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Infectious disease > HIV > Flashcards

HIV Flashcards

1
Q

what contributed to the decline of HIV/AIDs

A

safer sex programs
greater outreach to high-risk populations

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2
Q

who are the populations at risk of HIV/AIDS

A
  1. men who have sex with men
  2. transgender people
  3. people who inject
  4. sex workers
  5. heterosexuals
  6. healthcare workers
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3
Q

what are the ways HIV can be transmitted

A
  1. blood
  2. semen
  3. pre-seminal fluid
  4. rectal fluids
  5. vaginal fluids
  6. breast milk
  7. in utero
  8. during birth
    NOT in saliva, sweat, tears, vomit, urine, nasal secretions
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4
Q

what has the highest and lowest HIV transmission rates

A
  1. anal receptive intercourse
  2. blood transfusion
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5
Q

describe the 6 steps of how HIV invades a cell

A
  1. fusion of HIV to host cell surface
  2. HIV RNA and viral proteins enter host
  3. viral DNA formed by reverse transcriptase
  4. viral DNA transported across nucleus and integrates into host DNA
  5. new viral DNA is used as genomic RNA and to make viral proteins
  6. new viral DNA and proteins move to cell surface and a new, immature HIV forms and is released
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6
Q

what is the first cell to come into contact with the HIV cell

A

dendritic cell
best when it’s a mature DC

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7
Q

what are the 3 steps of transferring of virus from DCs to CD4+ T cells

A
  1. DCs capture and bind HIV
  2. HIV traffics within DC
  3. HIV is transferred to CD4+ T cells via trans-infection
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8
Q

what are the 4 stages of HIV infection

A
  1. viral transmission/HIV acquisition
  2. acute HIV infection/acute retroviral syndrome (symptomatic)
  3. chronic HIV infection
    - can be asx
    - often follows early symptomatic HIV infection
    - AIDS
  4. advanced HIV infection
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9
Q

what must happen in order to be considered AIDS

A

CD4 ct <200 cells/uL OR presence of AIDS defining condition

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10
Q

a CD4 ct of <50 cells/uL means ?

A

advanced HIV infection

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11
Q

4 step stages of acute HIV infection

A
  1. viral penetration of mucosal epithelium
  2. infection of submucosal CD4 T cells, dendritic cells, and monocytes
  3. spreads to lymph nodes
  4. HIV viremia
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12
Q

acute retroviral syndrome can be asx for an average ____

A

10 years

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13
Q

s/s of acute retroviral syndrome

A
  1. nonspecific viral syndrome - fever, chills, diaphoresis, pharyngitis, lymphadenopathy, myalgias/arthralgias, cephalgia, fatigue
  2. spontaneous resolution
  3. infection latent until progression to AIDS
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14
Q

who should be tested for HIV?

A
  1. known or suspected sexual or hematologic exposure
  2. sexually active people
  3. known drug abuse, especially IVDU
  4. accidental needle stick
  5. pregnancy
  6. recent STI
    CDC recommends routine screening ages 13-64 at least once
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15
Q

7 HIV tests

A
  1. serum HIV ELISA
  2. HIV rapid antibody test (10-20min)
  3. serum western blot
  4. serum p24 antigen
  5. serum HIV DNA PCR
  6. CD4 ct
  7. serum viral load (HIV RNA)
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16
Q

if the HIV test comes back positive, what are the next steps?

A
  1. confirm with western blot
  2. another ELISA
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17
Q

other testing for HIV

A
  1. pregnancy
  2. serum hepatitis B serology
  3. serum hepatitis C serology
  4. CBC w/ diff
  5. BMP or CMP
  6. UA, LFTs, fasting plasma glucose, lipid profile
  7. human leukocyte antigen-B*5701 testing
    - order only when prescribing abacavir if positive
  8. PPD, CXR
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18
Q

how to do lab monitoring for HIV pts

A
  1. offer ART regardless of CD4 ct
  2. monitor CD4 cts every 3-6 months
  3. monitor HIV viral load every 3-6 months
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19
Q

what is used for pre-exposure prophylaxis (PrEP)

A

tenofovir (truvada, drug class NRT1)

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20
Q

what is the prevention of perinatal transmission of HIV

A
  1. HIV testing of all pregnant women
  2. initiation of ART if HIV positive and likely C-section delivery based on viral load
  3. avoid breast feeding
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21
Q

what are the associated diseases of HIV? what are the tx of choice?

A
  1. TB - isoniazid + pyridozine (w/ sputum cx)
  2. syphilis - PCN
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22
Q

usual presentation of TB

A

upper lobe consolidations/cavitary lesions
+/-mediastinal or hilar adenopathy

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23
Q

how do you screen for syphilis

A
  1. rapid plasma reagin (RPR)
  2. venereal disease research laboratory (VRDL) test every 6 months
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24
Q

if someone presents with a small, painless sore on their genitals that healed by itself within 3-6 weeks, what type of syphilis do they have?

A

primary

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25
Q

if someone presents with nonpruritic, maculopapular rash on their palms and soles, what type of syphilis do they have?

A

secondary

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26
Q

5 additional measures to prevent HIV

A
  1. safe sex practices to avoid other STIs
  2. avoiding consumption of raw foods (toxoplasma, salmonella, campylobacter)
  3. avoid cleaning cat litter (toxoplasma)
  4. avoid cat scratches/bites (bartonella)
  5. avoid drinking tap water (crytosporidium
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27
Q

what is the perinatal HIV tx

A
  1. ART (if HIV positive)
  2. zidovudine (retrovir)
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28
Q

if a healthcare worker got exposed via need stick, what are the next steps

A
  1. HIV antibody testing and HIV viral load at baseline, 6 weeks, 3 months, 6 months
  2. ART ASAP and continued x 4wks
    - triple therapy = tenofovir + emtricitabine + dolutegravir/raltegravir
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29
Q

what is started in all patients regardless of CD4 ct and must be tested for resistance before initiating

A

antiretroviral therapy (ART)

30
Q

what is HAART

A

highly-effective antiretroviral therapy
combo therapy with at least 3 meds from two different classes to avoid resistance

31
Q

what are the 6 classes of antiretroviral therapy

A
  1. nucleoside reverse transcriptase inhibitors (NRTI)
  2. nucleotide reverse transcriptase inhibitors (NRTI)
  3. non-nucleoside reverse transcriptase inhibitors (NNRTI)
  4. protease inhibitors
  5. entry inhibitors/fusion inhibitors
  6. integrase inhibitors
32
Q

what antiretroviral therapy class has most of its agents complicated by peripheral neuropathy and often components of fixed dose antiretroviral combos?

A

nucleoside reverse transcriptase inhibitor

33
Q

what antiretroviral therapy class stops the conversion of HIV RNA to HIV DNA by blocking reverse transcriptase

A

NRTIs
- nucleoside
- nucleotide
NNRTIs

34
Q

what antiretroviral therapy class commonly leads to renal failure

A

nucleotide reverse transcriptase inhibitor

35
Q

what must you monitor when taking nucleotide reverse transcriptase inhibitor

A

creatinine
usually leads to renal failure

36
Q

what antiretroviral therapy class is usually well-tolerated and does not need special monitoring

A

NNRTIs

37
Q

what antiretroviral therapy class blocks new HIV from maturing, therefore suppressing HIV replication

A

protease inhibitors

38
Q

what antiretroviral therapy class is usually used to “boost” other regimens

A

protease inhibitors

39
Q

what antiretroviral therapy class blocks HIV envelope from fusing with the CD4 membrane

A

entry/fusion inhibitors

40
Q

what antiretroviral therapy class is used as add-on therapy for pts with multidrug resistance

A

entry/fusion inhibitors

41
Q

what antiretroviral therapy class slows HIV replication by blocking HIV integrase enzyme needed for viral multiplication

A

integrase inhibitors

42
Q

4 things to monitor for antiretroviral therapy

A
  1. resistance testing prior to initiating therapy, and during therapy if viral suppression is suboptimal
  2. adherence is key - stress importance/choose tolerable regimen
  3. lab monitoring for toxicity every 3-4 months
  4. CD4 ct and HIV viral load 1-2 months after regimen initiation/change, every 3-6 months once stable
43
Q

5 tx goals for HIV

A
  1. reduce HIV-related morbidity and mortality
  2. prevent transmission
  3. prevent viruses from multiplying
  4. give immune system a chance to recover and fight infections and HIV-related cancers
  5. reduce risk of HIV transmission (including infected mother to unborn child)
44
Q

3 definitions for AIDS

A
  1. outcome of chronic HIV infection and subsequent depletion of CD4 cells
  2. CD4 ct <200 OR presence of any AIDS defining condition regardless of CD4 ct
  3. advanced HIV infection CD4 ct <50
45
Q

14 AIDS defining conditions

A
  1. mucocutaneous candidiasis
    - oral
    - fungal rash
  2. oral hairy leukoplakia
  3. genital herpes
  4. herpes zoster/shingles
  5. molluscum contagiosum
  6. CAP
  7. pneumocystis jiroveci pneumonia
  8. esophageal candidiasis
  9. kaposi’s sarcoma
  10. wasting syndrome
  11. mycobacterium avium infection
  12. cryptococcal meningitis
  13. cytomegalovirus retinitis
  14. toxoplasmosis
46
Q

complaint of unpleasant taste or mouth dryness with pseudomembranous or erythematous plaques

A

mucocutaneous candidiasis - oral candidiasis

47
Q

usually seen as an inguinal rash

A

tinea cruris - fungal rash of mucocutaneous candidiasis

48
Q

caused by Epstein-Barr virus that leaves white lesions on the lateral aspect of the tongue

A

oral hairy leukoplakia

49
Q

small, grouped vesicles on penile shaft, labia, perianal skin, or buttocks

A

genital herpes

50
Q

common manifestation of HIV that leaves painful, vesicular lesions occurring along dermatome

A

herpes zoster/shingles

51
Q

often seen in children
umbilicated fleshy papules

A

molluscum contagiosum

52
Q

most common cause of pulmonary disease in HIV infected pts

A

CAP
- p. pneumonia
- h. flu
- p. aeruginosa

53
Q

most common opportunistic infection with AIDS
AIDS defining condition
fever, cough, dyspnea, hypoxemia
CXR -diffuse or perihilar infiltrates

A

pneumocystis jiroveci penumonia

54
Q

common AIDS complication
AIDS defining condition
dysphagia, or difficulty swallowing
commonly diagnosed via EGD

A

esophageal candidiasis

55
Q

AIDS defining condition that leaves purplish, nonblanching lesions

A

kaposi’s sarcoma

56
Q

decreased caloric intake - anorexia, N/V
malabsorption
increased metabolic rate
disproportionate loss of muscle mass

A

wasting syndrome

57
Q

spread by inhalation
encapsulated budding yeast found in soil and pigeon poop
gram stain of CSF with budding, encapsulated fungi

A

cryptococcal meningitis

58
Q

rapidly progressive visual loss with retinal perivascular hemorrhages and white fluffy exudate
most common retinal infection in AIDS pts

A

cytomegalovirus retinitis

59
Q

most common space-occupying lesion in HIV affect pts leading to HA, focal neurologic deficits, altered mental status, seizures, causing CNS damage

A

toxoplasmosis

60
Q

if the CD4 <200 what could be the opportunistic infection

A

pneumocystis

61
Q

if the CD4 <150 what could be the opportunistic infection

A

histoplasmosis

62
Q

if the CD4 <100 what could be the opportunistic infection

A
  1. toxoplasmosis
  2. cryptococcus
63
Q

if the CD4 <50 what could be the opportunistic infection

A

mycobacterium avium complex (MAC)

64
Q

why monitor CD4 cts every 3-6 months?

A
  • reflects degree of immune dysfunction
  • reflects efficacy of therapy
65
Q

why monitor HIV load every 3-6 months

A
  • assesses level of viral replication
  • provides prognostic information about disease progression
  • reflects efficacy of therapy
66
Q

Post-exposure prophylaxis for sexual and drug use exposures to HIV, and needlesticks is offered within ?

A

72h of exposure

67
Q

how do you choose antiretroviral therapy?

A
  1. Prior treatment experiences
  2. Medication side effects
  3. Underlying conditions
  4. Convenience of formulation
  5. Genotypic resistance testing
  6. Results of resistance testing
    → 15 - 20% of treatment naive patients resistant!
68
Q

which ART is metabolized by cytochrome P450 system → high potential for drug interaction

A

protease inhibitor

68
Q

which ART allows for more rapid decrease in viral load versus other regimens

A

integrase inhibitors

69
Q

May flare as part of Immune Reconstitution Inflammatory Syndrome

A

Kaposi’s sarcoma

70
Q

Causes disseminated infection in late-stage HIV (CD4 count <50/mcL), with persistent fever, weight loss, usually a positive blood culture

A

MYCOBACTERIUM AVIUM INFECTION

71
Q

Starts as pulmonary nodules and/or infiltrates that spread to CNS

A

CRYPTOCOCCAL MENINGITIS

Infectious disease (15 decks)

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