Management of HIV/AIDS Flashcards
What classifies if you have AIDS?
HIV infection
CD4 count of less than 200
CD4 cells <14% of all lymphocytes
AIDS defining conditions
What are the AIDS defining conditions?
Life threatening opportunistic infections Unusual cancers Invasive cervical carinoma Pulmonary TB Recurring pneumo
What is the most essential part in caring for someone who has HIV/AIDS?
Prevention of infection
How provides most of the care for a person suffering from HIV/AIDS?
Primary care physicians
What some way to prevent the transmission of HIV?
Universal precautions when handling blood or body fluids
Avoid IV drugs
Condom use
Screen for anti-HIV antibodies
ART of pregnant women to reduce neonatal transmission
What are the clinical manifestations of HIV/AIDS?
Acute retroviral syndrome Manifestations during chronic period Opportunistic infections Unusual cancers End-organ damage due to the HIV
What are the symptoms of acute retroviral syndrome?
Fever, lymphadenopathy, pharyngitis,rash, myalgia/arthraglia, diarrhea and meningitis
What could acute retroviral syndrome look like in examination?
Mono
What are the clinical and serologic findings in early HIV infection before 6 weeks?
ARS
Detection of viral RNA and p24
Antibodies can’t be detected
What are the clinical and serologic findings in early HIV infection after 6 weeks?
ARS
Detectable antibodies
Usually ELISA followed by Western blot
Viral RNA and p24 persistent
What would you expect to see in an acute HIV infection?
HIV RNA and p24 Ag are present but no antibodies are seen
If a pt has a recent HIV infection within the past 6 mo what would you expect to see?
Anti-HIV antibodies are detectable
ELISA and Western blot are used
What is a low positive HIV RNA and HIV antibodies?
<10,000 copies/mL
While good to have, what is the problem with home HIV tests?
Detect only HIV antibodies and cannot detect an early infection
What are the goals of HIV management?
- Keep the patient as healthy as possible
2. Prevent further transmission through contact tracing and patient education
What should you be looking for in an H&p and ROS for a person who has HIV?
Disease history and risk behavior Base line CD4 cell sount, WBC cell count, viral load and resistance Baseline everything Vaccination history STD screening
When is it okay to give an HIV pt a vaccine and which should you give them?
If their CD4 count is above 200 you’re good to go
Pneumococccal, influenza, varicella and hep A and B
What STDs should be screened for in an HIV infected patient?
Gonorrhea, chlamydia and syphillis
The higher the the viral load the _____ the prognosis.
Lower
What does the CD4 cell count indicate?
Indicator of immune function, disease progression
Key factor in determining urgency of ART treatment or need for prophylaxin
What is an adequate response to ART?
CD4 increase 50-150 cells/uL per year
When is ART strongly recommended?
Asymptomatic, CD4 count <350 c/mm
CD4 count 350 to 500 c/mm
What are the possible benefits to early ART?
Slower progression to immune dysfunction to chronic secondary T cell activation, inflammation and T cell immune deficiency
Reduction in the viral load
How would you determine which drugs to chose for the HIV pt?
Pre-ART: determine CD4 count, measure HIV RNA, resistance testing
Determine viral tropism
HLAB 5701 testing
What are the toxicities of NRTIs?
Lactic acidosis, hepatotoxicity
What are the toxicities of NNRTIs?
Heoatotxicity, rash and drug-drug rxns
What are the toxicities of PIs?
Lipodystrophy, hyperlipidemia and hepatotoxicity
Possible inc rick of diabetes and insulin resistance
What is the mechanism of NRTIs?
Completely inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain
What is the mechanism of NNRTIs?
Bind to reverse trancriptase at site different from NRTIs
What is the mechanism of integrase inhibitors?
Inhibits HIV genome integration into host cell chromosome by reversibly inhibiting HIV integrase
What is the mechanism of protease inhibitors?
Prevent to maturation of new viruses by blocking assembly of virions (cleavage of the polypeptide products)
What is the function of fusion inhibitors (enfuvitide)?
Binds to gp41 inhibiting viral entry
What is the function of fusion inhibitors (maraviroc)?
Binds CCR-5 on surface of T cell/monocytes inhibiting the actions of gp120
