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RRPA Clinical Decision Making I > HIV - Schoenwald > Flashcards

HIV - Schoenwald Flashcards

1
Q

HIV is a disease of _____ immunity.

A

Cell mediated

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2
Q

Function of CD4 cells?

A

Antigen presenting cells - help make antibodies

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3
Q

HIV transmission can be broken down into what 3 categories?

A

Blood
Sexual intercourse
Perinatal

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4
Q

T/F? HIV can be spread through breast milk.

A

True

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5
Q

Antiretroviral therapy in a pregnant mother reduces the risk of transmission to the child by how much?

A

Reduces risk by 2/3

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6
Q

What antiretroviral is traditionally used for prevention of mother to child transmission?

A

AZT

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7
Q

AIDS is defined by?

A

HIV + AIDS defining illness
OR
HIV with CD4 count < 200

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8
Q

What is the most common presentation of HIV?

A

Asymptomatic pts with positive screening test

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9
Q

Name some common co-infections with HIV

A

Syphilis (always test for HIV in pts with new syphilis diagnosis)
Hep B
Other STDs

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10
Q

Symptoms of acute HIV?

A

Extreme flu like symptoms - Fever, fatigue, pharyngitis, LAD, body wide maculopapular rash

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11
Q

What type if pneumonia is typically only found in immunocompromised patients, and is an AIDS defining illness?

A

Pneumocystis jiroveci

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12
Q

Pneumocystis jiroveci is classified as a ______.

A

Fungus

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13
Q

What is the gold standard test for PJP?

A

Silver stain on sputum sample.

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14
Q

Classic x ray appearance of PJP?

A

Bilateral hilar infiltrate

almost like a butterfly pattern

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15
Q

Symptoms of PJP?

A 
Fever
Dry cough
SOB
Hypoxia
Fatigue
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16
Q

Treatment for PJP?

A

High dose trimethoprim/sulfamethoxazole

+/- prednisone

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17
Q

Should HIV patients have prophylaxis for PJP?

A

If CD4 < 200

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18
Q

What medication is used for PJP prophylaxis?

A

Trimethoprim/sulfamethoxazole

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19
Q

What medication should be used for PJP prophylaxis in patients with sulfa allergies?

A

Dapsone or inhaled pentamidine

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20
Q

Purple, brownish lesions common in AIDS patients?

A

Kaposi’s sarcoma

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21
Q

Kaposi’s sarcoma is caused by?

A

Human herpes virus 8

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22
Q

Treatment for Kaposi’s sarcoma?

A

Antiretrovirals.

Reconstituting the immune system can get rid of them.

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23
Q

Name 3 early indicators of HIV infection.

A

Thrush
oral hairy leukoplakia
Shingles

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24
Q

What is a retrovirus?

A

A RNA virus that depends on reverse transcriptase

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25
Q

What is the most common type of HIV in the US?

A

HIV 1

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26
Q

Where is HIV 2 found?

A

West Africa

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27
Q

Which type of HIV is more virulent?

A

HIV 1

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28
Q

HIV enters CD4 cells via what receptors?

A

CCR5 and CXCR4 chemokine receptors

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29
Q

Acute HIV infection usually occurs within what time frame after exposure?

A

within 12 weeks of exposure

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30
Q

The most current screening test for HIV is?

A

Combination or 4th generation testing (EIA)

- Looks for both HIV ab and p24 antigen

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31
Q

Confirmation of a positive Combination or 4th generation testing (EIA) is done by?

A

HIV rna by PCR

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32
Q

What test is used to measure viral load?

A

Ultrasensitive quantitative rna by PCR

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33
Q

If testing by ELISA is positive for HIV, what test is used to confirm diagnosis?

A

Western blot

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34
Q

Combination or 4th generation testing (EIA) can show positivity how long after exposure?

A

2-6 weeks

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35
Q

HIV drug resistance testing should be done when?

A

If viral load > 1000

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36
Q

What other infections should you screen for after you diagnose a patient with HIV?

A

Hep A, B, C
TB and Toxoplasmosis
STDs

37
Q

Antiretroviral consists of medications of 4 classes. Name them.

A

Protease inhibitors
Nucleoside reverse transcriptase inhibitors (NRTI)
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Integrase inhibitors

38
Q

A goal of antiretroviral therapy is suppression of viral load to _____.

A

<50 copies/mL

39
Q 
Antiretroviral therapy typically consists of a backbone and a base. Which class of medications are the backbone.
Which are the base?
A

Backbone - typically two NRTIs

Base - either NNRTI or PI or integrase inhibitor

40
Q

Name 5 commonly used complete combination pills.

A 
Atripla
Biktarvy
Genvoya
Odefsey
Stribild
41
Q

What complete combination is injectable once per month?

A

Cabenuva

42
Q

Atripla is a combination of what medications?

A

Efavirenz, tenofovir disoproxil fumarate, emtricitabine.

43
Q

Biktarvy is a combination of what medications?

A

Bictegravir, tenofovir alafenamide, emtricitabine

44
Q

Genvoya is a combination of what medications?

A

Elvitegravir, cobicistat, tenofovir alafenamide, emtricitabine

45
Q

Odefsey is a combination of what medications?

A

Rilpivirine, tenofovir alafenamide, emtricitabine

46
Q

What medication is used for HIV in pregnancy?

A

AZT = retrovir = zidovudine

47
Q

What medications are approved for PrEP?

A

Truvada

Descovy

48
Q

Truvada is a combination of what medications?

A

Tenofovir disoproxil fumarate, emtricitabine

49
Q

Descovy is a combination of what medications?

A

Tenofovir alafenamide, emtricitabine

50
Q

Descovy and Truvada are what class of medications?

A

NRTIs

51
Q

What is a commonly used NNRTI?

A

Sustiva (efavirenz)

52
Q

What are 2 commonly used protease inhibitors?

A

Prezcobix (darunavir + cobicistat)

Prezista (darunavir)

53
Q

What is the difference between tenofovir disoproxil and alafenamide?

A

Disoproxil is older and has higher risk of renal failure and osteoporosis

54
Q

Protease inhibitors all end in?

A

navir

55
Q

What is the preferred protease inhibitor

A

Darunavir

56
Q

Stribild is a combination of what medications?

A

Elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil.

57
Q

Integrase strand transfer inhibitors end in?

A

tegravir

58
Q

According to the most recent guidlines, when should HIV treatment be started?

A

All HIV + patients should be considered for treatment

59
Q

What should patients be screened for before starting Abcavir?
Why?

A

HLA-B*5701

TO reduce the risk of a hypersensitivity reaction.

60
Q

What are some of the most common side effects of antiretroviral therapy?

A 
Rash (can be fatal)
Diarrhea
Pancreatitis
Hyperlipidemia/lipodystrophy
Cardiac risk
Psychological disturbances
61
Q

What are two physical exam findings consistent with HIV/AIDS?

A

Facial wasting

Buffalo hump

62
Q

What is the name of the condition caused by an inflammatory reaction in response to rapid reconstruction of CD4 counts?

A

IRIS - Immune Reconstitution Syndrome

63
Q

What testing should be done for HIV patients every 6-12 months?

A

CD4 and viral load

Anal Pap smears/cervical pap smears

64
Q

Patients should have prophylaxis for toxoplasmosis at CD4 counts _____.

A

<100

65
Q

What medication is used for prophylaxis of toxoplasmosis

A

TMP/SMX or Dapsone + pyrimethamine

66
Q

Patients should have prophylaxis for mycobacterium avium complex (MAC) at CD4 counts _____.

A

<50

67
Q

What medication is used for prophylaxis of MAC?

A

Clarithro/azithromycin

68
Q

Your HIV patient has a PPD reading of 6mm. What treatment should you initiate?

A

Isoniazid (INH) x 9 months

69
Q

What medications are commonly used for post exposure prophylaxis?

A

Truvada or Raltagravir

70
Q

How long are post exposure prophylaxis meds given?

A

1 month

71
Q

Post exposure prophylaxis should be started how soon after exposure?

A

ASAP, but generally within 72 hours.

72
Q

What should you check before starting a patient on PrEP?

A

Hep B immunity because tenofovir is a potential treatment, and you don’t want to create drug resistant Hep B

73
Q

HIV status should be checked how often in PrEP patients?

A

Every 3 months

74
Q

What PrEP med would you choose for a patient with renal impairment?

A

Descovy - it has tenofovir alafenamide rather than disproxil (which is the only difference between descovy and truvada)

75
Q

What opportunistic infection presents with an influenza like illness and is diagnosed by IgM/IgG serology?

A

Coccidioides immitis (San Joaquin Valley fever)

76
Q

Treatment for Coccidioides immits?

A

Fluconazole if pt is having persistent or severe infection.

77
Q

Is Coccidioides immits an AIDS defining illness?

A

No

78
Q

Histoplasmosis is linked to exposure of what along the Ohio River Valley?

A

Bird droppings and bat guano

79
Q

Treatment for Histoplasmosis?

A

Itraconazole for mild-moderate and Amphotericin B for severe disease

80
Q

Is histoplasmosis an AIDS defining illness?

A

Yes

81
Q

Blastomycosis is linked to exposure to _______ along the Ohio River Valley?

A

Dust

82
Q

T/F? Disseminated blastomycosis only occurs in AIDS and immunosuppressed patients.

A

False - can happen to anyone

83
Q

Diagnosis of Histoplasmosis is done by?

A

Serum, urine, or CSF antigen test
OR
tissue biopsy.

84
Q

Diagnosis of blastomycosis is done by?

A

Biopsy and culture

85
Q

Treatment for blastomycosis?

A

Itraconazole for mild-mod and amphotericin B for severe disease

86
Q

Toxoplasmosis is associated with exposure to?

A

Cat litter boxes

87
Q

Is toxoplasmosis in HIV usually primary infection or reactivation?

A

Reactivation

88
Q

When is toxoplasmosis usually a primary infection?

A

In pregnancy

89
Q

Characteristic findings on brain MRI in toxoplasmosis?

A

Punched out lesions

RRPA Clinical Decision Making I (17 decks)

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