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Infectious Diseases > Lecture 1: HIV/AIDS > Flashcards

Lecture 1: HIV/AIDS Flashcards

1
Q

What race/ethnicity group & sexual group has the highest overall lifetime risk of HIV diagnosis

A

African American MSM

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2
Q

Which state has the highest lifetime risk of HIV diagnosis

A

D.C

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3
Q

Screening for HIV

- what 2 group should be screen for HIV

A

Screening for HIV

  1. ALL pregnant women
  2. pts 15-65 y/o (& younger if at risk)
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4
Q

Screening/Testing for HIV

  1. what is the main screening test used today
  2. what is the assoc confirmation test
A

Screening/Testing for HIV

  1. screening test = 4th gen immunofluorescence assays HIV 1 & 2
  2. confirmation test = multispot HIV-1/2 differentiation assay
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5
Q

Screening/Testing for HIV: what test is used

  • if indeterminate results found on multispot HIV-1/2 differentiation assay
  • to Dx acute retroviral infxn
  • to monitor infectivity & tx effectiveness in HIV pts
A

Viral RNA by PCR

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6
Q

What type of virus is HIV

- name and type (RNA vs DNA)

A
  • retrovirus

- RNA virus

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7
Q

How does HIV replicate in humans

- what enzyme is responsible?

A

HIV = RNA virus

- converts RNA –> DNA by RT (reverse transcriptase) –> incorporated into host nucleus –> replicates

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8
Q

What are the 2 major methods of transmission of HIV

Others: vertical (during birth/breastfeeding), received blood products before 1985, mucosal contact w/infected blood, needle stick

A

Major transmission methods for HIV

  1. Sexual contact
  2. IV drug use
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9
Q

What is the major site for T-cell loss + early HIV replication
- what happens to the CD4 cell count during primary HIV infection

A

GALT = gut assoc lymphoid tissue
(most CD4 memory cells there)
- rapid depletion of CD4 count during primary HIV infection

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10
Q

HIV Primary Infection
- what is the name of the condition that occurs 2-4 wks after infection and is a/w flu like Sxs (fever, fatigue, malaise, generalized rash & LAD

other name for it

A

Acute Retroviral Syndrome or Acute Seroconversion

occurs 2-4 wks after infection and is a/w flu like Sxs (fever, fatigue, malaise, generalized rash & LAD

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11
Q

describe the typical rash in primary HIV infection

A

blanching maculopapular rash

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12
Q

Baseline evaluations: HIV Dz staging

  1. what 3 things are you testing to determine pt’s initial dz stage
  2. After baseline evaluations how often do you monitor a pt’s dz status & ART?
A

Baseline evaluations: HIV Dz staging

  1. 3 things testing fo at baseline =
    - CD4 cell count
    - HIV RNA viral lod
    - Resistance testing (genotype, +/- phenotype)
  2. monitor pt’s dz status & ART Q3-6 months
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13
Q

What annual evaluations are done for co-infections that are common in HIV (3 things)
- which on of the 3 is also done at baseline

A

Annual evaluations for Co-infxns common in HIV

  1. STIs
  2. TB - also done at baseline
  3. Cancer
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14
Q

What vaccines should you give a person w/any CD4 count levels for prevention and ppx of HIV (6)

A

Vaccines

  1. flu
  2. TDa
  3. pneumococcal
  4. Hep A + B
  5. Herpes suppression
  6. HPV
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15
Q

Infection prevention & OI ppx

  1. When pts have CD4 < 200 what are they at risk for & ppx for it?
  2. When pts have CD4 < 50 what are they at risk for & ppx for it?
A

Infection prevention & OI ppx

  1. CD4 < 200 = at risk for PJP –> give Bactrim as ppx
  2. CD4 < 50 = at risk for MAC – give Azithromycin
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16
Q

HIV Tx
1. what is the goal of ART for HIV &what indicates that this goal reached (& what does this mean in terms of transmission)

A

HIV Tx

1. goal of ART = total HIV suppression
- indicated by UNDETECTABLE viral load
means can transmit virus

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17
Q

HIV Tx w/ART

  1. why should all pts be started on ART ASAP
  2. does their CD4 count matter?
  3. How is treating HIV, prevention of it
A

HIV Tx w/ART

  1. ALL HIV pts should be started on ART ASAP –> to decr morbidity/mortality &prevent transmission
    (deferred tx = incr risk)
  2. CD4 count DOESNT MATTER
  3. Tx HIV –> PREVENT transmission to others
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18
Q

HIV Life Cycle

- what are the first 2 steps for the HIV life cycle

A

1&2 = binding & fusion

HIV Life Cycle

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19
Q

What step in HIV life cycle do the NRTIs and NNRTIs work?

A

3 Reverse Transcription

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20
Q

What does RT (Reverse Transcriptase) do

A

RT - converts single stranded HIV RNA –> double stranded HIV DNA so can be incorp into host

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21
Q

HIV life Cycle: #3 Reverse Transcription & Drug action

  1. What is the main NRTI & its 2 types
  2. what 3 options used in combo w/it?
A

HIV life Cycle: #3 Reverse Transcription & Drug action

  1. Main NRTI = Tenofovir (AF or DF)
  2. Tenofovir combined w/ Emtricitabine, Abacavir, or Lamivudine
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22
Q

HIV Life Cycle: #4 Integration

  1. what is the role of integrase–> & what type of virus results?
  2. What do the integrase inhibitors do?
  3. 3 examples of integrase inhbitors?
A

HIV Life Cycle: #4 Integration

  1. inetgrase incorp HIV DNA into host DNA –> provirus (inactive)
  2. Integrase inhibitors prevent HIV DNA from being incorp
  3. Integrase inhibitors “RED”
    - Raltegravir
    - Elvitegravir
    - Dolutegravir
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23
Q

HIV Life Cycle: #5 Transcription

  • what enzyme is used to make copies of the HIV genomic material after the host cell is activated
    (host or viral enxzyme?)
A

HIV Life Cycle: #5 Transcription

  • host RNA polymerase used to make copies of HIV genomic material
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24
Q

HIV Life Cycle: #6 Assembly

  1. what class of drugs work here?
  2. what drugs in this class is used as booster for other drugs in the class & other HIV meds
A

HIV Life Cycle: #6 Assembly

  1. protease inhibitors work at this step
  2. Ritonavir + Cobicstat = boosters
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25
Q

HIV Life Cycle: #7 Budding

  • when the virus buds out from host cell what part of the cell’s outer envelope does it steal & why is this necessary for viral spread
A

HIV Life Cycle: #7 Budding

  • steals glycoproteins from outer envelope –> needed to bind to CD4 rec & co-rec –> infect other cells
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26
Q

HIV Life Cycle: #8 Maturation

  • what becomes active that triggers the HIV life cycle to start again & produce more HIV
A

HIV Life Cycle: #8 Maturation

  • viral proteinase becomes active –> triggers the HIV life cycle to start again & produce more HIV
27
Q

HIV Tx

- what 5 things do you check before choosing Tx regimen?

A

HIV Tx: check before choosing Tx

  1. HBV (& C) status
  2. CD4 count
  3. viral load
  4. drug resis w/genotyping
  5. HLA-b5701
28
Q

HIV Tx

  1. if someone is HLA-b5701 (+) what drug should NOT be given
  2. if someone is Hep B (+) what drug is NEEDED
A

HIV Tx

  1. HLA-b5701 (+) –> DONT GIVE Abacavir
  2. Hep B (+) –> MUST have combo w/ tenofovir
29
Q

1st line Tx for HIV

- what 2 drug classes are combined
& how many of each are pts receiving

A

1st line Tx for HIV

Combo of: 1 integrase inhibitor + 2 NRTIs

30
Q

1st line Tx for HIV (specific)

  1. what are the 3 drug options that every pt gets
  2. plus what other 2 combinations
A

1st line Tx for HIV (specific)

  1. every pt = integrase inhbiitor “RED”
    - Raltegravir, Elvitegravir, Dolutegravir
  2. plus
    - tenofovir AF or DF w/emtricitabine or…
    - abacavir w/ lamivudine
31
Q

HIV Tx: Special considerations

  1. what drug should be avoid in Pregnancy for 1st 8 wks b/c teratogenic
  2. if pt has HBV what drug MUST be used
    - what if that drug cant be used alt can be added?
  3. HCV & HIV
    - what is the pro of treating both
    - what is the con w/ treating HCV (what can reactivate)
A

HIV Tx: Special considerations

  1. preg –> avoid efavirenz in 1st 8 wks (teratogenic)
  2. HBV –> MUST use tenofovir
    - alt = add entecavir
  3. Tx HCV + HIV = slow dz progression of other dz
    - Tx HCV –> can reactivate HBV
32
Q

What drug has the S/E of renal damage, joint necrosis and osteoporosis

A

Tenofovir DF

33
Q

PEP: post exp ppx

  1. how soon MUST you take these meds, what window is best?
  2. 3 drug combo given for 4 weeks?
A

PEP

  1. must take w/in 72 hrs (w/in 2 hrs = best)
  2. 3 drug combo
    - Raltegravir + tenofovir DF w/Emtricitabine
34
Q

PrEP: Pre exp ppx

  1. what is the only diff in drug regimen vs PEP?
  2. what 4 groups are mainly at risk for getting HIV and should be offered PrEP
  3. how long does it take to be eff in rectal vs vaginal tissues
  4. what test must be confirmed (-) before starting PrEP
  5. If pt on PrEP presents w/Sxs of acute HIV infxn what should you do?
A

PrEP

  1. no Raltegravir
    (Tenofovir DF w/Emtricitabine)
  2. MSM, IVDA, sex workers, h/o unprotected sex
  3. rectal tissues = 1 wk, vaginal tissues = 3 wks
  4. (-) 4th gen Ag/Ab test before starting PrEP
  5. pt on PrEP presents w/Sxs of acute HIV infxn –> D/C PrEP til (-) status confirmed
35
Q

HIV/AIDS complications: Oropharyngeal infections

- what 5 conditions a/w HIV/AIDS

A

HIV/AIDS complications: Oropharyngeal infections

  1. Oral ulcers
  2. Oral candidiasis
  3. Oral hairy leukoplakia
  4. Peridontal dz
  5. Kaposi’s Sarcoma
36
Q 
HIV/AIDS complications: Oropharyngeal infections 
#1 oral ulcers
  1. 3 main causes
  2. 2 main ways to Dx
A 
HIV/AIDS complications: Oropharyngeal infections 
#1 oral ulcers
  1. causes = HSV, CMV, Apthous stomatitis
  2. 2 main ways to Dx = cultures, Bx
37
Q

HIV/AIDS complications: Oropharyngeal infections

pt comes in w/pseudomembranous tongue & angular cheilitis, the white substance on his tongue scrapes off and he notes burning and altered taste.

Dx?
Tx?

A

HIV/AIDS complications: Oropharyngeal infections

Dx = oral candiasis

Tx = Nystatin or fluconazole

38
Q

HIV/AIDS complications: Oropharyngeal infections

  • how does oral hairy leukoplakia differ from oral candidiasis
A

HIV/AIDS complications: Oropharyngeal infections

oral hairy leukoplakia

  • does NOT scrape off tongue
  • no burning or altered taste
39
Q

HIV/AIDS complications: Oropharyngeal infections

pt comes in w/ marginal erythema of gums, gingival regression & palatal necrosis

Dx?

A

Dx = Periodontal dz

40
Q

HIV/AIDS complications: Oropharyngeal infections

pt w/ high CD4 count comes in w/ maculopapular rash w/nodules and plaque like lesions

Dx?
Tx?
what is the viral cause?

A 
Dx = Kaposi's Sarcoma (CA of endothelium)
Tx = HAART (HIV Tx)
Cause = herpes  virus (spp = HHV 8)
41
Q

HIV/AIDS complications: Cutaneous infxns

- what are the 5 types

A

HIV/AIDS complications: Cutaneous infxns

  1. VZV
  2. HSV
  3. Seborrheic keratosis
  4. Bacillary angiomatosis
  5. Molluscum contagiosum
42
Q

HIV/AIDS complications: Cutaneous infxns

  1. what dz is caused by bartonella
  2. what dz caused by poxvirus and a/w small, flesh colored umbilicated lesions
  3. what dz a/w velvety wart lesions w/greasy stuck on appearance
  4. what dz a/w dermatomal outbreaks, several dermatomes affected & disseminated dz
  5. what dz a/w gential lesions –> ulcers; complications of radiculomyelitis & proctitis
A

HIV/AIDS complications: Cutaneous infxns

  1. Caused by bartonella = Bacillary angiomatosis
  2. caused by poxvirus and a/w small, flesh colored umbilicated lesions = Molluscum contagiosum
  3. velvety wart lesions w/greasy stuck on appearance = seborrheic keratosis
  4. dermatomal outbreaks, several dermatomes affected & disseminated dz = VZV (shingles)
  5. a/w gential lesions –> ulcers; complications of radiculomyelitis & proctitis = HSV
43
Q

HIV/AIDS complications: Pulm infxns

- 2 main dz

A

HIV/AIDS complications: Pulm infxns

  1. PJP - Pneumocystis Jiroveci PNA
  2. Myobacterial Infxn (TB)
44
Q 
HIV/AIDS complications: Pulm infxns 
#1 PJP
  1. what type of infxn is it?
  2. what CD4 count incr pts risk?
  3. what test is diagnostic & which gives definitive dx?
  4. what is both the Tx and ppx for it?
A 
HIV/AIDS complications: Pulm infxns 
#1 PJP
  1. fungal infxn
  2. CD4 < 200 = incr risk
  3. diagnostic test = bronchoscopy,
    definitive = bronchoalveolar lavage
  4. Tx & ppx = Bactrim
45
Q

HIV/AIDS complications: Pulm infxns

  • pt comes in c/o fever, sweats fatigue and non-productive cough that has developed over the last few weeks. He also states he has exertional dyspnea and chest tightness.

CXR reveal bilat diffuse infiltrates

Dx?

A

Dx = PJP

46
Q 
HIV/AIDS complications: Pulm infxns 
#2 TB/mycobacterium

2 ways to Dx

A 
HIV/AIDS complications: Pulm infxns 
#2 TB/mycobacterium

Dx = sputum or bronchoscopy

47
Q

HIV/AIDS complications: Ocular infxns

pt presents w/ fever, blurry vision & floaters w/progressive vision loss over past few days. On fundo exam you see coalescing white exudates w/flame hemorrhages & edema?

Dx & Tx
What on pathology is diagnostic for this d/o?
Why is this an urgent condition (what can it progress to w/out Tx)?

A

HIV/AIDS complications: Ocular infxns

Dx = CMV Retinitis & Tx = intraocular cyclovir

Pathology = owl eye inclusions

Urgent condition b/c w/out Tx –> retinal detachment & permanent vision loss

48
Q

HIV/AIDS complications: CNS infxns

- 4 d/o in this category

A

HIV/AIDS complications: CNS infxns

  1. PML (Progressive Multifocal Luekoencephalopathy)
  2. Toxoplasmosis
  3. CMV
  4. Cryptococcus Meningitis
49
Q

HIV/AIDS complications: CNS infxns

  1. what d/o a/w polyradiculopathy, meningeal signs and flaccid paralysis, + owl eye appearane on Bx
  2. what d/o a/w HA, confusion, behav/mood changes, encephalitis + chorioretinitis and caused by a parasite a/w cats?
  3. what d/o a/w rapidly progressive focal neural deficits such as hemiparesis and visual field defects + white matter lesions on MRI
  4. what d/o a/w HA, AMS, seizures + neck stiffness, and caused by fungus and can be dx w/india ink stain
A

HIV/AIDS complications: CNS infxns

  1. polyradiculopathy, meningeal signs and flaccid paralysis, & owl eye appearane on Bx = CMV
  2. a/w HA, confusion, behav/mood changes, encephalitis & chorioretinitis and caused by a parasite a/w cats = Toxoplasmosis
  3. a/w rapidly progressive focal neural deficits such as hemiparesis and visual field defects + white matter lesions on MRI = PML
  4. a/w HA, AMS, seizures + neck stiffness, and caused by fungus and can be dx w/india ink stain = Cryptococcus meningitis
50
Q

HIV/AIDS complications: GI infxns

- 2 types in this category

A

HIV/AIDS complications: GI infxns

  1. CMV
  2. Cryptosporidum
51
Q

HIV/AIDS complications: GI infxns

  1. which d/o a/w persistent diarrhea + dx by examine stool
  2. which d/o can affect/cause inflam of entire GI system (esophagitis, gastritis, colitis), odonophagia, diarrhea, proctitis, fever abd pain and Dx = endo/colonoscopy w/Bx
A

HIV/AIDS complications: GI infxns

  1. a/w persistent diarrhea + dx by examine stool = Cryptosporidum
  2. can affect/cause inflam of entire GI system (esophagitis, gastritis, colitis), odonophagia, diarrhea, proctitis, fever abd pain and Dx = endo/colonoscopy w/Bx = CMV
52
Q

HIV/AIDS complications: Disseminated infxns

pt c/o fever, sweats, wt loss, fatigue, SOB and diarrhea. On exam you note HSM, RUQ pain and adenopathy. Labs reveal anemia

Dx?
PPx?

A

MAC (Mycobacterium Avium Complex)

ppx = Azithromycin

53
Q

HIV/AIDS complications: Prevention/PPx

  1. what is the ppx for both Toxoplamosis and PJP
  2. MAC ppx
  3. TB ppx drug?
A

HIV/AIDS complications: Prevention/PPx

  1. ppx for Toxoplamosis and PJP = Bactrim
  2. ppx for MAC = Azthiromycin
  3. ppx for TB = INH
54
Q

HIV/AIDS complications

pt started on ART 4 wks ago presenting today w/ worsening clinical status. CD4 count is 30 and there has been a rapid decline in viral load since starting tx

Dx?

A

dx = IRIS (Immune Reconstitution Inflammatory Syndrome)

55
Q

HIV & Aging: Medication issues in older pop

  1. what can HIV meds cause/worsen
  2. HIV meds have signific _____
  3. what is major med problem in elderly
A

HIV & Aging: Medication issues in older pop

  1. HIV meds cause/worsen comorbidities
  2. HIV meds = signific drug interactions
  3. Polypharmacy = prob in elderly
56
Q

HIV & Aging: Comorbidities

  • 3 or more of the following: exhaustion, slowed walking speed, low activity level, weakness and wt loss

means pts have what type of comorbidity?

A

HIV & Aging: Comorbidities

3+ = fragility phenotype

57
Q

HIV & Aging:

- What dz contributes to most deaths among HIV pts

A

CVD = biggest RF for mortality in HIV pts

58
Q

HIV & Aging:

- What dz is a complication of HIV ART, especially with the DF formulation of tenofovir

A

Kidney/Renal dz

59
Q

HIV & Aging:

- fully effective HIV Tx has lead to increased prevalence of what 3 things

A

fully effective HIV Tx has lead to increased prevalence of

  1. insulin resistance
  2. glucose intolerance
  3. DM
60
Q

HIV & Aging:

- lipodystrophy/buffalo hump is a/w what type of HIV drug

A

HIV & Aging:

- lipodystrophy/buffalo hump a/w older PIs (Protease inhib)

61
Q

HIV & Aging:

- what drug is a/w decr bone mineralization & osteoporosis

A

HIV & Aging:

- tenofovir DF = a/w decr bone mineralization & osteoporosis

62
Q

HIV & Aging: specific med effects

NRTIs, NNRTIs and PIs all affect lipids
- which one also incr risk of heard dz

note: tenofovir = unique AEs in previous cards

A

HIV & Aging: specific med effects

- incr risk of heart dz w/PIs

63
Q

HIV & Aging: polypharmacy

what 3 types of drugs CANNOT be given w/PIs

A

HIV & Aging: polypharmacy

  1. statins (Sim, Lova, Pita)
  2. St. John’s Wart
  3. BZs

Infectious Diseases (9 decks)

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