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Flashcards in 2: HIV Deck (60)
1

describe worldwide HIV epidemic in terms of numbers and access to treatment

-total number w/ HIV/AIDS increased worldwide
-less than 1/3 of people who need antiretroviral drugs have access to them

2

what method of contracting HIV has the highest transmission rate? the rest of the ways to contract HIV have what type of transmission rates?

transfusion of contaminated blood - 90%

rest of the methods are all

3

CDC testing guidelines

-"opt out testing"
-don't need specific informed consent
-persons at high risk should be screen at least annually
-prevention counseling not required, but strongly recommended for high risk persons

4

why are E Europe and Central Asia numbers still rising?

heroin/IV drug use

5

historical indications for HIV testing (long list)

-sexually active gay men
-persons w/ multiple partners
-current or past injection-drug users
-recipients of blood products b/w 1978 and 1985
-persons w/ current or past STIs
-commercial sex workers and their contacts
-persons sexually assaulted
-persons w/ occupational exposures
-pregnant women/women of childbearing age
-children born to HIV-infected moms
-sexual partners of those at risk of infection
-persons who consider themselves at risk/request testing

6

first good protease inhibitor

Indenovir

7

clinical indications for testing (long list)

-TB
-syphilis
-recurrent shingles
-unexplained chronic constitutional sx
-unexplained generalized adenopathy
-unexplained chronic diarrhea or wastin g
-unexplained encephalopathy
-unexplained thrombocytopenia
-thrush or chronic/recurrent vaginal candidiasis
-HIV-associated opportunistic diseases
-suspected primary HIV syndrome

8

significance of the release of HAART (the protease inhibitors) in 1996

60-80% reduction in deaths from AIDS in US

9

four H's are risk groups:

heroin addicts
homosexuals
hemophiliac
Haitians

10

common signs/sx of primary HIV infection:
-those presenting in 50-90% of patients (6)
-those presenting in 25-50% of patients (3)
-those presenting in

50-90%
-fever
-fatigue
-rash
-myalgia/arthralgia
-pharyngitis
-night sweats

25-50%
-N/V/D
-low wbc/plts
-weight loss

11

how long is the eclipse period of HIV infection?

10-12d (from time of initial infection to viral detection)

12

when does one start making Ab's to HIV?

after about 3w (period of seroconversion - from initial infection to first creation of Ab's)

13

testing for HIV: how are viruses detected (what component do they test for)?

HIV RNA in plasma

14

other options in the primary HIV ddx

-EBV mono
-CMV
-HSV
-flu
-rubella
-viral hepatitis
-toxoplasmosis
-syphilis
-disseminated GC
-rickettsial disease
-lyme disease
-streptococcal infection
-early TSS

15

clinical clues for primary HIV infection (7)

-mucocutaneous ulcerations
-rash
-abrupt onset: "10 sx/signs in 24h"
-GI sx
-antedecent high risk exposure
-prolonged sx

-cough/URI: diagnosis less likely

16

what test is used to detect HIV Abs?

ELISA (highly sensitive)
-if result is (-), HIV AB reported as (-)
-if result is (+), ELISA repeated
-if repeat (+), Western blot (more specific) for confirmation

17

what happens when western blot results are indeterminate?

means 1 of 3 characteristic bands present - recommend supplemental testing

18

what can an indeterminate western blot indicate?

presence of recent HIV-1 infection or HIV-2 infection, which is endemic in West Africa

19

can you use a low CD4+ count to diagnose HIV?

no - not diagnostic and cannot be used instead of HIV Ab testing

20

are there any rapid tests for HIV?

yes - blood and oral swabs can give results in 20 min

21

what should you determine in a newly diagnosed HIV history? (8)

-HIV risk behaviors (sexual and drug use)
-knowledge of HIV infection
-emotional response to diagnosis
-family and social situation
-employment and insurance status
-travel history
-exposure to TB, syphilis, other STIs, and viral hep (A,B,C)
-status of immunizations

22

labs to run on a newly diagnosed HIV patient (12)

-CBC and differential counts
-BUN/creatinine, liver fxn tests, fasting glucose/lipid profile
-CD4 count and HIV viral load
-HIV genotype test
-syphilis testing (RPR or VDRL)
-anti-HAV, HBsAg, HBcAb (HBsAB if prior immunization), anti-HCV
-toxoplasmosis (IgG) serology
-PPD
-chlamydia and GC assays in persons at risk
-consider anal pap smear in persons at risk
-G6PD quantitative testing (if needing pneumocystic prophylaxis)

23

what is the main surrogate marker for monitoring HIV disease progression?

CD4 count

24

normal range of CD4

350-1100/mm3

25

what is the average decline in CD4 count per year without treatment?

75-100/mm3 - but variability b/w patient and in a given patient over time

26

what are factors that can transiently affect the value of CD4?

-intercurrent illnesses
-inter- and intra-lab variability

27

what are the clinical uses of CD4 count?

-to determine need for antiretroviral therapy
-to determine need for antimicrobial prophylaxis
-to assess prognosis

28

prognostic indication of high early viral load

sx are worse for patients - knocks down the CD4s faster and indicates clinically that the meds will have a rough time

29

how do you measure viral RNA loads in plasma?

PCR or branched DNA techniques

30

what is the lower limit of detection of ultrasensitive PCR assay

31

what does a high level of viral RNA in plasma correlate to?

CD4 cell count decline and clinical disease progression

32

what is the normal variability of HIV viral load?

0.3 log (3- to 5-fold)

33

what are the clinical uses of monitoring HIV viral load?

-monitor antiretroviral therapy
-to assess prognosis

34

patient presentation with CD4 > 500/mm3

-most asymptomatic
-bacterial infections (pneumococcus, staph)
-pulmonary TB
-shingles
-other dermatologic conditions

35

patient presentation with CD4 200-500/mm3

-many asymptomatic
-generalized adenopathy
-thrush
-Kaposi's sarcoma

36

patient presentation with CD4

-PCP
-toxoplasmosis
-cryptococcus

37

patient presentation with CD4

-CMV and Mycobacterium avium complex infections
-increased risk of lymphoma
-highest mortality

38

indications of when to start HIV treatment (5)

-AIDS-defining condition
-CD4 count

39

targets of HIV drugs

-RT inhibitors
-integrase inhibitors
-protease inhibitors
-fusion/entry inhibitors

40

HIV meds: NRTIs

-abacavir
-didanosine
-emtricitabine
-lamivudine
-stavudine
-tenofovir
-zidovudine

41

HIV meds: PIs

-atazanavir
-darunavir
-fosamprenavir
-indinavir
-lopinavir
-nelfinavir
-ritonavir
-saquinavir
-timpranavir

42

HIV meds: NNRTIs

-delavirdine
-efavirenz
-etravirine
-nevirapine

43

HIV meds: integrase inhibitor

raltegravir

44

HIV meds: fusion inhibitor

enfuvirtide

45

HIV meds: CCR5 antagonist

maravioc

46

how many meds are administered at once? why? which ones?

usually 3 drugs at a time - virus can't make resistance to 3 at a time
-often two NRTIs with an integrase inhibitor

47

what other non-infectious disease state should be watched for in HIV treatment?

inflammatory disease

48

preferred initial treatment: NNRTI based

EFV/TDF/FTC
-don't use EFV in first trimester of pregnancy or in women trying to conceive or not using effective/consistent BC
-3TC can be used in place of FTC and vice versa

49

preferred initial treatment: PI based

ATV/r + TDF/FTC
DRV/r (QD) + TDF/FTC
-3TC can replace FTC

50

preferred initial treatment: II based

RAL + TDF/FTC
-3TC can replace FTC

51

preferred initial treatment: pregnant women

LPV/r (BID) + ZDV/3TC
-3TC can replace FTC

52

drug resistance testing before initiation of ART

-transmitted resistance in 6-16% of HIV patients
-w/ no therapy, resistance mutations may decline over time and become undetectable by current assays, but may persist and cause treatment failure when ART is started
-ID resistance mutations to optimize tx outcomes
-genotype recommended for all at entry to care
-recommended for all pregnant women

53

drug resistance testing in patients with virologic failure

-perform while patient is taking ART, or

54

list the complications of HIV treatment (5)

-lipodystrophy syndrome
-lactic acidemia/acidosis
-premature osteopenia and osteoporosis
-avascular necrosis of hips
-peripheral neuropathy

55

describe lipodystrophy syndrome

-body morphology changes and metabolic complications - this is why II > PI in terms of Rx: prevents buffalo humps, skinny arms, and temporal fat

56

describe the lactic acidemia/acidosis that can be caused by HIV tx

peripheral neuropathy, pancreatitis, myopathy, steatosis with liver failure

57

describe vaccinating people with HIV

-avoid live vaccines
-benefits increased if given early in disease
-pneomococcal: boost after 5y
-Hep A and B: if Ab(-)
-flu: yearly, avoid intranasal prep
-HPV: to males and females age 9-26
-H. influenzae: if asplenic
-varicella: if no immunity to varicella + CD4 >200
-tetanus: as w/ general pop (Tdap once)

-MMR and zoster: typically avoided

58

what occupations have the most HIV exposures?

-nurses
-ancillary staff
-surgeon
-dental workers
-EMS

59

what is the risk of seroconversion with needle stick exposure for each of the following: HBV, HCV, HIV

HBV: 30%
HCV: 3%
HIV: 0.3%

60

rates of perinatal HIV transmission for each of the following viral loads at time of delivery:
>100,000
40,000-100,000
3000-40,000
400-3000

>100,000: 32%
40,000-100,000: 21%
3000-40,000: 11%
400-3000: 6%