HIV Flashcards
stage 1 HIV
symptomatic primary infection ~2-4 weeks after infection. flu-like syndrome with fever, lymphadenopathy, pharyngitis, rash, myalgias
stage 2 HIV
asymptomatic infection, no abnormal findings
stage 3 HIV
symptomatic HIV infection, development of common infections
stage 4 HIV
advanced HIV disease/AIDS: severe immunosupression, CD4 <200
HIV goals of treatment
acheive maximal supression of plasma viral load for as long as possible. delay development of medication resistance. preserve CD4 T cell numbers. confer substantail clinical benefits leading to reducation in morb/mort
rationale for ART therapy
more than 20 approved drugs. treatment dynamic, rapidly changing arena. HIV medications always used in combo to reduce amount of HIV in blood
HIV outcome evaluation
treatment plans individualized to each patient. success determined by when the patient begins therapy and how well able to adhere.
HIV monitoring
adherence to meds/visits, MH problems, altererd glucose/lipid met, CV risk, hep B and co-infection, high risk behaviors, immunization status, renal/liver fxn, STIs, somatic s/s, tobacco/alc/drug use
discontinuation or interruption of ART
associated with HIV viral rebound, immune decompensation, and clinical progression. interruption may be necessary for: concurrent illness, severe drug tox, surgery not allowing pills, ART meds not available
ART failure
defined as failure to acheive or maintain supression of viral replication to <50 copies/mL. Either failure or virological rebound. Causes: adherence issues, toxicity
ART medication resistance
due to: poor adherence, drug/drug or drug/food interactions, abnormal abs/dist/met/or excretion of med. first sign of resistance is detectible plasma viral RNA levels. phenotype assays used to measure sensitivity to various ART drugs
cost considerations for HIV ART
expensive. costs vary widely. may be eligible for AIDS drug assistance programs (ADAP), congress mandates funds must be used for ADAP. pharmaceutical companies have copays to provide financial assistance
families of meds to treat HIV (6)
nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhjibitors (NNRTIs) , protease inhibitors PIs, fusion inhibitors FIs, integrase strand transfer inhibitors INSTIs, CCR5 antagonisists
principles of HIV therapy
ongoing HIV replication leads to immune system damage and progression to AIDS (plasma RNA and CD4 counts must be meausred every 3-6mos). treatment decisions should be individualized based on risk of disease progression as indicated by plasma HIV RNA levels and CD4 counts (goal of therapy should be maximal acheivable supression of HIV replication). Most effective way to achieive sustained supression of HIV replication is combo of effective anti HIV meds
who should ART be initiated in
AIDS-defining illness or CD4 <350, HIV-associated nephropathy, co infection with HBV, prego, CD4 counts between 350-500. potential benefits of early therapy should be weighed against risks
