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CMBM exam 4 > Management of HIV/AIDS > Flashcards

Management of HIV/AIDS Flashcards

1
Q

What classifies if you have AIDS?

A

HIV infection
CD4 count of less than 200
CD4 cells <14% of all lymphocytes
AIDS defining conditions

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2
Q

What are the AIDS defining conditions?

A 
Life threatening opportunistic infections
Unusual cancers
Invasive cervical carinoma 
Pulmonary TB
Recurring pneumo
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3
Q

What is the most essential part in caring for someone who has HIV/AIDS?

A

Prevention of infection

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4
Q

How provides most of the care for a person suffering from HIV/AIDS?

A

Primary care physicians

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5
Q

What some way to prevent the transmission of HIV?

A

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

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6
Q

What are the clinical manifestations of HIV/AIDS?

A 
Acute retroviral syndrome 
Manifestations during chronic period 
Opportunistic infections
Unusual cancers
End-organ damage due to the HIV
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7
Q

What are the symptoms of acute retroviral syndrome?

A

Fever, lymphadenopathy, pharyngitis,rash, myalgia/arthraglia, diarrhea and meningitis

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8
Q

What could acute retroviral syndrome look like in examination?

A

Mono

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9
Q

What are the clinical and serologic findings in early HIV infection before 6 weeks?

A

ARS
Detection of viral RNA and p24
Antibodies can’t be detected

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10
Q

What are the clinical and serologic findings in early HIV infection after 6 weeks?

A

ARS
Detectable antibodies
Usually ELISA followed by Western blot
Viral RNA and p24 persistent

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11
Q

What would you expect to see in an acute HIV infection?

A

HIV RNA and p24 Ag are present but no antibodies are seen

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12
Q

If a pt has a recent HIV infection within the past 6 mo what would you expect to see?

A

Anti-HIV antibodies are detectable

ELISA and Western blot are used

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13
Q

What is a low positive HIV RNA and HIV antibodies?

A

<10,000 copies/mL

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14
Q

While good to have, what is the problem with home HIV tests?

A

Detect only HIV antibodies and cannot detect an early infection

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15
Q

What are the goals of HIV management?

A
  1. Keep the patient as healthy as possible

2. Prevent further transmission through contact tracing and patient education

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16
Q

What should you be looking for in an H&p and ROS for a person who has HIV?

A 
Disease history and risk behavior
Base line CD4 cell sount, WBC cell count, viral load and resistance 
Baseline everything
Vaccination history 
STD screening
17
Q

When is it okay to give an HIV pt a vaccine and which should you give them?

A

If their CD4 count is above 200 you’re good to go

Pneumococccal, influenza, varicella and hep A and B

18
Q

What STDs should be screened for in an HIV infected patient?

A

Gonorrhea, chlamydia and syphillis

19
Q

The higher the the viral load the _____ the prognosis.

A

Lower

20
Q

What does the CD4 cell count indicate?

A

Indicator of immune function, disease progression

Key factor in determining urgency of ART treatment or need for prophylaxin

21
Q

What is an adequate response to ART?

A

CD4 increase 50-150 cells/uL per year

22
Q

When is ART strongly recommended?

A

Asymptomatic, CD4 count <350 c/mm

CD4 count 350 to 500 c/mm

23
Q

What are the possible benefits to early ART?

A

Slower progression to immune dysfunction to chronic secondary T cell activation, inflammation and T cell immune deficiency
Reduction in the viral load

24
Q

How would you determine which drugs to chose for the HIV pt?

A

Pre-ART: determine CD4 count, measure HIV RNA, resistance testing
Determine viral tropism
HLAB 5701 testing

25
Q

What are the toxicities of NRTIs?

A

Lactic acidosis, hepatotoxicity

26
Q

What are the toxicities of NNRTIs?

A

Heoatotxicity, rash and drug-drug rxns

27
Q

What are the toxicities of PIs?

A

Lipodystrophy, hyperlipidemia and hepatotoxicity

Possible inc rick of diabetes and insulin resistance

28
Q

What is the mechanism of NRTIs?

A

Completely inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain

29
Q

What is the mechanism of NNRTIs?

A

Bind to reverse trancriptase at site different from NRTIs

30
Q

What is the mechanism of integrase inhibitors?

A

Inhibits HIV genome integration into host cell chromosome by reversibly inhibiting HIV integrase

31
Q

What is the mechanism of protease inhibitors?

A

Prevent to maturation of new viruses by blocking assembly of virions (cleavage of the polypeptide products)

32
Q

What is the function of fusion inhibitors (enfuvitide)?

A

Binds to gp41 inhibiting viral entry

33
Q

What is the function of fusion inhibitors (maraviroc)?

A

Binds CCR-5 on surface of T cell/monocytes inhibiting the actions of gp120

CMBM exam 4 (27 decks)

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