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CDM 3 Exam 3 > Lecture 6 - HIV Infection 3 > Flashcards

Lecture 6 - HIV Infection 3 Flashcards

1
Q

PrEP

A

given prior to exposure to prevent establishment of infection

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2
Q

PEP

A

given after exposure to prevent infection

oPEP = occupational
nPEP = non-occupational

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3
Q

Preferred regimen for pregnant people, ARV naive

A

Dolutegravir**
Raltegravir = must be used twice
Atazanavir + ritonavir**
Darunavir + ritonavir = must be used twice

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4
Q

2 NRTI backbone for pregnant people, ARV naive

A

Emtricitabine/tenofovir
Lamivudine/tenofovir

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5
Q

Intrapartum care

A

expedited HIV testing + viral load, continue ART therapy

Give IV zidovudine until delivery w/ VL > 1,000 or unknown…continuous infusion
C.section at 38 weeks if VL high

IV Zidovudine not req for people receiving ART w/ VL < 50 copies and no adherence concerns

benefit&raquo_space; risk so just give IV honestly

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6
Q

Infant ARV prophylaxis suppressed mother

A

4 week zidovudine if virally suppressed mother….6/12hrs after birth

start regardless of zidovudine resistance history

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7
Q

Infant ARV prophylaxis non suppressed mother

A

6 week zidovudine + 2-6 weeks Lamivudine + nevirapine/raltegravir

do NAAT at birth, if neg then you can shorten the Lamivudine/neviraine/raltegravir

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8
Q

what bodily fluid not considered infectious unless visibly bloody?

A

the shit you excrete

Poop, boogies, salvia, sweat, vomit, pee etc

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9
Q

Factors associated with increased risk HIV transmission

A

Visible contaminated device
needle in vein or artery
deep injury
high viral load

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10
Q

Timing and duration of oPEP

A

start within 72hrs

duration ~ 4 weeks

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11
Q

Preferred oPEP regimen

A

Raltegravir 400 BiD + TDF/FTC (Truvada) 1 QD

Dolutegravir used in practice

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12
Q

oPEP monitoring and followup?

A

use contraceptives and avoid donating blood, breast-feeding during 6-12 weeks after exposure

follow up testing BL, 6,3-4 months
CBC, renal/hepatic function at BL and 2 weeks

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13
Q

nPEP is recommended when….

A

source of body fluids is known to be HIV positive and reported exposure present substantial risk for transmission

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14
Q

nPEP is not recommended when….

A

reported exposure present no substantial risk of HIV transmission OR care is sought > 72hrs after potential exposure

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15
Q

nPEP regimens

A

28 day course of 3 drugs

preferred: TDF/FTC + Raltegravir BID or dolutegravir QD

Alternative: TDF/FTC + darunavir + ritonavir

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16
Q

PrEP options for MSM/ Transwomen

A

TDF/FTC
TAF/FTC
Cabotegravir = Q8 weeks…possible use in high risk

Studies showed you could do daily or on demand

17
Q

PrEP options for Heterosexual w/ 1 partner having HIV and other doesn’t

A

cabotegravir found superior in cis women, so its an option

18
Q

PrEP for people who inject drugs

A

BANGKOK study

19
Q

indications for PrEP use by MSM?

A

adult man
without acute or established HIV infections
Any male partners in past 6 months
not monogamous with recently tested, HIV negative man

1 of following…anal w/o condom in past 6 month, STI in past 6 month, relationship with HIV positive male

20
Q

indications for PrEP by straight men/women

A

adult
w/o acute or established HIV infection
Any sex with opposite sex in past 6 months
non-monogamous w/ recently tested HIV neg partner

1 of following…man who is bi, infrequent condom use with 1+ partner with unknown status, sexual relationship with HIV positive partner

21
Q

indications for PrEP by people who inject drugs

A

adult
w/o acute or established HIV infection
injection drug use in last 6 months

1 of following….sharing injection equip, in detox, risk of sexual acquisition

22
Q

FDA approved PrEP regimens

A

TDF/FTC = QD
TAF/FTC = QD except cisgender women…vag sex no data
CAB = approved Q 2 months

23
Q

Can you do PrEP as expedited partner therapy?

A

nah

24
Q

PrEP education

A

adverse effects uncommon, mostly headache, nausea,farting during 1st month
adherence V important

25
Q

PrEP monitoring

A

Every 3 months….HIV, refill no more than 90-DS, STI testing

Every 6 months….Estimated CrCl, STI if lower risk

Every 12 months….eval if further need PrEP

26
Q

Discontinuing PrEP?

A

getting HIV
personal choice
changed life situations
intolerable toxicities
chronic non-adherence

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