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Dunedin RACP Study Course > ID - HIV > Flashcards

ID - HIV Flashcards

1
Q

Life expectancy of HIV +ve patient compared to -ve

A

8 years less (71 vs 79)

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2
Q

Which HIV patients should you treat with ART?

A

all

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3
Q

naming convention of HIV drugs

A

all integrase inhibitors end in: -gravir

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4
Q

Favoured combination of HIV drugs (class wise)

A

Integrase inhibitor + 2 NRTI

OR

Integrase inhibitor + 1 NRTI

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5
Q

If patient presents with new HIV and opportunistic infection what should you do re HIV meds

A

Start the HIV meds

2 caveats for delaying treatment:
- TB affecting the brain
- cryptococcal meningitis

(concerns regarding immune over-activation, inflammation and brain herniation)

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6
Q

Tenofovir forms and link

A

TAF - Tenofovir alafenamide
Prodrug of TDF converted to TDF intracellular
TDF - Tenofovir Disoproxil fumarate

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7
Q

AE Tenofovir (TDF)

A

renal disease, bone disease (more with TDF)
- less with TAF

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8
Q

Pharmacokinetic relation of tenofovir forms (TAF vs TDF)

A

Tenofovir alafenamide (TAF) Prodrug of TDF converted to TDF intracellular

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9
Q
A

TMP-SMX + pred

(Don’t treat CMV in HIV patients unless histological changes suggesting it’s pathogenic)

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10
Q

HIV drugs contra-indicated in pregnancy

A

all are fine

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11
Q

Abacavir AE

A

Hypersensitivity reaction ( 5-8%) if HLAB5701

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12
Q

zidovudine AE

A

anaemia, Lipodystrophy

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13
Q

Cardinal AIDS Defining Illnesses

A
  • Kaposi Sarcoma
  • CMV retinitis
  • Disseminated Mycobacterium avium complex/Tuberculosis
  • Pneumocystis pneumonia
  • Oesophageal Candidiasis
  • Toxoplasma encephalitis
  • Chronic cryptosporidiosis / microsporidiosis
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14
Q

CD4 count that HIV patients tend to get opportunistic infections

A

typically < 200

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15
Q

Vaccine and HIV

A

don’t give live vaccines if CD4 < 200

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16
Q

Primary prophylaxis in HIV

A
17
Q

HIV chest infections

A

Pneumococcus (S. Pneumonia)

Pneumocystis (PJP fungus)

TB (re-activation)

18
Q
A

PJP

19
Q

main symptom PJP pneumonia

A

SOBE

20
Q

Treatment for PJP pneumonia

A

trim-sulfa
- needs to make its own folate

Does not have ergosterol in it’s cell membrane therefore other antifungals (azoles/ampho) not effective

Steroids - If PaO2 < 70

21
Q

Diagnosis of PJP pneumonia

A

BAL PCR

22
Q

Indications of PJP prophylaxis (other than HIV with CD4 < 200)

A
  • Prednisone > 20 mg /day for > 4 weeks
  • ALL Induction to end of Maintenance
  • Allo-HSCT – Engraftment > 6 mos after transplant provide off immunosuppression and no GVHD
  • Alemtuzumab, Rituximab, anti-thymocyte - > 6 months after completion
  • Solid organ transplant > 6 months (?lifelong for lung/intestinal txplant)
23
Q

Sx of cryptococcal meningitis

A
  • Presents as subacute meningitis (25% do not have any meningeal signs (serum crypto ag+)
  • Due toљ ICH – CN palsies, seizures (cryptococcoma)– but typically confusion and fevers
24
Q

LP finding crytococcal meningitis

A
  • Opening pressure elevated in 60-80% - very high
  • Lymphocytic, low glucose (but only in 40%), elevated protein
  • CSF –Crypto Ag 94% positive, Culture 100% - PCR ~80%
25
Q

mgmt crytococcal meningitis

A

2 anti-fungal drugs until sterile LP (amphotericin + flucytosine)

then conslidaiton
- fluconazole 8 weeks

Maintenance
- 12 months lower dose fluconazole

Control ICH
- daily LP until < 25cm H2)

Hold off on ARV for a little while - Typically start 4-6 weeks, CSF sterile

26
Q

HIV CNS toxoplasmosis presentation

A
  • Most common cause of brain abscess – usually CD4 < 100, *<50
  • If higher CD4 = need to think TB, lymphoma
  • Common presentation – headache, fever, seizures, AMS, focal deficits
  • Dx – must have Toxo IgG + serum – PCR of CSF for Toxo
  • Imaging – ring enhancing lesions – multiple – single can be confused Lymphoma
27
Q

Transmission of toxoplasmosis

A
  • Feline feces (cats, lions)
  • Oocysts begin to be excreted 20 days post-infection
  • Rare meat (Lamb>Beef>Pork)
28
Q

HIV CNS toxoplasmosis treatment

A
  • TMP-SMX
  • Adjuvant dexamethasone, if develop SZ - antiepileptic

Teaching point – treat empirically for toxoplasmosis if ring enhancing lesions – if not better 2 weeks consult NS for brain biopsy

29
Q

IRIS

A

immune reconstitution inflammatory syndrome

  • results from restored immunity to specific infectious or non-infectious antigens.
  • A paradoxical clinical worsening of a known condition or the appearance of a new condition after initiating therapy characterizes the syndrome.
  • Many disease entities associated with IRIS – OI’s Sarcoidosis, Grave’s,
  • Timing – Usually w/i 6 weeks after ARV
30
Q

predicters of IRIS in HIV infection

A

high VL, low CD4 or high pathogen burden

31
Q

Most common IRIS opportunistic infections

A
  • Mtb, MAI (Mycobacterium avium and intracellulare)
  • Cryptococcus
  • CMV
32
Q

IRIS treatment

A
  • Continue ARV
  • Steroids – pred 40 -80 mg for 2-8 wks+, NSAID
  • Must exclude other entities AND no failure or your treatment of OI
33
Q

MAI infection

A

Mycobacterium avium-intracellulare infection

  • Decreasing incidence (hence why MAI prophylaxis dropped if starting ARVs)
  • Bx, blood cultures
34
Q

predicters of IRIS in HIV infection

A

high VL, low CD4 or high pathogen burden

35
Q

Appearnce of CMV retinitis

A

Ketchup on eggs

36
Q

Ix for CMV retinitis

A
  • Fundoscopic exam
  • Rarely vitreal tap done

CMV viral load not that helpful (correlates with CD4 count)

37
Q

Treatment of CMV retinitis

A

Immediate sight- threatening lesion
* ARV
* IV ganciclovir
* Intravitreal ganciclovir

Small peripheral lesion
* ARV
* Oral valganciclovir

Typically expect improvement in 10-14 days

Dunedin RACP Study Course (31 decks)

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