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Med 4 > ITM 2 The Young Adult > Flashcards

ITM 2 The Young Adult Flashcards

1
Q

What type of virus is HIV

A

RNA virus

Retrovirus

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2
Q

What is the p24 antigen

A

Early marker of infection in HIV

Capsid response releases p24 but over time disappears as antigens develop against it

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3
Q

What are nucleoside reverse transcriptase inhibitors

A

Zidovudine phosphorylated by intracellulae thymidine kinase to form active zidovudine 5-triphosphate

Zidovudine 5-triphosphate terminates viral DNA chain elongation via competition with TMP and incorporation into DNA

Resistance via mutations in reverse transcriptase codons

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4
Q

Non nucleoside reverse transcriptase inhibitors

A

Efavirenz
- diffuses into cell and binds adjacent to active site of reverse transcriptase, leading to conformation change to inhibit
Different site from NRTIs

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5
Q

What do protease inhibitors do in HIV

A

Virus takes over the cells and produces new viral proteins. Protease enzyme processes these
HIV viral protease is essential for infectivity
Cleaves viral polyprotein into:
- reverse transcriptase
- integrase
- protease
- structural proteins

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6
Q

What are fusion inhibitors

A 
Eg enfuvirtide 
Similar to segment of viral glycoprotein gp41 
Prevents binding of virus to host cell 
Given IV 
Very expensive
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7
Q

What is HAART

A

Highly active antiretroviral therapy
2 nucleoside transcriptase inhibitors and either
- non nucleoside transcriptase inhibitor
Or
- protease inhibitor
Or
- integrase inhibitor

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8
Q

When are fusion inhibitors used

A

When the patient has been on HAART but have not responded to it (viral load has not been reduced)

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9
Q

When is HIV untransmissable

A

When the viral load has been undetectable for 6 months

97% of patients diagnosed with HIV are virally suppressed

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10
Q

What is molnupiravir

A

Pro drug
Ribonucleoside analogue increases the number of mutations in viral RNA
Prevents replication - lethal mutagenesis
Anti coronavirus medication (first oral)
50% reduction in hospital admission
30% reduction in severe complications (for unvaccinated patients)
For patients with at least 1 risk factor

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11
Q

What is remdesivir

A

Nucleotide prodrug of an adenosine analogue
An inhibitor of the viral RNA-dependent, RNA polymerase
IV
For hospitalised patients

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12
Q

What is HIV

A

A virus spread through certain body fluids that attacks the immune system
Life long condition
Highly stigmatised
Disproportionately affects vulnerable groups
Very treatable

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13
Q

Pathology of HIV

A

HIV infects lymphocytes with CD4 receptors
HIV binds to the CD4 receptor and enters cell
Uses enzymes to make copies of itself
CD4 cell destroyed in process
Decline in CD4 cells leads to immunosuppression

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14
Q

Describe the primary / acute infection of HIV

A

Within 7-21 days HIV becomes detectable in the blood stream- acute HIV symptoms due to extremely high levels of viraemia may occur within weeks to few months of infection

  • main target CD4 T helper cells - can fall considerably at this time
  • fever, rash, lymphadenopathy, meningitis, rarely opportunistic infections
  • by 6 months CD4 recovers to a level as viral load falls to a set point
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15
Q

What are the stages of HIV infection

A

1) seroconversion: flu like illness shortly after infection. Viral load high, no anti HIV antibodies
2) asymptomatic: stable infection, no symptoms, lasts for years. Viral load low, anti HIV antibodies, stable CD4
3) symptomatic: signs of damaged immune system, infections, tiredness, weight loss, diarrhoea, cancers etc. any viral load, low CD4

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16
Q

What opportunistic infections are common at a CD4 count of >500

A

Persistent generalised lymphadenopathy

Candidal vaginitis

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17
Q

What opportunistic infections are common at a CD4 count of 200-500

A

Bacterial pneumonia
Pulmonary TB
Herpes zoster
Oral candidiasis

18
Q

What opportunistic infections are common at a CD4 count of <200

A

Pneumocystis jiroveci pneumonia

Miliary / extrapulmonary TB

19
Q

What opportunistic infections are common at a CD4 count of <100

A

Candida oesophagitis
Penicillinosis
Toxoplasmosis
Cryptococcosis

20
Q

What opportunistic infections are common at a CD4 count of <50

A

Mycobacterium avium complex

Disseminated cytomegalovirus

21
Q

Side effects of anti HIV medications

A 
GI upset: nausea, diarrhoea 
Rashes and allergies 
Renal toxicity 
Liver toxicity 
Reduced bone mineral density 
Lipodystrophy and weight gain 
Increased cardiovascular risk / blood pressure / lipids / blood sugars 
Peripheral neuropathy
22
Q

Drug interactions in anti HIV drugs

A 
Very common with antiretrovirals 
Induction or inhibition of liver metabolism 
Gastric pH changing absorption 
Divalent cations reducing absorption 
Additive side effects 
Blocking renal excretion
23
Q

Why is adherence so important in HIV patients

A

Need high levels of drugs in the blood all the time to stop virus multiplying

Taking tablets correctly all the time

  • no missed doses
  • no late doses
  • follow food restrictions
24
Q

Management of the HIV patient

A

Biannual visit once established on treatment and undetectable
Viral load, clinical chemistry, haematology, lipids, HbA1c, sexual health screening

Height, weight, BP, waist circumferece
Discuss adherence, mood, partners, bone risks, contraception, vaccination

25
Q

Describe mother to baby transmission of HIV

A

Can occur:

  • in utero (rare)
  • at delivery (15-25%)
  • breastfeeding (5-20%)

If no intervention at all and mother not on ART, rate of transmission is about 25% up to 45%
In the UK currently fewer than 5 babies per year are diagnosed with HIV

26
Q

Prevention of HIV transmission during pregnancy

A

Pregnant women on an effective regimen should continue it

Newly diagnosed pregnant women start triple therapy asap with a resistance test

27
Q

How is an infant with a HIV infected mother treated

A

Undetectable viral load x 2 in mother and on ART >10 weeks - 14 days of zidovudine monotherapy
- extend to 4 weeks if undetectable but other criteria is not filled

If mother >50 copies, unknown or adherence uncertain: start neonatal PEP within 4 hours with combination

Women in UK advised to formula feed

28
Q

What is the Paul bunnell test

A

Tests for infectious mononucleosis which is caused by the Epstein barr virus (member of the herpes family)

29
Q

What is the HIV p24 antigen

A

Present during the short period between HIV infection and seroconversion (when you have just been infected)
Thought of as not a very useful test as doesn’t give us much information as can usually tell the rough period of time of infection depending on the symptoms

30
Q

How should you prepare for breaking bad news to a patient

A 
Signpost / warn them you are about to break bad news 
Private room 
Allow time for questions 
Allow time for silence 
Patient doesn’t want it flowered 
Don’t give results with a friend or relative in the room 
Time 
Optimistic outlook
31
Q

What are peer educators

A

People with HIV that have gone through training to offer support to people with newly diagnosed HIV

32
Q

What does CD4 count indicate

A

T cells

33
Q

What immunisations should someone with HIV be offered

A

Influenza each yea r
Hep B testing and immunisation as appropriate
Pneumococcal vaccination
Annual cervical smear recommended

Due to immune system becoming suppressed

34
Q

Why would someone with HIV be given a bone mineral density scan using DXA

A

As HIV infection and some HIV medications increase the risk of osteoporosis
DXA is a dual energy X-ray used to measure bone mineral density with spectral imaging

35
Q

What is atripla

A

600mg efavirenz
200mg emtrictiabine
300mg tenofovir disoproxil

36
Q

What are the actions of the 3 drugs in atripla

A

Efavirenz: inhibits the activity of viral RNA directed DNA polymerase
Emtricitiabine: chain termination and ceases vira DNA synthesis
Tenofovir disoproxil fumarate: inhibits HIV-1 reverse transcriptase

37
Q

Disadvantages of atripla

A

As it is 3 drugs in one it poses the issue of multiple drug reactions and side effects
Also adherence as if levels drop too low there is a risk of drug resistance

38
Q

How to counsel a patient taking atripla

A

Take on an empty stomach, preferably at bedtime as helps to make the side effects less bothersome

Take the tablets at the same time every day

Can cause dizziness, trouble sleeping, drowsiness, unusual dreams and trouble concentrating

Avoid grapefruit juice as it can interfere with how the body deals with the drug

Side effects should start 1-2 days after starting the medication and usually go away within 2-4 weeks

Body fat may redistribute

Can cause bone problems and joint stiffness

39
Q

Clinical monitoring during therapy with atripla

A

Creatinine clearance
Serum phosphate
After 2-4 weeks of treatment, after 3 months of treatment and every 3-6 months thereafter

40
Q

How can atripla affect pregnancy

A

Can interfere with the contraceptive pill and stop it from being effective
Reinforce importance of condoms

41
Q

What advice should you give to someone with HIV regarding pregnancy

A

Can conceive and have a normal pregnancy
Usual to use some form of self insemination to not infect partner
If viral load is low, expect a normal pregnnacy and uninflected baby
Not able to breastfeed
May have to have a ceserean
Baby will be put on 2 weeks of antivirals when born

42
Q

Why should you avoid St. John’s wort with atripla

A

Can interact with efavirenz and decrease its concentration Severely
Moderately interacts with tenofovir by decreasing its exposure

Med 4 (12 decks)

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