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CDM > HIV - Schoenwald > Flashcards

HIV - Schoenwald Flashcards

1
Q

HIV is a disease of _____ immunity.

A

Cell mediated

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2
Q

Function of CD4 cells?

A

Antigen presenting cells - help make antibodies

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3
Q

HIV transmission can be broken down into what 3 categories?

A

Blood
Sexual intercourse/Mucosa
Perinatal

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4
Q

T/F? HIV can be spread through breast milk. and intrapartum.

A

True

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5
Q

Antiretroviral therapy in a pregnant mother reduces the risk of transmission to the child by how much?

A

Reduces risk by 2/3

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6
Q

What antiretroviral is traditionally used for prevention of mother to child transmission?

A

AZT= Zidovudine (NRTI)

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7
Q

AIDS is defined by?

A

HIV + AIDS defining illness
OR
HIV with CD4 count < 200

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8
Q

What is the most common presentation of HIV?

A

**Asymptomatic pts

WITH (+) SCREENING TEST

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9
Q

Name a common co-infection (STI) with HIV

A

Syphilis “these 2 go hand in hand”

ALWAYS test new syphilis pts with HIV

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10
Q

Symptoms of HIV?

What viral load do they occur at

A
  • Fever,
  • night sweats
  • LAD (cervical),
  • unexpected wt loss

Occur at ANY CD4 ct. (MC <200)

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11
Q

What type if pneumonia is typically only found in immunocompromised patients, and is an AIDS defining illness?

A

Pneumocystis jiroveci (PCP)

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12
Q

Pneumocystis jiroveci is classified as a ______.

A

Fungus

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13
Q

What is the gold standard test for PJP?

A

Silver stain on sputum sample.

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14
Q

Classic x ray appearance of PJP?

A

Bilateral hilar infiltrate

butterfly pattern

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15
Q

Symptoms of PJP?

A
  • Fever
  • Dry cough
  • SOB
  • SEVERE HYPOXIA
  • Fatigue
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16
Q

Treatment for PJP?

A

High dose TMP/SMX
15-20mg/kg IV QD divided Q6-8hr dose.

+/- prednisone if paO2<70mmHg

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17
Q

When should HIV patients have prophylaxis for PCP?

A

If CD4 < 200

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18
Q

What medication is used for PJP prophylaxis?

A

Trimethoprim/sulfamethoxazole PO

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19
Q

What medication should be used for PJP prophylaxis in patients with sulfa allergies?

A

Dapsone or inhaled pentamidine

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20
Q

Purple, brownish lesions common is AIDS patients?

A

Kaposi’s sarcoma

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21
Q

Kaposi’s sarcoma is caused by?

A

Human herpes virus 8

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22
Q

Treatment for Kaposi’s sarcoma?

A

Reconstituting the immune system can get rid of them.

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23
Q

Name 3 early indicators of HIV infection.

Are they AIDs defining illnesses

A 
TB
Shingles
oral hairy leukoplakia
Thrush
“TOTS”

These are not AIDs defining illnesses

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24
Q

What is a retrovirus?

A

A RNA virus that depends on reverse transcriptase (RNA-dependent DNA polymerase) to replicate

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25
Q

What is the most common type of HIV in the US?

A

HIV 1

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26
Q

Where is HIV 2 found?

A

West Africa

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27
Q

Which type of HIV is more virulent?

A

HIV 1

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28
Q

HIV enters CD4 cells via what receptors?

Which is the main receptor?

A

CCR5 and CXCR4 chemokine receptors

CCR5

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29
Q

Acute HIV infection usually occurs within what time frame after exposure?

A

within 2 weeks of exposure

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30
Q

The most current screening test for HIV is?

What does it check?

A

COMBO or 4th generation testing (EIA)
Checks Ag-AB (Ag not on old ELIZA test)
Ie HIV AB &p24 AG

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31
Q

What test do you do after a (+) EIA/COMBO/4th gen to Confirm?

A

After EIA, CONFIRM with:

HIV RNA by PCR (by/ viral load)

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32
Q

What test is used to measure viral load?

A

Ultrasensitive quantitative RNA by PCR

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33
Q

What ID/medical screenings need to be done after a (+) EIA/COMBO & HIV RNA by PCR?

A 
SYPHILIS
TB, Toxoplasmosis (opportunistic infections)
Hepatitis
also,
CMP, CBC, LFTs, PAP
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34
Q

Combination or 4th generation testing (EIA) can show positivity how long after exposure?

A

2-6 weeks

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35
Q

When should HIV drug resistance testing be considered?

A

If viral load > 1000 copies/mL

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36
Q

Antiretroviral consists of medications of 4 classes. Name them.

A

Protease inhibitors (PI)
Nucleoside reverse transcriptase inhibitors (NRTI)
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Integrase inhibitors (INSTI)

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37
Q

A goal of antiretroviral therapy is suppression of viral load to _____.

A

<50 copies/mL

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38
Q 
Antiretroviral therapy typically consists of a backbone and a base. Which class of medications are the backbone.
Which are the base?
A

Backbone - typically two NRTIs

Base - either NNRTI or PI or integrase inhibitor

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39
Q

Name 4 commonly used complete combination pills.

A 
"GOAT"
Genvoya
Odefsey
Atripla
Triumeq
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40
Q

What complete combination is injectable once per month?

A

Cabenuva (cabotegravir + ripivirine)

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41
Q

Atripla is a combination of what medications?

A

Backbones: Tenofovir Disoproxil + Emtricitabine.
Base: Efavirenz (NNRTI)

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42
Q

Genvoya is a combination of what medications?

A

Backbones:
Tenofovir Alafenamide + Emtricitabine
Base: Elvitegravir, (INSTI)
Booster: cobicistat

“New Gen still likes Elvis”

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43
Q

Odefsey is a combination of what medications?

A

Backbones: tenofovir alafenamide + emtricitabine
Base: Rilpivirine (NNRTI)

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44
Q

What medications are approved for PrEP?

A

Descovy
Truvada
Cabotegravir

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45
Q

Truvada is a combination of what medications?

A

Backbones:
Tenofovir disoproxil
emtricitabine

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46
Q

Backbones of Descovy?

A

Backbones:
Tenofovir alafenamide
emtricitabine

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47
Q

Descovy and Truvada are what class of medications?

A

NRTIs

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48
Q

What is a commonly used NNRTI?

A

Efavirenz-Sustiva

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49
Q

Recommend screening for what STD in HIV (+) pts

A

Syphilis

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50
Q

What is the difference between tenofovir disoproxil and tenofovir alafenamide?

A

Disoproxil is older and has higher risk of renal failure and osteoporosis

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51
Q

Protease inhibitors all end in?

A

-navir

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52
Q

What is the preferred protease inhibitor

A

Darunavir

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53
Q

Integrase strand transfer inhibitors end in?

A

-egravir

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54
Q

According to the most recent guidlines, when should HIV treatment be considered?

A
  • *ALL HIV (+) PATIENTS should be considered for treatment, regardless of CD4 count.
  • *START EARLY
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55
Q

What should patients be screened for before starting Abcavir (In Triumeq)?
Why?

A

HLA-B*5701

To reduce the risk of a hypersensitivity reaction.

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56
Q

What are some of the most common side effects of PI’s (group w/most S/E)?

A 
Facial wasting
HLD
Lipodystrophy
Hepatotoxicity
GI intolerance
increased bleed in hemophiliacs
DDI
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57
Q

What are some s/e of NRTIs

A

Lactic acidosis
Hepatic steatosis
Lipodystrophy

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58
Q

What is IRIS - Immune Reconstitution Syndrome

When does it happen?

A

Condition caused by an inflammatory reaction in response to rapid increase of CD4 counts
-Occurs after initiation of ART

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59
Q

What testing should be done for HIV patients every 6-12 months?

A

CD4 and viral load
Anal Pap smears
Cervical pap smears

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60
Q

Patients should have prophylaxis for toxoplasmosis at CD4 counts _____.

A

<100

61
Q

What medication is used for prophylaxis of toxoplasmosis

A

TMP/SMX or Dapsone + pyrimethamine

62
Q

Patients should have prophylaxis for mycobacterium avium complex (MAC) at CD4 counts _____.

A

<50

63
Q

T/F: Immune Reconstitution Syndrome is a diagnosis of exclusion

A

True

64
Q

What medications are commonly used for pre exposure prophylaxis (PrEP)?

A

Truvada (only men)
or Raltagravir
or Cabotegravir

65
Q

How long are post exposure prophylaxis (PEP) meds given?

A

1 month

66
Q

Post exposure prophylaxis (PEP) should be started how soon after exposure?

A

ASAP, but generally within 72 hours.

67
Q

Failure rate of PrEP?

A

1-6%

68
Q

HIV status should be checked how often in PrEP patients?

A

3mo!!

Cabotegravir needs an earlier f/u 1mo after initialtion.

69
Q

What PrEP med would would you choose for a patient with renal impairment?

A

Descovy - it has tenofovir alafenamide rather than tenofovir disoproxil

70
Q

What opportunistic infection presents with an influenza like illness and is diagnosed by IgM/IgG serology?

A

Coccidioidomycosis
Coccidioides immitis
(San Joaquin Valley fever)

71
Q

Treatment for Coccidioidomycosis

(Coccidioides immits)?

A

No tx normally

Fluconazole/DifluCan if pt is having persistent or severe infection.

72
Q

Is Coccidioides immits an AIDS defining illness?

A

No

73
Q

Histoplasmosis is linked to exposure to ________ along the Ohio River Valley?
How is it diagnosed?

A 
Bird droppings and bat guano
Ag test (serum, CSF, urine) or tissue Bx
74
Q

Treatment for Histoplasmosis?

A

itraconazole for mild-moderate and amphotericin B for severe disease

75
Q

Is histoplasmosis an AIDS defining illness?

A

Yes

76
Q

Blastomycosis is linked to exposure to _______ along the Ohio River Valley?

A

Dust

“Blasts from InDUSTrial sites”

77
Q

T/F? Disseminated Blastomycosis only occurs in AIDS and immunosuppressed patients.

A

False - can happen to anyone

“Blast for both parties”

78
Q

Diagnosis of Histoplasmosis is done by?

A

Serum, urine, or CSF antigen test
OR
tissue biopsy.

79
Q

Diagnosis of blastomycosis is done by?

A

Biopsy and culture

“Bx for Blasto”

80
Q

Treatment for blastomycosis?

A

Itraconazole for mild-mod dz

amphotericin B for severe disease

81
Q

Toxoplasmosis is associated with exposure to?

A

Cat litter boxes

82
Q

IS toxoplasmosis in HIV usually primary infection or reactivation?

A

Reactivation

83
Q

When is toxoplasmosis usually a primary infection?

A

In pregnancy

84
Q

Characteristic findings on brain MRI in toxoplasmosis?

A

***Punched out lesions

85
Q

Risk to HCW with needle stick?

A

LOW

1:300

86
Q

Common AIDS defining Illnesses

A
  • **Candidiasis of Esophagus
  • Candidiasis of bronchi, trachea, or lungs
  • Coccidioidomycosis, DISSEMINATED
  • Histoplasmosis, DISSEMINATED
  • Kaposi Sarcoma
  • Burkitts lymphoma
  • Primary Lymphoma of brain (99% in AIDS)
  • Pneumocystis carnii PNA (PJP/PCP)
87
Q

T/F? PJP PNA pts often present without severe hypoxia

A

False

PJP often present w/severe hypoxemia

88
Q

People with deletions in what chemokine receptor are less likely to become infected with HIV?

A

CCR5

89
Q

What does the HIV virus do to the cell during the latent state?

How long can the Latent State of HIV last?

A

Integrates HIV genome into host cell genome.

Could be up to 10yrs

90
Q

What happens to CD4 count with increased length of HIV infection?

A

CD4 count ↓ w/ ↑ length of infect

91
Q

What is Acute Retrovirus Syndrome (Acute HIV) MC mistaken for?

A

MONO

Flu like symptoms

92
Q

Diff B/W Mono & HIV

A

Rash 5-10% time MONO

Rash >80% of time in Acute HIV
Maculopapular rash & mucosal ulcerations

93
Q

SxS of ARS (Acute HIV)?

A
  • HIGH fever
  • Fatigue
  • LAD
  • Pharyngitis
  • Rash
94
Q

MC Infections w/CD4 200-500

A
  • Thrush
  • Oral Hairy Leukoplakia**
  • TB
  • Shingles
    “200 TOTS”
95
Q

MC infections w/CD4 <200

A
  • Candida esophagitis**
  • HSV**
  • PCP**
    “CHP”
96
Q

MC infections W/CD4 <100

A
  • Cryptococcus
  • Histoplasmosis
  • Aspergillus
97
Q

MC infections w/CD4 <50

A
  • M avium complex

- CMV

98
Q

T/F: HIV is a chronic illness that we can manage

A

True

99
Q

T/F? Rapid testing (saliva) is as sensitive as combo 4th gen Ab-Ag (EIA) testing?

A

False

EIA then HIV RNA by PCR is test of choice

100
Q

T/F? ELIZA looks for Both HIV AB & p24 AG

A

False. That is Combo 4th gen testing (EIA)
Eliza only looks for ABs

P24 is a structural protein that makes up most of the HIV viral core

101
Q

What is it called when a TB test is negative because the CD4 count is <50?

A

anergy

102
Q

Who should be tested for HIV?

What does the CDC recommend?

A

CDC recommends opt-out testing but…….

  • Anyone 13-64 that:
  • IVDU and their sex partners
  • Persons who exchange sex for money or drugs
  • Sex partners of HIV infected persons
  • Anyone who has sex
103
Q

Triumeq is a combo of what drugs?

A

Backbones:
Lamivudine
Abacavir
Base: Dolutegravir (INSTI)

“LA Dodgers are triumphant”

104
Q

Common 1st line regiments of ART

A

Preferred: 2 NRTI’s + 1 INSTI
Historic: 2 NRTI’s + 1 NNRTI (ie Atripla)
or
Triumeq (check for Abacavir rash) (lamuvidine+ Abacavir + dolutegravir)
or
Dovato (Lamivudine+dolutegravir)

105
Q

T/F: End organ damage can occur at any stage of HIV infection?

A

True

106
Q

How to use CD4 count levels to guide ART Tx (1st 2yrs)?:

A
  • check CD4 Immediately before starting ART
  • check baseline 2x in Q3-6mo,
  • check baseline Q3-6mo for 2yr after
107
Q

Common S/E for PI’s

A 
*Facial Wasting
Hyperlipidemia 
Lipodystrophy 
Hepatotoxicity
GI intolerance
Possibility of ↑ bleeding risk
for hemophiliacs
Drug-drug interactions
108
Q

Common S/E from NRTI’s

A

Lactic acidosis
Hepatic steatosis
Lipodystrophy
(highest incidence with Stavuine)

109
Q

Common S/E from NNRTI’s

A
  • Rash, including Stevens-Johnson syndrome
  • Hepatotoxicity (Nevirapine)
  • DDI

Sustiva (CNS Effects-sleepwalking)

110
Q

How long can HIV be dormant?

A

10yr

111
Q

Blood transfusion risk if blood infected?

A

95%

112
Q

What is HIV?

A

Virus present w/o AIDS defining illness

113
Q

T/F: If Dx with AIDS and CD4 comes up (>200), pt now has HIV?

A

False, will still have AIDS even if CD4 count comes up.

114
Q

T/F: Are all opportunistic infections AIDS defining Illnesses?

A

False. ie Thrush, oral hairy leukoplakia, shingles

115
Q

What stage of HIV infection MOST LIKELY presents with symptoms?
Is this the most common presentation?

A

ACUTE HIV
2wks post exposure

No, MC presentation with symptoms is years later with opportunistic infection.

116
Q

Locations of Kaposi Sarcoma?

A
  • Body wide

- inside mouth

117
Q

How many cases of HIV in US?

What percent of HIV pts are unaware?

A

1mil

20%

118
Q

What groups are most affected by HIV?

A

Gay and bisexual men

119
Q

What groups have the highest number of new HIV dx?

A

Black gay & bisexual men

120
Q

What tests are performed after confirmation of EIA/Combo/4th gen & HIV RNA by PCR?

A
  • CD4 count (baseline)
  • Ultrasensitive quantitative RNA by PCR
  • Rapid Testing (not as sensitive as combo/EIA)- saliva, SUDS in ER- serum test)

“CUR”

121
Q

Name 3 Historic NRTI’s and 2 newer choices

A 
Historical:
Zidovudine (AZT)- preggers
Lamivudine (3TC)
Abacavir (ABC)
“ZAL”

Newer Choices:
Emtricitabine (FTC)
Tenofovir (TAF)
“ET”

122
Q

Benefits of early HIV tx

A
  1. Earlier ART prevents HIV-related End-Organ Damage
  2. decreases HIV-assoc inflammation
  3. Potential decrease in risk of complications (Nephropathy, Liver dz from Hep, CVD, Malignancies, Neurocognitive decline, Blunted immune respone of old age)
123
Q

T/F: Start Cabotegravir PO (Vocabria) with Cabotegravir IM (Cabenuva) Q1wk to start before sole Cabenuva IM tx

A

Yup, that’s what you do

124
Q

S/E of ART

A 
High potential for adverse effects
- rash
- diarrhea
- pancreatitis
- HLD
- Lipodystrophy
- inc CVD risk
CNS effects (distrubances)
125
Q

Vaccinations for Prophylactic HIV mgmt

A
  • pneumococcal
  • Hep A&B
  • TDaP
  • Meningitis
  • FLu
  • COVID
  • SHingles
  • HPV (all <26yo. 26-45 shared decision)
126
Q

HIV mgmt checklist post-2yrs(5)?
If CD4 <200?
If CD4 <50?

A
  • CD4 & viral load (Q6-12mo)
  • PPD/Quantiferon
  • RPR (syphilis coinfect)
  • Toxoplasmosis (AB- reactivation infection)
  • Anal/Cervical PAP (Q6-12mo)
    If CD4 <200 (PCP prophylaxis)
    If CD4 <50 (MAC prophylaxis)
127
Q

T/F: you can give Cabotegravir for PEP

A

False, only indicated for PrEP

128
Q

If source of HIV (+) exposure is known, what is used for PEP?

A

PEP with the effective agent utilized by the person

129
Q

How much does PrEP decrease risk of HIV by?

A

92-99%

130
Q

(+) screenings for PrEP from assessing risk behavior in heterosexual men?
These pts need discussion &/or use of PrEP

A
  • Bacterial STI in 6mo
  • 1+ partners w/unk HIV status
  • Don’t use condoms
  • HIV known partner
131
Q

Pearls for PrEP (3)

A
  • Check HIV status prior to initiation & Q3mo after
  • check for SxS acute HIV (ie Fever, Rash, LAD)
  • Check for other STIs Q3-6mo
  • Check renal function (CrCl >30)
  • Check Hep B immunity
132
Q

T/F: PrEP reduces risk of other STIs

A

Nope!

133
Q

T/F: Descovy PrEP is for men & transgender women only

A

True

“Descovy=dicks only’

134
Q

Cabotegravir dosing for PrEP

A

dose 600mg=3mL injection
2nd dose 4wks later
then 8wks

135
Q

How often is follow up for PrEP?

A

**1st FOLLOW UP IS 1mo FROM 1st VISIT

**CHECK HIV STATUS EVERY 3mo!!

136
Q

F/U for PrEP

A 
Q3mo
HIV testing
Medication monitoring/stress adherance
Counseling/behavioral risk reduction
Assess renal function, if normal, then Q6mo
Oral/rectal STD screening if appropriate
Pregnancy testing if appropriate
137
Q

F/U for Cabotegravir PrEP

A
138
Q

T/F: It is better to start Zidovudine early (14wks or later) in pregnancy for best outcomes?

A

Trueee

139
Q

T/F: Coccidioidomycosis is often asx and should be treated with Diflucan always

A

False. Cocci is often asx

but should only use Diflucan if immunosuppressed.

140
Q
  1. _____ is a disseminating dz in immunocomrpomised pts/AIDS

2. ______ is a disseminating dz possible in ALL pts

A
  1. Histoplasmosis
  2. Blastomycosis

“Histo dissem in HIV”
“Blasto for Both”

141
Q

What is a reactivation infection?

A

Reactivation is the mechanism whereby a latent virus that has infected a host cell switches to a lytic stage, undergoing productive viral replication and allowing the virus to spread.

142
Q

During the eclipse period, what viral marker goes up first? How do we detect this marker?

A

RNA (before p24 AG)
HIV RNA by PCR (NAT)

This is also the confirmatory test for EIA

143
Q

3 Drugs that have tenofovir alafenamide?

A

Genvoya
Odefsey
Descovy
“Ala= GOD”

144
Q

2 Drugs that have tenofovir disoproxil?

A

Atripla
Truvada
“DAT”

145
Q

PEP Rx?

A

Truvda

Raltegravir

146
Q

How often do we check STDs in PrEP pts?

A

Q3-6mo

147
Q

SxS Histoplasmosis

A

Many infections “asymptomatic”

usually pulmonary symptoms if presenting

148
Q

SxS Blastomycosis

A

Many infections “asymptomatic”; usually start as pulmonary infections with CUTANEOUS DISSEMINATION

149
Q

SxS Toxoplasmosis

A

focal neurologic findings

fever

CDM (16 decks)

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