardiac risk - CNS effect: psychological disturbances
108
Q

ART: What are adverse effects of PIs?

A
  • Hyperlipidemia - lipodystrophy - Hepatotoxicity - GI intolerance - Possibility of Increased bleeding risk for hemophiliacs - Drug-Drug interactions.
109
Q

ART: Which medication is contraindicated in all HIV Tx options?

A
  • Rifampin
110
Q

ART: Why is rifampin contraindicated with all HIV Tx options?

A
  • Because Rifampin can render the HIV drugs ineffective.
111
Q

ART: Adverse effects associated with NRTIs?

A
  • Lactic acidosis - Hepatic steatosis - lipodystrophy
112
Q

ART: Adverse effects associated with NNRTIs?

A
  • Rash (including Stevens-Johnson syndrome) - Hepatotoxicity (especially NVP) - Drug-drug interactions
113
Q

ART: What is lipoatrophy?

A
  • A term describing the loss of fat tissue. - Often associated with the face. In this instance referred to as “facial wasting”
114
Q

ART: What is lipodystrophy?

A
  • lipodystrophy refers to medical problem where there is an abnormal distribution of fat in the body. - this can refer both to fat loss (lipoatrophy) and abnormal accumulation of fat tissue. - the disease may be inherited genetically, (for example, familial partial lipodystrophy or FPLD), or acquired

CDM I (9 decks)

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