HIV - Schoenwald Flashcards
HIV is a disease of _____ immunity.
Cell mediated
Function of CD4 cells?
Antigen presenting cells - help make antibodies
HIV transmission can be broken down into what 3 categories?
Blood
Sexual intercourse
Perinatal
T/F? HIV can be spread through breast milk.
True
Antiretroviral therapy in a pregnant mother reduces the risk of transmission to the child by how much?
Reduces risk by 2/3
What antiretroviral is traditionally used for prevention of mother to child transmission?
AZT
AIDS is defined by?
HIV + AIDS defining illness
OR
HIV with CD4 count < 200
What is the most common presentation of HIV?
Asymptomatic pts with positive screening test
Name some common co-infections with HIV
Syphilis (always test for HIV in pts with new syphilis diagnosis)
Hep B
Other STDs
Symptoms of acute HIV?
Extreme flu like symptoms - Fever, fatigue, pharyngitis, LAD, body wide maculopapular rash
What type if pneumonia is typically only found in immunocompromised patients, and is an AIDS defining illness?
Pneumocystis jiroveci
Pneumocystis jiroveci is classified as a ______.
Fungus
What is the gold standard test for PJP?
Silver stain on sputum sample.
Classic x ray appearance of PJP?
Bilateral hilar infiltrate
almost like a butterfly pattern
Symptoms of PJP?
Fever Dry cough SOB Hypoxia Fatigue
Treatment for PJP?
High dose trimethoprim/sulfamethoxazole
+/- prednisone
Should HIV patients have prophylaxis for PJP?
If CD4 < 200
What medication is used for PJP prophylaxis?
Trimethoprim/sulfamethoxazole
What medication should be used for PJP prophylaxis in patients with sulfa allergies?
Dapsone or inhaled pentamidine
Purple, brownish lesions common is AIDS patients?
Kaposi’s sarcoma
Kaposi’s sarcoma is caused by?
Human herpes virus 8
Treatment for Kaposi’s sarcoma?
Antiretrovirals.
Reconstituting the immune system can get rid of them.
Name 3 early indicators of HIV infection.
Thrush
oral hairy leukoplakia
Shingles
What is a retrovirus?
A RNA virus that depends on reverse transcriptase
What is the most common type of HIV in the US?
HIV 1
Where is HIV 2 found?
West Africa
Which type of HIV is more virulent?
HIV 1
HIC enters CD4 cells via what receptors?
CCR5 and CXCR4 chemokine receptors
Acute HIV infection usually occurs within what time frame after exposure?
within 12 weeks of exposure
The most current screening test for HIV is?
Combination or 4th generation testing (EIA)
Confirmation of a positive Combination or 4th generation testing (EIA) is done by?
HIV rna by PCR
What test is used to measure viral load?
Ultrasensitive quantitative rna by PCR
If testing by ELISA is positive for HIV, what test is used to confirm diagnosis?
Western blot
Combination or 4th generation testing (EIA) can show positivity how long after exposure?
2-6 weeks
HIV drug resistance testing should be done when?
If viral load > 1000
What other infections should you screen for after you diagnose a patient with HIV?
Hep A, B, C
TB and Toxoplasmosis
STDs
Antiretroviral consists of medications of 4 classes. Name them.
Protease inhibitors
Nucleoside reverse transcriptase inhibitors (NRTI)
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Integrase inhibitors
A goal of antiretroviral therapy is suppression of viral load to _____.
<50 copies/mL
Antiretroviral therapy typically consists of a backbone and a base. Which class of medications are the backbone. Which are the base?
Backbone - typically two NRTIs
Base - either NNRTI or PI or integrase inhibitor
Name 5 commonly used complete combination pills.
Atripla Biktarvy Genvoya Odefsey Stribild
What complete combination is injectable once per month?
Cabenuva
Atripla is a combination of what medications?
Efavirenz, tenofovir disoproxil fumarate, emtricitabine.
Biktarvy is a combination of what medications?
Bictegravir, tenofovir alafenamide, emtricitabine
Genvoya is a combination of what medications?
Elvitegravir, cobicistat, tenofovir alafenamide, emtricitabine
Odefsey is a combination of what medications?
Rilpivirine, tenofovir alafenamide, emtricitabine
What medication is used for HIV in pregnancy?
AZT = retrovir = zidovudine
What medications are approved for PrEP?
Truvada
Descovy
Truvada is a combination of what medications?
Tenofovir disoproxil fumarate, emtricitabine
Descovy is a combination of what medications?
Tenofovir alafenamide, emtricitabine
Descovy and Truvada are what class of medications?
NRTIs
What is a commonly used NNRTI?
Sustiva (efavarenz)
What is a commonly used protease inhibitor?
Reyataz (atazanavir)
What is the difference between tenofovir disoproxil and alafenamide?
Disoproxil is older and has higher risk of renal failure and osteoporosis
Protease inhibitors all end in?
navir
What is the preferred protease inhibitor
Darunavir
Stribild is a combination of what medications?
Elvitegravir, comicistat, emtricitabine, and tenofovir disoproxil.
Integrase strand transfer inhibitors end in?
egravir
According to the most recent guidlines, when should HIV treatment be started?
All HIV + patients should be considered for treatment
What should patients be screened for before starting Abcavir?
Why?
HLA-B*5701
TO reduce the risk of a hypersensitivity reaction.
What are some of the most common side effects of antiretroviral therapy?
Rash (can be fatal) Diarrhea Pancreatitis Hyperlipidemia/lipodystrophy Cardiac risk Psychological disturbances
What are two physical exam findings consistent with HIV/AIDS?
Facial wasting
Buffalo hump
What is the name of the condition caused by an inflammatory reaction in response to rapid reconstruction of CD4 counts?
IRIS - Immune Reconstitution Syndrome
What testing should be done for HIV patients every 6-12 months?
CD4 and viral load
Anal Pap smears/cervical pap smears
Patients should have prophylaxis for toxoplasmosis at CD4 counts _____.
<100
What medication is used for prophylaxis of toxoplasmosis
TMP/SMX or Dapsone + pyrimethamine
Patients should have prophylaxis for mycobacterium avium complex (MAC) at CD4 counts _____.
<50
What medication is used for prophylaxis of MAC?
Clarithro/azithromycin
Your HIV patient has a PPD reading of 6mm. What treatment should you initiate?
Isoniazid (INH) x 9 months
What medications are commonly used for post exposure prophylaxis?
Truvada or Raltagravir
How long are post exposure prophylaxis meds given?
1 month
Post exposure prophylaxis should be started how soon after exposure?
ASAP, but generally within 72 hours.
What should you check before starting a patient on PrEP?
Hep B immunity because tenofovir is a potential treatment, and you don’t want to create drug resistant Hep B
HIV status should be checked how often in PrEP patients?
Every 3 months
What PrEP med would would you choose for a patient with renal impairment?
Descovy - it has tenofovir alafenamide rather than disproxil (which is the only difference between descovy and truvada)
What opportunistic infection presents with an influenza like illness and is diagnosed by IgM/IgG serology?
Coccidioides immitis (San Joaquin Valley fever)
Treatment for Coccidioides immits?
Fluconazole if pt is having persistent or severe infection.
Is Coccidioides immits an AIDS defining illness?
No
Histoplasmosis is linked to what exposure to ________ along the Ohio River Valley?
Bird droppings and bat guano
Treatment for Histoplasmosis?
itraconazole for mild-moderate and amphotericin B for severe disease
Is histoplasmosis an AIDS defining illness?
Yes
Blastomycosis is linked to exposure to _______ along the Ohio River Valley?
Dust
T/F? Disseminated blastomycosis only occurs in AIDS and immunosuppressed patients.
False - can happen to anyone
Diagnosis of Histoplasmosis is done by?
Serum, urine, or CSF antigen test
OR
tissue biopsy.
Diagnosis of blastomycosis is done by?
Biopsy and culture
Treatment for blastomycosis?
Itraconazole for mild-mod and amphotericin B for severe disease
Toxoplasmosis is associated with exposure to?
Cat litter boxes
IS toxoplasmosis in HIV usually primary infection or reactivation?
Reactivation
When is toxoplasmosis usually a primary infection?
In pregnancy
Characteristic findings on brain MRI in toxoplasmosis?
Punched out lesions
