Schoenwald - HIV Flashcards
(179 cards)
1
Q
mc opportunistic infxn associated w. HIV
A
PCP - pneumocystis PNA
2
Q
mc opportunistic infxn associated w. HIV
A
PCP - pneumocystis PNA
3
Q
2 types of immunity
A
innate
adaptive
4
Q
innate immunity includes (3)
A
skin/mucosa
cells
complement
5
Q
3 types of cells associated w. innate immunity
A
WBC
macrophages
natural killer cells
6
Q
2 types of cells associated w. adaptive immunity
A
B-lymphocytes → plasma cells
T-lymphocytes → CD4, CD8
7
Q
2 types of adaptive immunity
A
humoral
cell mediated
8
Q
cells associated w. humoral immunity
A
B
9
Q
cells associated w. cell mediated immunity
A
T
10
Q
HIV directly affects what type of cell
A
CD4
helper T cells
11
Q
3 major modes of HIV transmission
A
mucosa → genital/rectal
blood
breast feeding
12
Q
4 blood transmission modes of HIV
A
transfusion
MTCT (mother to child transmission)
injxn drug use
needle stick
13
Q
universal precautions for HIV transmission prevention
A
hand washing
safe disposal of infected material
14
Q
t/f: hep B and C are more transmissible than HIV
A
T!
15
Q
most infectious blood borne pathogen
A
hep B
16
Q
HIV definition
A
presence of virus w.o AIDS defining illness
(+) blood test, no symptomology
17
Q
AIDS definition
A
HIV (+) w. AIDS defining illness
AND/OR
HIV (+) w. CD4 < 200
18
Q
besides CD4 count, another lab value suggestive of AIDS
A
low platelets
not diagnostic, she just mentioned this
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!
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
21
Q
what type of candidiasis is NOT considered an AIDS defining illness
A
thrush
22
Q
4 sx of HIV/AIDS
A
fever
unintentional wt loss
night sweats
LAD
23
Q
mc presentation of HIV
A
asymptomatic
incidental dx
24
Q
if not asymptomatic, HIV may present w.
A
opportunistic infxn
25
anyone w. new dx of __ should be screened for HIV
syphilis
26
what stage of HIV is most likely to be symptomatic
acute
27
PJP is same-same
PCP
*pneumocystis carinii vs jiroveci*
28
what type of PNA is PCP/PJP
fungal
29
gs test for PCP/PJP
**silver stain** on sputum or bronchi wash
30
preferred test for PCP/PJP
PCR
31
CXR findings of PCP/PJP
bilateral hilar infiltrates
32
what is this CXR showing
PCP/PJP
bilatral hilar PNA
33
4 sx of PCP/PJP
fever
dry cough
SOB/**severe hypoxemia**
fatigue
34
pharm for PCP/PJP
trimethoprim/sulfamethoxazole
prednisone
35
dosing for trimethoprim/sulfamethoxazole for PCP/PJP
15-20 mg/kg IV q day divided into 6-8 hr dosing
36
dosing for prednisone for PCP/PJP
40 mg po bid
37
indication for prednisone for PCP/PJP
paO2 \< 70 mm/HG
38
indication for PCP/PJP prophylaxis
CD4 \< 200
39
1st line for PCP/PJP prophylaxis
PO trimethoprim/sulfamethoxazole
40
med for PCP/PJP prophylaxis if pt has sulfa allergy
dapsone
OR
inhaled pentamidine
*must go to infusion center*
41
what are these showing
kaposi's sarcoma →
purplish, brownish lesions
can be body wide → inside of mouth
42
kaposi's sarcoma is caused by
human herpes virus 8
43
tx for kaposi's sarcoma
reconstitute/restore immune fxn
44
4 pathogens of concern with CD4 count \> 500
acute retroviral syndrome
thrush
esophagitis
PCP/PJP
45
4 pathogens of concern when CD4 is btw 200-500
thrush
oral hairy leukoplakia
TB
shingles
46
3 pathogens of concern when CD4 is \<200
HSV
candida esophagitis
PCP/PJP
47
7 pathogens of concern when CD4 is \< 100
histoplasmosis
toxoplasmosis
cryptococcosis
cryptosporcollosis
aspergillus sp
m. avium complex
CMV
48
4 major pathogens of concern when CD4 is \< 50
myobacterium
aspergillus sp
m. avium complex
CMV
49
2 pops w. highest number of new HIV dx
AA
gay/bisexual men
50
pt pop most affected by HIV
gay/bisexual men
51
region of US most affected by HIV
south
52
HIV is a retrovirus that depends on __ to replicate
reverse transcriptase
RNA dependent DNA polymerase
53
most prevalent type of HIV in US
HIV 1
54
t/f: HIV 1 is more virulent than HIV 2
T!
55
HIV enters CD4 cells via what 2 chemokine receptors
**CCR5**
CXCR4
56
pharm for HIV targets __ chemokine receptor
CCR5
57
T/F: people w. CCR5 deletions are less likely to become infected w. HIV
T!
58
what stage of HIV is characterized by integration of HIV genome into the cell
latent
59
5 stages of HIV
1. viral entry
2. reverse transcriptase
3. integration
4. transcription/translation
5. assembly/budding
60
90% of HIV is asymptomatic, what are 5 common presenting sx if not
fever/night sweats/wt loss
kaposi's sarcoma
lymphoma
oral lesions → hairy leukoplakia
thrush (not considered AIDS defining)
61
3 stages of HIV infxn
**acute retroviral syndrome** → 1-12 weeks
**clinical latency** → 6-10 years
**AIDS →** 1-2 years
62
when do sx/infxns related to AIDS/HIV occur
CD4 is going down
viral load coming up →
acute and AIDS
63
acute retroviral syndrome begins w.
exposure
64
sx of acute retroviral syndrome
nonspecific flu like →
fever
fatigue
pharyngitis
LAD
rash
65
t/f: pt's are **highly** infectious during acute retroviral syndrome
T!
66
describe the rash associated w. acute retroviral syndrome
body wide → including mucosa
lacy
67
acute retroviral syndrome may mimic
mono
68
in acute retroviral syndrome, rash is present in \_\_% of cases
in mono, rash is present in \_\_% of cases
80%
5-10%
69
what is this showing
rash associated w. acute retroviral syndrome
70
CDC recommends __ for HIV screening, but most places in US do not do this
opt out testing
71
T/F: in CO you have to get consent before testing for HIV
T!
72
who should be screened for HIV
anyone who is sexually active
73
what HIV test is no longer used clinically
ELISA w. western blot confirmation
74
gs test for HIV screening (now recommended over ELISA)
combo or 4th gen testing → **EIA**
75
what test confirms EIA results
NAT → quantitative HIV RNA by PCR
*measures viral load*
76
EIA test can be positive as soon as __ days after infxn
10
77
the EIA test measures (2)
HIV ab
p24 ag
78
next steps if EIA test is positive (2)
measure CD4 count
ultrasensitive quantitative RNA by PCR (NAT)
79
HIV test done in the ER
SUDS → rapid test
80
the ELISA test measures __ only
and takes __ weeks for results
abs
4-12
81
clinical usefulness of baseline CD4 testing
compares baseline CD4 to CD4 as viral load increases
*not done on every pt*
82
HIV pt's should also be screened for (4)
hep A, B, C
TB
toxoplasmosis
STIs
83
HAART (highly active antiretroviral therapy) is same-same
antiretroviral therapy
*they are all highly reactive*
84
4 types of antiretroviral therapy
protease inhibitors
integrase inhibitors
nucleoside reverse transcriptase inhibitors (NRTI) → “nucs”
non nucleoside reverse transcriptase inhibitors (NNRTI) → “non-nucs”
85
what do you think when you see an HIV pt who is blue colored
colloidal silver supplement
86
viral load goal of antiretroviral therapy
\< 50 copies/ml
*undetectable is preferred*
87
3 drug antiretroviral regimen
backbone → NRTI
base/add-in → NNRTI OR PI
integrase inhibitor → reltegravir
88
complete regimen 2 drug combo pills
cabenuva → cabotegravir + rilpivirine
dovato → dolutegravir + lamivudine
juluca → dolutegravir + rilpivirine
89
3 commonly used complete regimen 3 drug combo pills
atripla
genvoya
triumeq
90
what drug is a commonly used entry inhibitor (anti CCR5)
**selzentry**
* pt must have CCR5 receptor for drug to work → testing done first*
* not a 1st line drug*
91
commonly used 2 drug PREP combo
descovy
truvada
*not complete therapy alone*
92
historical choice NRTIs (backbone) (3)
zidovudine (AZT)
lamivudine (3TC)
abacavir (ABC)
93
newer choice NRTIs (backbone) (2)
emtricitabine (FTC)
tenofivir (TAF)
94
1st gen NNRTIs (3)
nevirapine (NVP)
delavirdine (DLV)
efavirenz (EFV)
95
2nd gen NNRTIs (2)
etravirine (ETR)
rilpivirine (RPV)
96
which NNRTI is commonly added to backbone of ETC or TAF
efavirenz (EFV)
97
2 formulations of tenofivir
original → disoproxil
new → alafenamide
98
which formulation of tenofivir has a higher risk of causing renal failure and OP
original → tenofivir disoproxil
99
4 protease inhibitors that are still used
**-navir**
lopinavir (LPV)
atazanavir (ATV)
ritonavir (RTV)
darunavir (DRV)
100
preferred PI
darunavir (DRV)
101
which PI is used as part of COVID therapy but has lots of DDIs
ritonavir (RTV)
102
INSTIs (integrase inhibitors) (4)
**-egravir**
raltegravir (RAL)
elvitegravir (EVG)
dolutegravir (DTG)
cavetagravir
103
which PI is newer and injectable
cavetagravir
104
HIV combo meds to know (6)
atripla
stribild
genvoya
complera
odefsey
triumeq
105
historic choice for combo complete regimen drug (once daily dosing)
**atripla** →
tenofivir disoproxil
emtricitabine
efavirenz
106
HIV combo med that is not used as 1st line anymore
stribild
107
genvoya
elvitegravir/cobicistat
emtricitabine
tenofivir alfenamide
108
\_\_ acts as a booster to help elvitegravir get into cells
cobicistat
109
what HIV combo med is contraindicated in renal dz
genvoya
110
complera
emtricitabine
rilpivirine
tenoficir disoproxil
111
odefsey
emtricitabine
rilpivirine
tenoficir alafenamide
112
triumeq
dolutegravir
abacavir
lamivudine
113
historical tx guidelines based on CD4 count
\>500 → monitor
\<500 → consider initiation
\<350 → initiate tx
114
most recent guideline for initiation of tx
all HIV (+) should be considered for initiation of tx regardless of CD4 count
115
3 common first line regimens for HIV
**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
common first line regimen that needs HLAB\*570 testing prior to initiation
**triumeq →**
dolutegravir
**abacavir -\> causes life threatening rash**
lamivudine
117
why do we need to do HLAB\*570 testing prior to initiation of triumeq
**abacavir** can cause fatal allergic rash
118
2 drug regimen that is a common first line regimen
**dovato →**
dolutegravir
lamivudine
119
t/f: end organ damage occurs at all stages of HIV infxn
T!
*tx should be started early*
120
CD4 monitoring guidelines (4)
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
monitoring of CD4 300-500
q 12 months
122
monitoring of CD4 \> 500
optional
123
step 2 of HIV life cycle
reverse transcription
124
step 3 of HIV life cycle
integration
125
step 5 of HIV life cycle
assembly and budding
126
which drugs work at step 2 of HIV life cycle
NRTIs
NNRTIs
127
which drug works at step 3 of the HIV life cycle
integrase inhibitors
128
which drug works at step 5 of HIV life cycle
protease inhibitors
129
t/f: ART has high potential for adverse effects
T
130
common s.e of ART
rash
diarrhea
pancreatitis
hyperlipidemia/lipodystrophy
increased cardiac risk
CNS → psychological disturbance
131
s.e of PIs (6)
hyperipidemia
lipodystrophy
hepatotoxicity
GI intolerance
bleeding risk for hemophiliacs
ddi
132
s.e of NRTIs
lactic acidosis
hepatic steatosis
lipodystrophy
133
risk of hepatic steatosis is highest w.
in order:
d4T
ddl
zdv
134
risk of hepatic steatosis is lowest w.
tdf
abc
3tc
ftc
135
risk of lipodystrophy is highest w.
d4t
136
s.e of NNRTIs
rash/SJS
hepatotoxicity
ddi
sleep walking/vivid dreams/nightmares
137
hepatotoxicity is highest w. which NNRTI
NVP
138
what is this showing
lipodystrophy
139
inflammatory rxn in response to rapid reconstitution of CD4 counts after initiation of ART
IRIS → immune reconstitution syndrome
140
IRIS can unmask \_\_
and is a dx of \_\_
opportunistic infxn
exclusion
141
routine management for HIV pt
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
prophylaxis if cd4 \< 200
PCP/PJP
143
prophylaxis if cd4 \< 50
PCP/PJP
MAC (myobacterium avium complex)
144
prophylaxis if cd4 \< 100
trimethoprim sulfa
OR
dapsone + pyrimethamine
145
prophylaxis for MAC
clarithro/azithro
146
PEP should be given w.in __ hours of exposure
72
147
how long is PEP given
1 month
148
2 approved and mc used PEP regimens (post exposure)
**Truvada** → emtricitabine + tenofivir disoproxil
**Descovy →** emtricitabine + tenofivir alafenamide
149
how often are Truvada and Descovy taken
daily
150
USPSTF guidelines for who should take PREP (pre exposure)
persons at high risk for infxn
IV drug usage and/or sexual risk for HIV
151
3 drugs approved for PREP
Truvada
Descovy
Cabotegravir (Apretude)
152
what new PREP drug is injectable and administered q 2 months, but is not currently approved
cabotegravir
153
4 high risk factors considered in PREP indications
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
Truvada for PREP is approved for
men
women
transgender
155
Descovy for PREP is approved for
men
transgender women
156
cabotegravir for PREP is recommended for
men
women
transgender
157
for patient's on PREP, HIV status should be checked (2)
prior to initiation
q 3 months after initiation
158
besides HIV status, 4 other screening tests for patients on PREP
**STI** q 3-6 months
**renal fxn**
**Hep B** immunity
**pregnancy**
159
risk of perinatal transmission when no tx is given
26%
160
drug administered during pregnancy/labor and delivery to reduce risk of vertical transmission by ⅔
Zidovudine
161
when can Zidovudine be administered in pregnant pt
as early as 14 weeks into pregnancy
162
4 miscellaneous opportunistic infxns
coccidioidomycosis
histoplasmosis
blastomycosis
toxoplasmosis
163
coccidioidomycosis is same-same
san joaquin valley fever
164
40% of pt w. san joaquin valley fever present w.
flu like sx
high fever, night sweats
165
dx for san joaquin valley fever
serology → IgM/IgG
166
generally, no tx is indicated for san joaquin valley fever - pharm if tx is indicated
diflucan
167
opportunistic infxn that is linked to bird droppings or bat guano exposure along ohio river valley
histoplasmosis
168
if not asymptomatic, presenting sx of histoplasmosis
pulmonary sx
169
dx for histoplasmosis (2)
**antigen** → serum, urine, CSV
OR
**tissue bx**
170
tx for histoplasmosis: mild-mod and severe
mild-mod: itraconazole
severe: amphotericin B
171
opportunistic infxn linked to soil exposure along ohio river valley - esp dust exposure (ex. construction)
blastomycosis
172
if not asymptomatic, presenting sx of blastomycosis
pulmonary infxn
cutaneous dissemination
173
dx for blastomycosis
bx and culture
174
tx for blastomycosis mild-mod and severe
mild-mod: itraconazole
severe: amphotericin B
175
opportunistic infxn associated w. litter boxes
toxoplasmosis
176
toxoplasmosis infxn in HIV pt is usually \_\_
and not primary infxn
reactivation of infxn
177
sx of toxoplasmosis
focal neurologic findings
fever
178
MRI findings of toxoplasmosis
punched out lesion
179
what is this showing
punched out lesion → toxoplasmosis
