L5_HIV infection management

Question 1

Which exposure group are at high risk of HIV?

Answer 1

• heterosexual men.

Question 2

What is the most common route of HIV transmission globally?

Answer 2

• unprotected vaginal sex.

Question 3

Name and describe the clinical stages of HIV infection.

Answer 3

• primary infection.
• CDC A = asymptomatic.
• CDC B = symptomatic.
• CDC C = AIDS defining illness.

Question 4

List some of the clinical conditions that occurs during the CDC B stage of HIV.

Answer 4

• oral candida.
• oral hairy leukoplakia.
• cervical intra-epithelial neoplasia (CIN 2/3).
• multidermatomal HZV (herpes zoster).
• peripheral neuropathy.
• constitutional symptoms.
• immune thrombocytopenic purpura (blood disorder with decreased platelets in the blood).

Question 5

List some of the clinical conditions that occurs during the CDC C stage of HIV.

Answer 5

• TB / MAI (mycobacterium avium-intracellulare).
• cryptococcus / histoplasma.
• PCP (pneumocystis pneumonia).
• oesophageal candida.
• PML (progressive multifocal leukoencephalopathy).
• CMV / persistent HSV (cytomegalovirus).
• KS/NHL.
• Toxoplasma.
• Micro-/cryptosporidia.
• Recurrent bacterial pneumonia.

Question 6

What levels of CD4 are concerning in HIV?

Answer 6

• < 350 cells/mm^3.

Question 7

A patient is diagnosed with late stage HIV with a CD4 count below 200 and is presenting with PCP. How would you treat this patient?

Answer 7

• primary prophylaxis.

- the preferred regimen is trimethoprim-sulfamethoxazole (aka co-trimoxazole/septrin).

Question 8

Some drugs given to treat HIV are nucleoside/tide reverse transcriptase inhibitors (NRTi). Give some examples.

Answer 8

• AZT (zidovudine).
• 3TC (lamivudine).
• FTC (emtricitabine).
• Abacavir.
• Tenofovir.

Question 9

What is the mechanism of action of nucleoside/tide reverse transcriptase inhibitors (NRTi)?

Answer 9

-

Question 10

Which NRTi is not used as much anymore and why?

Answer 10

• AZT.

- toxic and it causes major blood dyscrasia e.g. anaemia, pancytopenia, lipoatrophy.

Question 11

Which combination of drugs is typically prescribed in HIV?

Answer 11

• 2 NRTis are usually combined with a non-nucleoside RTI or with a boosted protease inhibitor.
• abacavir with tenofovir or new tenofovir (aka TAF) with rilpivirine (non-nucleoside RTI).
• or with atazanavir or duranavir (boosted PI).

Question 12

Why is tenofovir not prescribed with FTC or 3TC?

Answer 12

• bc it can affect kidney function.

Question 13

Out of the non-nucleoside RTIs, why is rilpivirine prescribed over nevirapine and efavirenz?

Answer 13

• bc nevirapine can cause a drug-induced hepatitis.

- efavirenz can cause sleep disturbance and mood changes.

Question 14

When is lopinavir a suitable boosted protease inhibitor drug for HIV?

Answer 14

• it is a drug available to take in liquid form therefore ideal for patients who have problems swallowing.

Question 15

Why is ritonavir prescribed with boosted PIs at a very low dose?

Answer 15

• potent inhibitor of cyt p450.

- therefore increases the conce of the boosted PIs.

Question 16

Which 3 drugs did ATRIPLA contain?

Answer 16

• tenofovir, FTC and efavirenz.

Question 17

Give two examples of integrase inhibitors.

Answer 17

• dolutegravir and bictegravir.

Question 18

How do CCR5 inhibitors work? Name two examples.

Answer 18

• bc HIV most commonly uses the CCR5 receptors on host immune cells to enter the cell.
• CCR5 is a chemokine receptor found on CD4 cells.
• maraviroc and vicriviroc.

Question 19

Which level should the viral load of HIV be post-treatment in a patient for the disease to be undetectable?

Answer 19

• <20 copies of RNA/ml of blood.

Question 20

What is the number 1 cause of treatment failure in HIV patients?

Answer 20

• poor adherence to pills.