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HIV pt 3 Flashcards

1
Q

IRIS: What does this acronym stand for?

A

Immune reconstitution syndrome.

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2
Q

IRIS: When would this occur?

A
  • After the initiation of HAART
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3
Q

IRIS: Describe the pathophysiology of this syndrome.

A
  • Inflammatory reaction in response to rapid reconstitution of CD4 counts
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4
Q

IRIS: How does this syndrome relate to opportunistic infections of HIV?

A
  • IRIS can “unmask” underlying opportunistic infections.
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5
Q

IRIS: Dx?

A
  • Dx of exclusion - No Dx studies available
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6
Q

HIV Mgmt: What is important to remember about PPD tests with HIV PTs?

A
  • People with low CD4 counts will not have a positive PPD test. - They cannot amount a response to the test.
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7
Q

HIV Mgmt: Since PPD tests are unreliable in the HIV population, how should you test for tuberculosis?

A
  • Quantiferon gold testing
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8
Q

HIV Mgmt: How often should RPR testing be done?

A
  • Every year - Especially with patients who have new sexual partners
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9
Q

HIV Mgmt: How often should anal and/or cervical PAP smears be done?

A
  • 6-12 months
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10
Q

HIV Mgmt: (T/F) Toxoplasmosis Ab testing is ineffective in HIV patients.

A
  • FALSE - Toxoplasmosis Ab testing is indicated in HIV management.
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11
Q

HIV Mgmt: If a patient’s CDC count drops below 200 (but above 50), you want to start that patient on what antibiotic as prophylaxis for what opportunistic infection?

A
  • TMP-SMX (PO) - Pneumocystis pneumonia (PCP)
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12
Q

HIV Mgmt: If a patient’s CDC count drops below 50, and you have already started the patient on TMP-SMX prophylaxis for PCP, what do you want you want to start that patient on what antibiotic as prophylaxis for what other opportunistic infection?

A
  • Azythromycin - Mycobacterium avium (MAI)
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13
Q

Prophylaxis for opportunistic infxs: Below what CD4 count are you concerned about PCP?

A

< 200 cells/uL

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14
Q

Prophylaxis for opportunistic infxs: Regimen for PCP prophylaxis?

A
  • TMP-SMX
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15
Q

Prophylaxis for opportunistic infxs: Below what CD4 count are you concerned about Toxoplasmosis?

A

< 100 cells/uL

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16
Q

Prophylaxis for opportunistic infxs: In addition to a CD4 count <100 cells/uL, what other lab test needs to be positive to indicate a toxoplasmosis regimen?

A
  • CD4 < 100 cells/uL [AND] - IgG positive
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17
Q

Prophylaxis for opportunistic infxs: Regimen for toxoplasmosis?

A
  • TMP-SMX [or] - Dapsone + pyrimethamine
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18
Q

Prophylaxis for opportunistic infxs: Indication for phrophylaxis for Mycobacterium avium complex/infection (MAC/MAI)?

A
  • CD4 < 50 cells/uL
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19
Q

Prophylaxis for opportunistic infxs: Regimen for MAC/MAI?

A
  • Azithromycin [OR] - Clarithromycin
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20
Q

Prophylaxis for opportunistic infxs: Indication for TB prophylaxis?

A

+PPD (5mm) [or] Quantiferon gold positive

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21
Q

Prophylaxis for opportunistic infxs: Regimen for TB?

A
  • INH (9 months)
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22
Q

Vaccination: What are vaccinations that need to be considered with HIV PTs?

A
  • Pneumococcal - Hepatitis A and B - Tetanus, diphtheria, pertusis - Meningitis - Influenza - HPV*
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23
Q

Vaccination: What are the special considerations surrounding HPV vaccination?

A
  • Definitely in those < 26 years old - Insurance may not cover in patients 27 to 45 years old even though it is a medically viable option.
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24
Q

Post-exposure prophylaxis: When is this indicated?

A
  • Indicated when someone has true exposure to HIV.
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25
Post-exposure prophylaxis: Why do we do this?
- ART decreases risk of converting to infection (almost unheard of)
26
Post-exposure prophylaxis: What is the time-frame to initiate ART?
- Begin within 72 hours of exposure
27
Post-exposure prophylaxis: (T/F) If the source is known HIV positive, it is recommended to prophylax with agents known to be effective against that patient's virus.
- TRUE
28
Post-exposure prophylaxis: Duration of ART?
- 1 month
29
Post-exposure prophylaxis: When the HIV source is unknown, what is the common prophylaxis regimen?
- Truvada [combo, 2 x NRTI] + raltegravir (RAL) [INTSI]
30
Post-exposure prophylaxis: Truvada [combo, NRTI] is a combination drug consisting of what two medications?
- tenofovir disoproxil (TDF) [NRTI] - emtricitabine (FTC) [NRTI]
31
PrEP: What does this stand for?
- Pre-exposure prophylaxis
32
PrEP: Benefit?
- Can reduce risk of HIV infection by 92%
33
PrEP: Common PrEP medication?
- Truvada (TDF-FTC) [NRTIx2] - Descovy (TAF-FTC) [NRTIx2]
34
PrEP: How often would you take Truvada?
- Daily dosing available
35
PrEP: What population is indicated for PrEP?
- the new federal and USPSTF guidelines recommend for People who are HIV-negative and at substantial risk for HIV infection.
36
PrEP: What type of assessment should be performed for heterosexual men and women to determine if they are HIV-negative and at substantial risk for HIV infection?
- risk behavior assessment questionnaire
37
PrEP: Guidelines for MSM?
- Adult man without acute or established HIV infection - Any male sex partners in past 6 months - Not in a monogamous partnership with a recently tested, HIV-negative man - AND at least one of the following: --- Any anal sex without condoms (receptive or
38
PrEP: (T/F) Transgender women could be of high benefit for PrEP but is often overlooked.
- TRUE
39
PrEP: (T/F) Transgender women of color are at the same risk as transgender white women.
- FALSE - Transgender women of color are at particularly high risk.
40
PrEP: How often should patients receiving PrEP be tested for HIV?
- Every 3-6 months
41
PrEP: What baseline labs should be performed prior to initiating PrEP?
- HIV status prior to initiation (and every 3-6 months after) - Check renal function (every 3 months) - Hepatitis B immunity
42
PrEP: (T/F) Truvada can reduce the risk of other STI transmission.
- FALSE - PrEP does not reduce the risk of other STIs
43
PrEP: How often should follow-ups occur?
- Every 3 months
44
PrEP: What kind of assessment(s) should be performed every three months during follow-up visits?
- HIV testing - Medication monitoring (stress adherance) - Counseling/behavioral risk reduction - Assess renal function (if normal, then Q6mos) - Oral/rectal STI screening (if appropriate) - Pregnancy testing (if appropriate)
45
Perinatal transmission: If no treatment is provided, what is the risk of vertical transmission?
~26%
46
Perinatal transmission: What ART is routinely administered during pregnancy, labor, and delivery to reduce the risk of vertical transmission?
- zidovudine (AZT) [NRTI]
47
Perinatal transmission: Administration of zidovudine (AZT) [NRTI] can decrease the risk of vertical transmission by how much?
3-Feb
48
Perinatal transmission: A patient can start zidovudine (AZT) [NRTI] as early as ___ weeks into the pregnancy.
14
49
Misc opportunistic infxs: What are the less common "miscellaneous" opportunistic infections?
- Coccidioidomycosis - Histoplasmosis - Blastomycosis - Toxoplasmosis
50
Coccidioidomycosis: What is another name for this infection?
- San Joaquin Valley fever
51
Coccidioidomycosis: Clinical presentation?
40% present with influenza-like illness: - High fever - Night sweats
52
Coccidioidomycosis: Dx studies?
Serology: - IgM - IgG
53
Coccidioidomycosis: Tx?
- Nonspecific treatment indicated unless specific risk factors (i.e., immunosuppresion). - Tx with Diflucan if indicated
54
Coccidiodiomycosis: (T/F) This is typically a self-limiting condition.
- TRUE
55
Histoplasmosis: Organism?
- Histoplasma capsulatum
56
Histoplasmosis: This condition is linked to what event and where?
- Linked to bird droppings or bat guano exposure along Ohio River Valley.
57
Histoplasmosis: Clinical presentation?
- Most are asymptomatic. - if presenting, then pulmonary symptoms.
58
Histoplasmosis: Clinical presentation in AIDS patients or patients in immunocompromised states?
- Disseminated disease is common
59
Histoplasmosis: Dx studies?
- Antigen test (serum, urine, or CSF) [or] - Tissue biopsy
60
Histoplasmosis: Tx for mild-moderate disease?
- Itraconazole
61
Histoplasmosis: Tx for severe disease?
- amphotericin B
62
Blastomycosis: organism?
- Blastomyces dermatitidis
63
Blastomycosis: Linked to what event and where?
- Linked to soil exposure along Ohio River Valley, Especially dust exposure (i.e., construction)
64
Blastomycosis: Clinical presentation?
- Many infections are asymptomatic. - Usually starts as pulmonary infections with cutaneous dissemination
65
Blastomycosis: (T/F) Disseminated disease is present exclusively in AIDS patients or patients in an immunocompromised state.
- FALSE - Disseminated disease is possible in all patients.
66
Blastomycosis: Dx studies?
- Biopsy - Culture
67
Blastomycosis: Tx for mild-moderate disease?
- Itraconazole
68
Blastomycosis: Tx for severe disease?
- amphotericin B
69
Toxoplasmosis: organism?
- Toxoplasma gondii
70
Toxoplasmosis: Associated with what environment?
- Associated with cat boxes * This is why we tell pregnant women to not change cat boxes.
71
Toxoplasmosis: How does this typically present in the setting of HIV?
- Usually reactivation in the setting of HIV, not primary infection
72
Toxoplasmosis: Clinical presentation?
- Focal neurologic findings - fever
73
Toxoplasmosis: Describe the characteristic finding on MRI associated with this condition.
- Punched out lesion
74
Toxoplasmosis: Tx/Mgmt?
- Referral to ID

CDM I (9 decks)

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