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CMBM Exam 4 CL > Medical Management of HIV/AIDS > Flashcards

Medical Management of HIV/AIDS Flashcards

1
Q

How do you define a case definition of AIDS?

A

HIV infection and
CD4 count < 200 (adults) and/or
CD4 cells < 14% total lymphocytes and/or
AIDS-defining conditions

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2
Q

What are some AIDS-defining conditions?

A

Life-threatening opportunistic infections
Unusual cancers (B cell lymphomas of CNS, Kaposi’s sarcoma)
Invasive cervical carcinoma
Pulmonary TB
Recurrent pneumonias

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3
Q

What is an essential aspect of health counseling for HIV in primary care?

A

Prevention of infection

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4
Q

What is the prevalence of HIV infection in US estimated to be?

A

1.2 million

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5
Q

What is the incidence of new HIV infections in the US?

A

50,000/year

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6
Q

What are the 2 types of post-exposure prophylaxis?

A

Occupational exposure & sexual encounter exposure

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7
Q

How does post-exposure therapy work?

A

Take it within 72 hours of potential exposure; follow a 28-day regimen of anti-retroviral therapy.

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8
Q

Why are PCPs managing the care of many HIV patients today?

A

It has become a chronic, rather than acute, disease. Many patients are living into their 70s, 80s. Early prognosis was about 2 years. Current prognosis today can be as long as a few decades.

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9
Q

What kind of care should be provided for HIV patients?

A

ART and routine preventive care recommended for all patients.

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10
Q

What are you using when you assume that everybody’s blood and bodily fluids which you are about to handle are contaminated?

A

Universal precautions

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11
Q

Abstinence & avoidance of IV drug use, testing (especially if at risk), monogomous relationship with HIV(-) partner, condom use, clean needle use by IVDAs, screening for anti-HIV antibodies in blood, and ART of pregnant women are all examples of what?

A

Prevention of HIV transmission

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12
Q

What is high risk heterosexual contact?

A

Multiple partners, prostitution

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13
Q

What are clinical manifestations of HIV/AIDS?

A 
Acute retroviral syndrome
Manifestations during chronic period
Opportunistic infections
Unusual cancers
End-organ damage due to HIV itself
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14
Q

We generally have B cell lymphomas floating around, but if you find a rise in them in the ______, your patient is severely ______.

A

…..CNS…..immunocompromised.

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15
Q

Within what time frame would you expect to see manifestations of acute retroviral syndrome?

A

Within 6 weeks

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16
Q

What clinical and serological findings would you expect to see within first 5-6 weeks of HIV infection?

A

ARS
Antibodies are not detectable yet
Viral RNA & p24 are detectable

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17
Q

What clinical and serological findings would you expect to see after 6 weeks of HIV infection?

A

ARS
Antibodies are detectable
Viral RNA and p24 persist

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18
Q

What tests should you perform to confirm HIV diagnosis?

A

ELISA, followed by Western Blot

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19
Q

What is p24?

A

Structural protein that makes up most of the HIV viral core/capsid

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20
Q

When would you expect to see high levels of p24 in blood serum of newly infected individuals?

A

During the short period between infections and seroconversion.

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21
Q

What is the time frame for recent HIV infection?

A

6 weeks - 6 months

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22
Q

How do you diagnose HIV?

A

Usually, have detectable HIV RNA or p24 antigen with negative/indeterminate HIV antibody test result. If diagnosis is made by HIV RNA testing, confirmatory serologic testing should be performed in 3-6 months.

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23
Q

What is the problem with combination HIV Ag/Ab tests?

A

Do not differentiate between Ag & Ab positivity. If reactive retest with Ab assay. If negative/indeterminate, check HIV RNA if acute HIV is suspected.

24
Q

What is the problem with home HIV tests?

A

Only detect HIV antibodies; will not detect (antigens) for very early infection.

25
Q

What are the goals of HIV management?

A

Keep the patient as healthy as possible.

Prevent further transmission.

26
Q

What can you do to help keep the patient as healthy as possible?

A

ART
Screening, prevention, treatment for opportunistic infections & cancers as necessary
Regular preventive care - especially for cardiovascular function, lipid panels, cancer screenings, osteoporosis screenings, diabetes, kidney & liver function

27
Q

How can you help prevent further transmission?

A

Contact tracing

Patient education

28
Q

What would you include in the work up of a newly diagnosed HIV-infected patient that you wouldn’t necessarily include for your average healthy patient?

A

Baseline CD4 cell count (repeated every 4-6 months)
Baseline viral load (check every 6-12 months)
Check for viral resistance patterns
Baseline CBC & differential, UA, BUN, total protein & albumin, serum liver enzymes, electrolytes, creatinine, fasting lipid profile, blood glucose
Screen for diabetes, osteoporosis, cervical & colon cancer
Vaccinations! - pneumo, influenza, varicella, HAV, HBV
Screen for other STDs, particularly gonorrhea, chlamydia, syphilis, Trichomonas vaginalis
Screen for TB infection & viral hepatitis (Histoplasma, Toxoplasma, CMV if patient is at risk)
Counseling on ways to prevent transmission and maintain health at EVERY office visit

29
Q

As long as the CD4 count is at _____, you can vaccinate your patient.

A

200

30
Q

What are the immunologic/virologic assessments for newly diagnosed HIV-infected patients that you should perform?

A

CD4 count
Viral load
Viral resistance testing

31
Q

How often should you check your patient’s CD4 count?

A

Repeat after initiation of ART and regularly thereafter.

32
Q

How often should you check your patient’s viral load?

A

Repeat after initiation or change in ART and regularly thereafter.

33
Q

How often should you check your patient’s viral resistance testing?

A

Repeat if viral load increases while on ART.

34
Q

How might a newly infected HIV patient have a resistant strain?

A

Infected partner had one.

35
Q

If virus becomes resistant, viral load can go _____ without seeing _____ ______ ______ ______.

A

…..up…..symptoms of disease progression.

36
Q

How do you measure viral load?

A

PCR

37
Q

What is considered a high viral load?

A

100,000 copies/mL or greater

38
Q

What is considered a low viral load?

A

10,000 copies/mL or greater

39
Q

What is considered an undetectable viral load?

A

below 400 or 50 copies/mL, depending on test

40
Q

What does it mean to say that viral load is a prognostic indicator?

A

High viral load predicts more rapid progression to AIDS.

41
Q

If the initial viral load is high, how crucial is it to begin ART?

A

Very

42
Q

What is the goal of ART in terms of viral load?

A

Reduce it to < 20-75 copies/mL of blood

43
Q

CD4 count is the major indicator of what?

A

Immune function

44
Q

What is an adequate response of CD4 cells to ART?

A

50-150 cells/micro-L per year

45
Q

When CD4 count decreases to a certain level, prevention of some opportunistic infections can be accomplished in what way?

A

Administration of prophylactic antimicrobials

46
Q

What prophylaxis would you give to a patient with low CD4 counts who is at risk for pneumocystis, toxoplasma, and mycobacterium avium infections?

A 
Pneumocystis (CD4 < 200/cmm) & Toxoplasma (CD4 < 50/cmm) - TMP/SMX
Mycobacterium avium (CD4 < 50/cmm) - asithromycin or clarithromycin
47
Q

Your treatment-naive patient is asymptomatic and has a CD4 count < 350 cells/mm^3. ART recommendation?

A

Strongly recommended

48
Q

Your treatment-naive patient has a CD4 count 350-500 cells/mm^3. ART recommendation?

A

Strongly recommended

49
Q

Your treatment-naive patient has a CD4 count > 500 cells/mm^3. ART recommendation?

A

Moderately recommended

50
Q

What are the classes of drugs being prescribed to treatment-naive patients?

A

NRTI, NNRTI, PI, INSTI, FI, chemokine receptor antagonist

51
Q

Why is ART treatment so important?

A

It can encourage a longer latency.

52
Q

What are potential benefits of early ART?

A

Slow progression (immune dysfunction secondary to chronic T cell activation, inflammation, T cell immune deficiency; HIV-related end-organ disease)
Reduction in viral load can decrease risk of transmission
All pregnant HIV-infected patients should receive ART to reduce risk of transmission to neonate

53
Q

What are the goals of ART?

A

Improve quality of life
Improve adherence to ART
Reduce toxicities
Reduce risk of virology failure

54
Q

What are potential disadvantages of early ART?

A

Some drugs have strong toxicities
Patients not exhibiting any symptoms could feel worse on drugs
Fear that resistance will wipe out all drug effectiveness (not really a true concern these days)

55
Q

How do you determine which drugs to chose after determining CD4 count, measuring viral load, and performing resistance testing?

A

Determine viral tropism

HLAB 5701 testing - prior to initiation of abacavir due to risk of hypersensitivity reaction

56
Q

What are some toxicities that may be caused by ART?

A 
Lactic acidosis
Hepatotoxicity
Lipodystrophy
Nephrotoxicity
Hyperlipidemia

CMBM Exam 4 CL (17 decks)

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