Management of HIV/AIDS (Buxton) 2 hours, 6 questions

Question 1

Clinical manifestations of Acute Retroviral Syndrome (ARS)

Answer 1

fever
lymphadenopathy
pharyngitis
rash
myalgia
diarrhea
meningitis

Question 2

Findings with first 6 weeks of HIV infection (aka Acute HIV infection):

Answer 2

ARS
detectable viral RNA and p24
Antibodies NOT detectable

Question 3

findings after 6 weeks of HIV infection (aka Recent HIV infection:

Answer 3

ARS
viral RNA and p24 persist
Antibodies detectable

Question 4

initial screening for HIV is mot commonly _________ based followed by a confirmatory test, ________________.

Answer 4

ELISA

Western Blot

Question 5

Acute HIV infection: Diagnosis

Answer 5

1. detection of HIV(viral) RNA or p24 Ag w/ negative or indeterminate HIV Ab result

Question 6

Combination HIV Ag/Ab tests

Answer 6

• Don’t differentiate between Ag and Ab positivity.
• if reactive: retest with Ab assay
• if negative/indeterminate: check HIV RNA if acute HIV is suspected

Question 7

Home HIV tests

Answer 7

• screening method, not confirmatory
• detects HIV antibodies ONLY
• will not detect an early infection (<6 wks)

Question 8

importance of CD4 count in the management of the HIV infected patient

Answer 8

• major indicator of immune function
• best predictor of disease progression
• key factor in determining urgency of ART or need for OI prophylaxis
• repeat every 4-6 months

Question 9

importance of CD4 count in determining response to ART

Answer 9

Adequate response: CD4 increases 50-150 cells/uL per year

Question 10

What prophylaxis is given when CD4 decreases below 200/cmm?

Answer 10

-TMP/SMX for prevention of pneumocystis

Question 11

What prophylaxis is given when CD4 decreases below 50/cmm?

Answer 11

• TMP/SMX for prevention of Toxoplasma

- Azithromycin or Clarithromycin for prevention of Mycobacterium avium

Question 12

importance of viral load in the management of the HIV infected patient

Answer 12

• prognostic indicator (high viral load = more rapid progression to AIDS)
• viral load reflects response to treatment
• rise in viral load may indicate need for change in ART
• checked every 6-12 months in stable patients

Question 13

viral load reflects ___________

viral load is measured by ____

Answer 13

amount of virus in the blood

PCR

Question 14

importance of viral resistance testing in the management of the HIV infected patient

Answer 14

• done prior to starting ART
• repeat after starting or changing ART regimen
• checked periodically in stable patients

Question 15

initial labs needed for newly diagnosed HIV-infected patient

Answer 15

• baseline CD4, viral load and viral resistance levels

- baseline CBC, CMP(lipids, BUN, liver, creatinine, etc)

Question 16

explain the importance of the non immunological labs in the newly diagnosed HIV infected patient(CBC, CMP, UA)

Answer 16

• testing function of kidneys, liver, etc to choose the best ART (ie avoid choosing one with nephrotoxicity if kidneys not healthy)
• testing for presence of end-organ damage caused by HIV itself

Question 17

classes of antiretrovirals

Answer 17

1. nucleoside reverse transcriptase inhibitors (NRTIs)
2. Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
3. Protease Inhibitors (PIs)
4. Integrase Inhibitor
5. Fusion Inhibitor
6. Chemokine receptor antagonists (CCR5 Antagonists)