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Summer 3 > HIV SG > Flashcards

HIV SG Flashcards

1
Q

When was AIDS first published

A

1981

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2
Q

What is HIV

A

a retrovirus; uses reverse transcriptase to turn RNS into DNA, integrate it’s genetic material into host DNA, and new virus is produced

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3
Q

What does HIV target

A

T cells (esp CD4 helper cells) Also, B lymphocytes and macrophages

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4
Q

What do lymphocytes do

A

WBC that defend against VIRUSES, fungi, some bacteria, and protozoa

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5
Q

What are B and T cells

A
  • B cells make Abs to attack antigens
  • CD4 T cells enhance immune response and tell B cells to make Abs
  • CD8 killer cells destroy foreign agents
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6
Q

How does HIV replication occur

A

HIV particle fuses to CD4 component HIV incorporated into host cell by reverse transcriptase New copies of HIV released

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7
Q

How is HIV transmitted

A

Sexually: exchange of body fluids IVDU Needlestick injuries (occupational) Blood products (extremely low risk now) HIV infected mom to infant -Basically, requires infectious body fluid and portal of entry! Not spread via casual contact!

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8
Q

What is the risk of transmission

A

Insertive vaginal sex: 1/10K Receptive vaginal sex: 1/1K Needle stick: 1/300 Shared drug needle: 1/150 Receptive anal: 1/50

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9
Q

What is acute HIV

A

2-6 weeks after exposure, HIV initiates the attack and CD4 cells drop rapidly You develop mono or flu-like Sx that ;ast about 2 weeks, then resolve (this indicates your body initially fighting back at the disease) Patient is highly infectious

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10
Q

What do labs show in acute HIV

A

HIV antibody test is usually negative! it is too early for your body to have developed antibodies HIV RNA (viral load) is measurable, and extremely high (>100K) -Providers often only order the Ab test, which comes back negative, they tell the pt they are negative, and then they go infect others. -Elevated LFT’s, Leukopenia, anemia, thrombocytopenia

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11
Q

What does catching acute HIV allow

A

To stop the spread of disease to others But, once you have HIV, you can’t stop the disease progression

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12
Q

What are common manifestations of acute HIV

A

Fever adenopathy sore throat rash* upper trunk, neck, face Mucocutaneous ulcers myalgias arthralgias HA diarrhea N/V

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13
Q

What is clinical latency

A

It begins as immune system responds to infection (acute illness resolves)- lasts appx 10 years Patient seroconverts (serum becomes HIV antibody +) around 3 months after infection Viral load decreases to a set point and slowly rises over time (HIV is active in lymph nodes this whole time) CD4 slowly declines Patient is ASx usually

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14
Q

What happens during a symptomatic infection

A

Lymph nodes and tissue are damaged (burnt out) Virus may mutate and be more pathogenic Body fails to keep up with replacement of CD4 cells Viral load (HIV RNA) increases CD4 count decreases

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15
Q

What are HIV Sx

A

fever, night sweats LAD fatigue, malaise arthralgias weight loss *Hairy leukoplakia prolonged diarrhea cervical dysplasia (HPV) Molluscum, dermatophyte infection, seborrheic dermatitis *Kaposi Sarcoma recurrent HZV ITP

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16
Q

What is a normal CD4 count

A

600-1200 (then she says 500-1400)

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17
Q

What is usually the first Sx of HIV

A

Tuberculosis! immune system fails revealing TB Sx

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18
Q

What is AIDS

A

CD4 count <200 OR HIV + 1 of 27 AIDS defining conditions

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19
Q

What occurs at different CD4 counts

A

<200: P. jiroveci PNA, <100: Toxoplasmosis <50: MAC, CMV Any: Kaposi, Candida

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20
Q

What is pneumocystic jiroveci pneumonia

A

airborne fungus that reactivates when CD4 count is <200 Common opportunistic infx associated w/ AIDS Presents w/ nonspecific Sx (fever, cough, SOB) =/- hypoxemia CXR shows diffuse perihilar infiltrates

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21
Q

How do you diagnose and treat P. jirovecii PNA

A

Sputum sample; can also get LDH (elevated) Tx: Bactrim DS*** and supportive care

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22
Q

What is Toxoplasmosis

A

Parasite (toxoplasma gondii) that reactivates when CD4 <100 Causes encephalitis, IC lesions Acquired via cat feces, contaminated raw food or utensils If immunocompetent, you rarely show Sx

23
Q

How does toxoplasmosis present in HIV

A

HA FND seizures AMS Retinitis Pneumonitis

24
Q

How do you diagnose Toxoplasmosis

A

CT/MRI will show contrast enhancing lesions on brain Seropositive for toxoplasmosis

25
Q

What is MAC

A

Mycobacterium avium/intracellulare, found in soil and dust, is inhaled or ingested Can cause pulmonary infections in immunocompetent In AIDS, can cause systemic disease, night sweats, weight loss, abdominal pain, diarrhea, anemia

26
Q

How do you diagnose MAC

A

Sputum acid fast bacillus (+) Positive sputum sultures Positive blood cultures

27
Q

What is CMV retinitis

A

MC retinal infections in AIDS! herpes virus (CMV) transmitted by blood, sex, or perinatally, causes visual disturbances that may lead to blindness

28
Q

How do you diagnose CMV retinitis

A

Perivascular hemorrhages and white fluffy exudates on fundoscope (cotton wool spots, infiltrates, and hemorrhages) Seropositive (+ Abs) for CMV

29
Q

How is CD count related to candidiasis

A

The more invasive the esophageal or vaginal candidiasis, the lower the CD4 count

30
Q

What is Kaposi’s sarcoma

A

Vascular neoplasm that can occur at any T cell count MC in older eastern european and mediterranean males MC in homosexual men Lesions are multifocal and widespread, w/ associated LAD

31
Q

How do you treat Kaposi sarcoma

A

Many Tx available, like Thalidomide (teratogen that causes short limbs)

32
Q

HIV is…

A

a CHRONIC disease, not a terminal disease!

33
Q

Who should be screened for HIV at LEAST once

A

everyone 13-64 (can opt out) anyone who is starting TB Tx At each STD presentation Annually for at risk patients (MSM) Pregnant women -Not providers, because we generally can not transmit HIV to our patients

34
Q

Who should get more frequnt HIV testing

A

Opportunistic infections TB Sx of established HIV: weight loss, fever, tiredness, LAD, diarrhea >1 week, sores of mouth, anus, genitals, PNA, unexplained neuro Sx Sx associated w/ acute HIV

35
Q

What is the HIV antibody test

A

Detects the antibody our bodies make 4-12 weeks after infection, after patient seroconverts

36
Q

What is a rapid HIV test

A

another HIV antibody test done by saliva or blood If positive, you need a confirmation test Will not show positive if acute HIV

37
Q

What is preferred testing for HIV

A

Combination HIV antibody&antigen testing! WILL detect acute HIV (viral load will be high)

38
Q

If a combination HIV Ab/Ag test comes back positive…

A

Must differentiate between HIV 1 & 2 thru the differentiation immunoassay (In US, MC is: HIV1 +, HIV2 -)

39
Q

What is your pt has no insurance/is very young

A

Maricopa county STD clinic: $20 but, only the rapid test is available Minors can get STD testing w/o parents, but HIV is not explicitly included. Send minors to county

40
Q

What treatment is recommended in ALL HIV patients (esp. acute/early infection)

A

Antiretroviral Therapy (ART) The earlier you treat, the more immunologic and virologic benefits you experience

41
Q

If you diagnose someone with HIV, how do you proceed

A

Call the HIV clinic, set up an appointment for the NEXT DAY Get them on Tx ASAP!

42
Q

How do you select ART

A

Based on genotypic drug resistance preformed at referral

43
Q

How long do you treat HIV

A

Lifelong! they must be willing to commit They can postpone Tx if they will not be compliant and CD4 is higher, around 400ish, because being non-compliant is dangerous. it can lead to resistance

44
Q

What are Tx goals for HIV

A

Suppress plasma HIV RNA levels to undetectable

45
Q

Possible HIV exposures include

A

Unprotected sex Condom broke or fell off Rape or sexual assault Work related injury Sharing needles for drugs

46
Q

What is post-exposure prophylaxis

A

Reduces risk of you acquiring HIV once you have been exposed! MUST start within 72 hours of exposure

47
Q

What is pre-exposure prophylaxis

A

Daily medication (Truvada) that may be prescribed by HIV specialist or PCP

48
Q

What Sx do you see at different CD4 levels

A

Normal (500-1400): thrush, Kaposi sarcoma (people do well usually if 350+) 200: opportunistic infections <200= AIDS (or any CD4 with a opportunistic AIDS infx)

49
Q

What meds do you give to patients based on CD4 counts

A

<200: Bactrim (prophylaxis for PJP) <100: Bactrim (prophylaxis for toxoplasma) CD4 <50: Azithromycin (prophylaxis for MAC)

50
Q
  • Is the incidence of HIV increasing or decreasing?
  • Which sex has higher rates?
  • What age group has highest rates of NEW infection?
A
  • Increasing slightly
  • Men
  • 20-29
51
Q
  • Which 2 races are “disporportionately affected” by HIV?
  • Which 3 categories of people are at highest risk?
A
  • African Americans
  • Hispanic/Latino
  1. Male to Male sex
  2. Heterosexual sex
  3. IV drug use
52
Q
  • What are the 2 types of HIV and which one is MC in the United States?
  • Which is MC in West Africa?
A
  • HIV 1: US
  • HIV 2: Africa
53
Q
A

Summer 3 (12 decks)

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