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Clinical Decision Making Exam 2 > Schoenwald - HIV > Flashcards

Schoenwald - HIV Flashcards

1
Q

mc opportunistic infxn associated w. HIV

A

PCP - pneumocystis PNA

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2
Q

mc opportunistic infxn associated w. HIV

A

PCP - pneumocystis PNA

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3
Q

2 types of immunity

A

innate

adaptive

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4
Q

innate immunity includes (3)

A

skin/mucosa

cells

complement

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5
Q

3 types of cells associated w. innate immunity

A

WBC

macrophages

natural killer cells

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6
Q

2 types of cells associated w. adaptive immunity

A

B-lymphocytes → plasma cells

T-lymphocytes → CD4, CD8

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7
Q

2 types of adaptive immunity

A

humoral

cell mediated

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8
Q

cells associated w. humoral immunity

A

B

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9
Q

cells associated w. cell mediated immunity

A

T

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10
Q

HIV directly affects what type of cell

A

CD4

helper T cells

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11
Q

3 major modes of HIV transmission

A

mucosa → genital/rectal

blood

breast feeding

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12
Q

4 blood transmission modes of HIV

A

transfusion

MTCT (mother to child transmission)

injxn drug use

needle stick

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13
Q

universal precautions for HIV transmission prevention

A

hand washing

safe disposal of infected material

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14
Q

t/f: hep B and C are more transmissible than HIV

A

T!

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15
Q

most infectious blood borne pathogen

A

hep B

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16
Q

HIV definition

A

presence of virus w.o AIDS defining illness

(+) blood test, no symptomology

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17
Q

AIDS definition

A

HIV (+) w. AIDS defining illness

AND/OR

HIV (+) w. CD4 < 200

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18
Q

besides CD4 count, another lab value suggestive of AIDS

A

low platelets

not diagnostic, she just mentioned this

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19
Q

t/f: once pt has dx of AIDS, they will always have this dx even if CD4 count comes back up

A

T!

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20
Q

6 AIDS defining illnesses Schoenwald stressed

A

candidiasis of esophagus, bronchi, trachea, lungs

histoplasmosis

disseminated isosporiasis

kaposi’s sarcoma

lymphoma: burkitt’s, immunoblastic, primary brain/CNS

toxoplasmosis of brain

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21
Q

what type of candidiasis is NOT considered an AIDS defining illness

A

thrush

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22
Q

4 sx of HIV/AIDS

A

fever

unintentional wt loss

night sweats

LAD

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23
Q

mc presentation of HIV

A

asymptomatic

incidental dx

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24
Q

if not asymptomatic, HIV may present w.

A

opportunistic infxn

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25
Q

anyone w. new dx of __ should be screened for HIV

A

syphilis

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26
Q

what stage of HIV is most likely to be symptomatic

A

acute

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27
Q

PJP is same-same

A

PCP

pneumocystis carinii vs jiroveci

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28
Q

what type of PNA is PCP/PJP

A

fungal

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29
Q

gs test for PCP/PJP

A

silver stain on sputum or bronchi wash

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30
Q

preferred test for PCP/PJP

A

PCR

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31
Q

CXR findings of PCP/PJP

A

bilateral hilar infiltrates

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32
Q

what is this CXR showing

A

PCP/PJP

bilatral hilar PNA

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33
Q

4 sx of PCP/PJP

A

fever

dry cough

SOB/severe hypoxemia

fatigue

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34
Q

pharm for PCP/PJP

A

trimethoprim/sulfamethoxazole

prednisone

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35
Q

dosing for trimethoprim/sulfamethoxazole for PCP/PJP

A

15-20 mg/kg IV q day divided into 6-8 hr dosing

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36
Q

dosing for prednisone for PCP/PJP

A

40 mg po bid

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37
Q

indication for prednisone for PCP/PJP

A

paO2 < 70 mm/HG

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38
Q

indication for PCP/PJP prophylaxis

A

CD4 < 200

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39
Q

1st line for PCP/PJP prophylaxis

A

PO trimethoprim/sulfamethoxazole

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40
Q

med for PCP/PJP prophylaxis if pt has sulfa allergy

A

dapsone

OR

inhaled pentamidine

must go to infusion center

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41
Q

what are these showing

A

kaposi’s sarcoma →

purplish, brownish lesions

can be body wide → inside of mouth

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42
Q

kaposi’s sarcoma is caused by

A

human herpes virus 8

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43
Q

tx for kaposi’s sarcoma

A

reconstitute/restore immune fxn

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44
Q

4 pathogens of concern with CD4 count > 500

A

acute retroviral syndrome

thrush

esophagitis

PCP/PJP

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45
Q

4 pathogens of concern when CD4 is btw 200-500

A

thrush

oral hairy leukoplakia

TB

shingles

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46
Q

3 pathogens of concern when CD4 is <200

A

HSV

candida esophagitis

PCP/PJP

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47
Q

7 pathogens of concern when CD4 is < 100

A

histoplasmosis

toxoplasmosis

cryptococcosis

cryptosporcollosis

aspergillus sp

m. avium complex

CMV

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48
Q

4 major pathogens of concern when CD4 is < 50

A

myobacterium

aspergillus sp

m. avium complex

CMV

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49
Q

2 pops w. highest number of new HIV dx

A

AA

gay/bisexual men

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50
Q

pt pop most affected by HIV

A

gay/bisexual men

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51
Q

region of US most affected by HIV

A

south

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52
Q

HIV is a retrovirus that depends on __ to replicate

A

reverse transcriptase

RNA dependent DNA polymerase

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53
Q

most prevalent type of HIV in US

A

HIV 1

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54
Q

t/f: HIV 1 is more virulent than HIV 2

A

T!

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55
Q

HIV enters CD4 cells via what 2 chemokine receptors

A

CCR5

CXCR4

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56
Q

pharm for HIV targets __ chemokine receptor

A

CCR5

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57
Q

T/F: people w. CCR5 deletions are less likely to become infected w. HIV

A

T!

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58
Q

what stage of HIV is characterized by integration of HIV genome into the cell

A

latent

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59
Q

5 stages of HIV

A
  1. viral entry
  2. reverse transcriptase
  3. integration
  4. transcription/translation
  5. assembly/budding
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60
Q

90% of HIV is asymptomatic, what are 5 common presenting sx if not

A

fever/night sweats/wt loss

kaposi’s sarcoma

lymphoma

oral lesions → hairy leukoplakia

thrush (not considered AIDS defining)

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61
Q

3 stages of HIV infxn

A

acute retroviral syndrome → 1-12 weeks

clinical latency → 6-10 years

AIDS → 1-2 years

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62
Q

when do sx/infxns related to AIDS/HIV occur

A

CD4 is going down

viral load coming up →

acute and AIDS

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63
Q

acute retroviral syndrome begins w.

A

exposure

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64
Q

sx of acute retroviral syndrome

A

nonspecific flu like →

fever

fatigue

pharyngitis

LAD

rash

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65
Q

t/f: pt’s are highly infectious during acute retroviral syndrome

A

T!

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66
Q

describe the rash associated w. acute retroviral syndrome

A

body wide → including mucosa

lacy

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67
Q

acute retroviral syndrome may mimic

A

mono

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68
Q

in acute retroviral syndrome, rash is present in __% of cases

in mono, rash is present in __% of cases

A

80%

5-10%

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69
Q

what is this showing

A

rash associated w. acute retroviral syndrome

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70
Q

CDC recommends __ for HIV screening, but most places in US do not do this

A

opt out testing

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71
Q

T/F: in CO you have to get consent before testing for HIV

A

T!

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72
Q

who should be screened for HIV

A

anyone who is sexually active

73
Q

what HIV test is no longer used clinically

A

ELISA w. western blot confirmation

74
Q

gs test for HIV screening (now recommended over ELISA)

A

combo or 4th gen testing → EIA

75
Q

what test confirms EIA results

A

NAT → quantitative HIV RNA by PCR

measures viral load

76
Q

EIA test can be positive as soon as __ days after infxn

77
Q

the EIA test measures (2)

A

HIV ab

p24 ag

78
Q

next steps if EIA test is positive (2)

A

measure CD4 count

ultrasensitive quantitative RNA by PCR (NAT)

79
Q

HIV test done in the ER

A

SUDS → rapid test

80
Q

the ELISA test measures __ only

and takes __ weeks for results

81
Q

clinical usefulness of baseline CD4 testing

A

compares baseline CD4 to CD4 as viral load increases

not done on every pt

82
Q

HIV pt’s should also be screened for (4)

A

hep A, B, C

TB

toxoplasmosis

STIs

83
Q

HAART (highly active antiretroviral therapy) is same-same

A

antiretroviral therapy

they are all highly reactive

84
Q

4 types of antiretroviral therapy

A

protease inhibitors

integrase inhibitors

nucleoside reverse transcriptase inhibitors (NRTI) → “nucs”

non nucleoside reverse transcriptase inhibitors (NNRTI) → “non-nucs”

85
Q

what do you think when you see an HIV pt who is blue colored

A

colloidal silver supplement

86
Q

viral load goal of antiretroviral therapy

A

< 50 copies/ml

undetectable is preferred

87
Q

3 drug antiretroviral regimen

A

backbone → NRTI

base/add-in → NNRTI OR PI

integrase inhibitor → reltegravir

88
Q

complete regimen 2 drug combo pills

A

cabenuva → cabotegravir + rilpivirine

dovato → dolutegravir + lamivudine

juluca → dolutegravir + rilpivirine

89
Q

3 commonly used complete regimen 3 drug combo pills

A

atripla

genvoya

triumeq

90
Q

what drug is a commonly used entry inhibitor (anti CCR5)

A

selzentry

  • pt must have CCR5 receptor for drug to work → testing done first*
  • not a 1st line drug*
91
Q

commonly used 2 drug PREP combo

A

descovy

truvada

not complete therapy alone

92
Q

historical choice NRTIs (backbone) (3)

A

zidovudine (AZT)

lamivudine (3TC)

abacavir (ABC)

93
Q

newer choice NRTIs (backbone) (2)

A

emtricitabine (FTC)

tenofivir (TAF)

94
Q

1st gen NNRTIs (3)

A

nevirapine (NVP)

delavirdine (DLV)

efavirenz (EFV)

95
Q

2nd gen NNRTIs (2)

A

etravirine (ETR)

rilpivirine (RPV)

96
Q

which NNRTI is commonly added to backbone of ETC or TAF

A

efavirenz (EFV)

97
Q

2 formulations of tenofivir

A

original → disoproxil

new → alafenamide

98
Q

which formulation of tenofivir has a higher risk of causing renal failure and OP

A

original → tenofivir disoproxil

99
Q

4 protease inhibitors that are still used

A

-navir

lopinavir (LPV)

atazanavir (ATV)

ritonavir (RTV)

darunavir (DRV)

100
Q

preferred PI

A

darunavir (DRV)

101
Q

which PI is used as part of COVID therapy but has lots of DDIs

A

ritonavir (RTV)

102
Q

INSTIs (integrase inhibitors) (4)

A

-egravir

raltegravir (RAL)

elvitegravir (EVG)

dolutegravir (DTG)

cavetagravir

103
Q

which PI is newer and injectable

A

cavetagravir

104
Q

HIV combo meds to know (6)

A

atripla

stribild

genvoya

complera

odefsey

triumeq

105
Q

historic choice for combo complete regimen drug (once daily dosing)

A

atripla →

tenofivir disoproxil

emtricitabine

efavirenz

106
Q

HIV combo med that is not used as 1st line anymore

107
Q

genvoya

A

elvitegravir/cobicistat

emtricitabine

tenofivir alfenamide

108
Q

__ acts as a booster to help elvitegravir get into cells

A

cobicistat

109
Q

what HIV combo med is contraindicated in renal dz

110
Q

complera

A

emtricitabine

rilpivirine

tenoficir disoproxil

111
Q

odefsey

A

emtricitabine

rilpivirine

tenoficir alafenamide

112
Q

triumeq

A

dolutegravir

abacavir

lamivudine

113
Q

historical tx guidelines based on CD4 count

A

>500 → monitor

<500 → consider initiation

<350 → initiate tx

114
Q

most recent guideline for initiation of tx

A

all HIV (+) should be considered for initiation of tx regardless of CD4 count

115
Q

3 common first line regimens for HIV

A

1.

  • historic: 2NRTI + INSTI
    • tenofivir and emtricitabine + bictegravir
  • preferred: 2NRTI + NNRTI
    • tenofivir and truvada + efaverenz = atripla

2. Triumeq: 2NRTI + INSTI

  • abacavir and lamivudine + dolutegravir

3. Dovato: 2 drug regimen - NRTI + INSTI

  • lamivudine + dolutegravir
116
Q

common first line regimen that needs HLAB*570 testing prior to initiation

A

triumeq →

dolutegravir

abacavir -> causes life threatening rash

lamivudine

117
Q

why do we need to do HLAB*570 testing prior to initiation of triumeq

A

abacavir can cause fatal allergic rash

118
Q

2 drug regimen that is a common first line regimen

A

dovato →

dolutegravir

lamivudine

119
Q

t/f: end organ damage occurs at all stages of HIV infxn

A

T!

tx should be started early

120
Q

CD4 monitoring guidelines (4)

A

baseline x 2 and q 3-6 months

immediately before beginning ART OR if CD4 < 300

after 2 years on ART w. HIV RNA consistently suppressed

121
Q

monitoring of CD4 300-500

A

q 12 months

122
Q

monitoring of CD4 > 500

123
Q

step 2 of HIV life cycle

A

reverse transcription

124
Q

step 3 of HIV life cycle

A

integration

125
Q

step 5 of HIV life cycle

A

assembly and budding

126
Q

which drugs work at step 2 of HIV life cycle

A

NRTIs

NNRTIs

127
Q

which drug works at step 3 of the HIV life cycle

A

integrase inhibitors

128
Q

which drug works at step 5 of HIV life cycle

A

protease inhibitors

129
Q

t/f: ART has high potential for adverse effects

130
Q

common s.e of ART

A

rash

diarrhea

pancreatitis

hyperlipidemia/lipodystrophy

increased cardiac risk

CNS → psychological disturbance

131
Q

s.e of PIs (6)

A

hyperipidemia

lipodystrophy

hepatotoxicity

GI intolerance

bleeding risk for hemophiliacs

ddi

132
Q

s.e of NRTIs

A

lactic acidosis

hepatic steatosis

lipodystrophy

133
Q

risk of hepatic steatosis is highest w.

A

in order:

d4T

ddl

zdv

134
Q

risk of hepatic steatosis is lowest w.

A

tdf

abc

3tc

ftc

135
Q

risk of lipodystrophy is highest w.

136
Q

s.e of NNRTIs

A

rash/SJS

hepatotoxicity

ddi

sleep walking/vivid dreams/nightmares

137
Q

hepatotoxicity is highest w. which NNRTI

138
Q

what is this showing

A

lipodystrophy

139
Q

inflammatory rxn in response to rapid reconstitution of CD4 counts after initiation of ART

A

IRIS → immune reconstitution syndrome

140
Q

IRIS can unmask __

and is a dx of __

A

opportunistic infxn

exclusion

141
Q

routine management for HIV pt

A

cd4/viral load q 6-12 mo

PPD/quantiferon gold testing → TB

RPR → sypillis

toxoplasmosis abs

anal pap/cervical pap q6-12 mo

prophylaxis if indicated

142
Q

prophylaxis if cd4 < 200

143
Q

prophylaxis if cd4 < 50

A

PCP/PJP

MAC (myobacterium avium complex)

144
Q

prophylaxis if cd4 < 100

A

trimethoprim sulfa

OR

dapsone + pyrimethamine

145
Q

prophylaxis for MAC

A

clarithro/azithro

146
Q

PEP should be given w.in __ hours of exposure

147
Q

how long is PEP given

148
Q

2 approved and mc used PEP regimens (post exposure)

A

Truvada → emtricitabine + tenofivir disoproxil

Descovy → emtricitabine + tenofivir alafenamide

149
Q

how often are Truvada and Descovy taken

150
Q

USPSTF guidelines for who should take PREP (pre exposure)

A

persons at high risk for infxn

IV drug usage and/or sexual risk for HIV

151
Q

3 drugs approved for PREP

A

Truvada

Descovy

Cabotegravir (Apretude)

152
Q

what new PREP drug is injectable and administered q 2 months, but is not currently approved

A

cabotegravir

153
Q

4 high risk factors considered in PREP indications

A

HIV (+) partner

1 or more sex partners of unknown HIV status

had bacterial STI in past 6 months

IVDU

all sexually active should have counseling about PREP

154
Q

Truvada for PREP is approved for

A

men

women

transgender

155
Q

Descovy for PREP is approved for

A

men

transgender women

156
Q

cabotegravir for PREP is recommended for

A

men

women

transgender

157
Q

for patient’s on PREP, HIV status should be checked (2)

A

prior to initiation

q 3 months after initiation

158
Q

besides HIV status, 4 other screening tests for patients on PREP

A

STI q 3-6 months

renal fxn

Hep B immunity

pregnancy

159
Q

risk of perinatal transmission when no tx is given

160
Q

drug administered during pregnancy/labor and delivery to reduce risk of vertical transmission by ⅔

A

Zidovudine

161
Q

when can Zidovudine be administered in pregnant pt

A

as early as 14 weeks into pregnancy

162
Q

4 miscellaneous opportunistic infxns

A

coccidioidomycosis

histoplasmosis

blastomycosis

toxoplasmosis

163
Q

coccidioidomycosis is same-same

A

san joaquin valley fever

164
Q

40% of pt w. san joaquin valley fever present w.

A

flu like sx

high fever, night sweats

165
Q

dx for san joaquin valley fever

A

serology → IgM/IgG

166
Q

generally, no tx is indicated for san joaquin valley fever - pharm if tx is indicated

167
Q

opportunistic infxn that is linked to bird droppings or bat guano exposure along ohio river valley

A

histoplasmosis

168
Q

if not asymptomatic, presenting sx of histoplasmosis

A

pulmonary sx

169
Q

dx for histoplasmosis (2)

A

antigen → serum, urine, CSV

OR

tissue bx

170
Q

tx for histoplasmosis: mild-mod and severe

A

mild-mod: itraconazole

severe: amphotericin B

171
Q

opportunistic infxn linked to soil exposure along ohio river valley - esp dust exposure (ex. construction)

A

blastomycosis

172
Q

if not asymptomatic, presenting sx of blastomycosis

A

pulmonary infxn

cutaneous dissemination

173
Q

dx for blastomycosis

A

bx and culture

174
Q

tx for blastomycosis mild-mod and severe

A

mild-mod: itraconazole

severe: amphotericin B

175
Q

opportunistic infxn associated w. litter boxes

A

toxoplasmosis

176
Q

toxoplasmosis infxn in HIV pt is usually __

and not primary infxn

A

reactivation of infxn

177
Q

sx of toxoplasmosis

A

focal neurologic findings

fever

178
Q

MRI findings of toxoplasmosis

A

punched out lesion

179
Q

what is this showing

A

punched out lesion → toxoplasmosis

Clinical Decision Making Exam 2 (10 decks)

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