HIV

Question 1

HIV transmission

Answer 1

Blood
- transfusion 
- injection drug use 
Sexual intercourse
- heterosexual 
- male to male 
Perinatal 
- intrapartum 
- breast feeding

Question 2

HIV vs AIDS

Answer 2

HIV= virus without AIDS defining illness
AIDS= HIV + AIDS defining illness OR
= HIV + CD4 count <200

Question 3

Examples of aids defining illnesses

Answer 3

Candidiasis 
Disseminated Isosporiasis 
Kaposi sarcoma 
Lymphoma 
Pneumocystis carinii pneumonia

Question 4

HIV symptoms

Answer 4

Lymphadenopathy
Fever
Unexpected weight loss
Night sweats

Question 5

Pneumocystis pneumonia gold standard test

Answer 5

Silver stain on sputum sample

Question 6

Pneumocystis pneumonia new test

Answer 6

PCR based

Question 7

Pneumocystis pneumonia CXR pattern

Answer 7

bilateral hilar infiltrate- butterfly pattern

Question 8

Pneumocystis pneumonia symptoms

Answer 8

Fever
Dry cough
SOB
Fatigue

Question 9

Pneumocystis pneumonia treatment

Answer 9

high dose trimethoprim/ sulfamethoxazole
15-20mg/kg IV q day / 6-8h dosing

Prednisone if <70% PaO2

Question 10

Pneumocystis pneumonia ppx

Answer 10

at CD4 count <200
trim/sulfa PO- lower dose than tx

Dapsone or pentamidine

Question 11

Pneumocystis pneumonia ppx alternatives to trim/sulfa

Answer 11

Dapsone or inhaled pentamidine

Question 12

what is kaposi sarcoma

Answer 12

purplish brownish lesions

body wide- including mouth

Question 13

most prevalent HIV in US?

Answer 13

HIV 1

Question 14

HIV enters CD4 via what receptors ?

Answer 14

CCR5 and CXCR4

Question 15

HIV historic test and confirmation

Answer 15

ELISA
- HIV ab - 4-12 w
Western blot confirmation

Question 16

HIV new recommended test and confirmation

Answer 16

Combo or 4th gen
- HIV ab and ag - 2-6 w
HIV RNA by PCR

Question 17

HIV tx typical backbone

Answer 17

2 NRTIs

Question 18

HIV tx typical base

Answer 18

either NNRTI or PI

Question 19

NRTIs

TEAL

Answer 19

Zidovudine (AZT) 
Lamivudine (3TC) 
Abacavir (ABC) 
Emtricitabine (FTC) 
Tenofovir (TAF) 
- Disoproxil 
- Alafenamide

Question 20

NNRTIs

NDEER

Answer 20

Nevirapine (NVP) 
Delavirdine (DLV) 
Efavirenz (EFV) 
Etravirine (ETR) 
Rilpivirine (RPV)

Question 21

PIs (-navir)

LARD

Answer 21

Ritonavir (RTV)
Lopinavir (LPV)
Atazanavir (ATV)
Darunavir (DRV)- recommended

Question 22

INSTIs (-egravir)

RED

Answer 22

Raltegravir (RAL)
Elvitegravir (EVG)
Dolutegravir (DTG)

Question 23

HIV combo meds (once daily dosing)

Answer 23

Atripla (Efavirenz + Emtricitabine + Tenofovir Disoproxil)

Stribild (Elvitegravir + Cobicistat + Emtricitabine + Tenofovir Disoproxil)

Genvoya (Elvitegravir + Cobicistat + Emtricitabine + Tenofovir Alafenamide)

Complera (Rilpivirine + Emtricitabine + Tenofovir Disoproxil Fumarate)

Odefsey (Rilpivirine + Emtricitabine + Tenofovir Alafenamide)

Triumeq (Dolutegravir + Abacavir + Lamivudine)

Question 24

Triumeq needs what prior to initiation

Answer 24

HLAB 5701 testing

Question 25

HLAB 5701 testing is needed due to what med?

Answer 25

ABC

Question 26

CD4 monitoring

Answer 26

- At baseline (x2) + 3-6 m - before starting ART - q3-6 m first 2 yrs of ART or if CD4 <300 - after 2 y of ART w HIV RNA consistently suppressed - --- 300-500= q 12m - --- >500= optional

Question 27

HIV ART adverse effects

Answer 27

``` Rash Diarrhea Pancreatitis Hyperlipidemia and lipodystrophy Increased cardiac risk CNS effect- psychological disturbances ```

Question 28

NRTIs adverse effects

Answer 28

lactic acidosis and hepatic steatosis

Question 29

NNRTIs adverse effects

Answer 29

rash including SJS

Question 30

PIs adverse effects

Answer 30

hyperlipidemia and lipodystrophy GI Bleeding risk

Question 31

Immune reconstitution syndrome is

Answer 31

inflammatory reaction in response to rapid reconstitution of CD4 counts- a diagnosis of exclusion happens after HAART initiation

Question 32

TOXO indication and regimen

Answer 32

CD4 <100 + IgG | Tri sulfa or dapsone + pyrimethamine

Question 33

MAC indication and regimen

Answer 33

CD4 <50 | clarithro/azithro

Question 34

TB indication and regimen

Answer 34

+PPD (5mm) | INH- 9 m

Question 35

HIV- Post exposure PPX within ___ and given for ____ Agent = ___

Answer 35

72h 1m Truvada/ Raltagravir

Question 36

HIV Pre exposure PPX Agent= ____

Answer 36

Truvada- 1 daily - M, F, T Descovy- 1 daily- M, T Cabotegravir- q 2 m (injection)- M, F, T

Question 37

Indications for PrEP in sexually active

Answer 37

Anal or vag sex in past 6 m HIV + partner or unknown or detectable VL 1 or more sex partners of unknown HIV status and did not use condoms Bacterial STI in past 6m

Question 38

Indications for PrEP in persons who inject drugs

Answer 38

injected drugs past 6m | shared injection equipment

Question 39

Perinatal transmission prevention of HIV

Answer 39

AZT (zidovudine) as early as 14w

Question 40

Coccidioidomycosis "valley fever" symptoms, diagnosis and tx

Answer 40

Flu like- fever, night sweats Serology None - if RFs or persistent/severe- Diflucan

Question 41

Histoplasmosis symptoms, diagnosis and tx

Answer 41

bird droppings or bat guano asymp antigen test or tissue bx Itraconazole or Amp B

Question 42

Blastomycosis symptoms, diagnosis and tx

Answer 42

soil or dust asymp Bx or culture Itraconazole or Amp B

Question 43

Toxoplasmosis symptoms and imaging characteristic

Answer 43

cats focal neurological findings, fever punched out lesions on MRI