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Tropical Medicine > HIV > Flashcards

HIV Flashcards

1
Q

What are the two types of HIV 1 and 2

A

HIV 1: 4 groups M(Major), N(New), O, P
M has C and B
HIV2: Less pathogenic and less transmissble, only in W. Africa

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2
Q

What is the risk of transmitting HIV to a child in HIV infected women without prophylaxis?

A

15-40% without ppx
<2% if ART is used
15-29% due to breast feeding

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3
Q

HIV transmission risk if donor is HIV positive

A

90%

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4
Q

What are forms of PREP you can use?

A

Tenofovir-based oral PREP, Dapivirine ring for women, Cabotegravir long-acting injection since 2022

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5
Q

What tests should you run in acute HIV infections?

A

HIV Viral Load, p24 viral antigen, Ag/Ab 4th generation ELISA. Western blot/Serology will be negative in the first week

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6
Q

Common clinical manifestations with C4 counts 100-200

A

PCP, Histoplasmosis, Extrapulmonary TB, ML

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7
Q

Common clinical manifestations in patients with CD4<100

A

Cryptococcosis, Toxolasmosis, Cryptosporidiosis, Candida, Microsporidiosis, CMV, MAC, CNS lymphoma

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8
Q

Definition of WHO Clinical 1

A

ASymptomatic, Generalized LAD

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9
Q

WHO Clinical Stage 2

A

Weight loss <10%, Recurrent oral ulces, angular cheilitis, pruritic papular eruptions, seborrheic dermatitis, shingles, fungal nail infections, recurrent upper respiratory infections

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10
Q

Definition of WHO stage 3

A

Weight loss >10%, chronic diarrhea , >1 month of fever, thrush, oral hairy leukoplakia, pulmonary or lymphatic TB, PNA, pyomyositis, osteomyelitis, acute necrotizing ulcerative gingitivits, anemia, neutropenia, thrombocytopenia, bed ridden for <50% of previous month

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11
Q

WHO Clinical stage 4 definitions

A

Wasting defined as weight loss>10%, chronic diarrhea, prolonged fever; may have OIs of PCP, toxo ,crypto, MAC, esophageal candida, PML, disseminated mycosis, chronic crypto, isosporiosis, chronic herpetic ulcers, CMV; extra pulmonary TB, recurrent severe bacterial pneumonia, kaposis, CNS or NH lymphoma, HIV encephalopathy, bed ridden >50% of previous month

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12
Q

How do you understand HIV infection in children

A

CD4% is helpful (not CD4); Recurrent invasive bacterial infections common and OIs are more agressive

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13
Q

NRTIs Class toxicities

A

Mitochondrial toxicity (lactic acidosis, neuropathy), lipodystrophy, GI disturbances

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14
Q

TDF

A

NRTI-Tenofovir. Preferred agent in WHo
-Once a day, Can have renal problems
-Can be active against HBV

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15
Q

What are the common NRTIs

A

Tenofovir, Lamivudine (3TC), emtricitabine (FTC) , Zifovudine (AZT), Stavudine, Didanosine, Abacavir

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16
Q

AZT side effect

A

zidovudine (AZT)-anemia, mitochondrial toxicity

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17
Q

d4T

A

Stavudine -twice a day, tolerated in the first few months but very toxic to use; lactic acidosis risk is high *DO NOT USE

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18
Q

Didanosine side effects

A

neuropathy, pancreatitis. DO NOT use with d4T

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19
Q

Abacavir side effects

A

hypersensitivity reaction -Test for HLA b5701 before. Rash is common

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20
Q

HIV drugs that cause lipodystrophy

A

NRTIs, but mostly d4T and AZT (Stavudine) and Zidovudine

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21
Q

Most common side effects of NNRTIs

A

Rash and hepatotoxicity

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22
Q

Efavirenz

A

WHO preferred NNRTI. Side effects of vivid dreams, rash, hepatotoxicity; use with TB and in pregnancy

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23
Q

Nevirapine

A

NNRTI. CD4 restrictions *must check CD4 first; Men CD4>400, Women CD4>250

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24
Q

Which drug class has a high rate of resistance

A

NNRTI (efavirenz), especially hard to stop without supervision because of prolonged half life

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25
Q

What are the general side effects of PIs

A

GI, Hepatotoxicity, dyslipidemia; metabolized by p450

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26
Q

Atazanavir

A

PI -boosted preferred, used in limited settings; 5-7% develop jaundice; cannot use with PPI

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27
Q

Lopinavir/Ritonavir

A

PI-can get diarrhea

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28
Q

Side effect of INdinavir

A

Kidney stones, renal toxicity

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29
Q

Common integrase inhibitors

A

Raltegravir, Elvitegravir, Dolutegravir, Bictegravir, Cabotegravir

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30
Q

Raltegravir

A

Integrase Inhibitor; Can use with TB, just need to increase dose ; good for neonates and childdren

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31
Q

Bictegravir

A

integrase inhibitor, but interacts with rifampin (do not use in TB)

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32
Q

Dolutegravir

A

Preferred WHO ; Integrase inhibitor; increase with Tb; can cause weight gain

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33
Q

First line HIV treatment

A

2 NRTIs + Integrase inhibitor (Tenofovir, lamiduvine, dolutegravir) Can also do efavirenz instead of dolutegravir

34
Q

When do you start ART in OIs

A

TB: within 2 weeks
Crypto meningitis: 4-6 weeks

35
Q

What are theh preferred medications in HIV-TB Coinfection

A

Dolutegravir or efavirenz (PIS should be avoided for rifampin interaction p450 metabolism)

36
Q

Treat HIV with HBV

A

Start ART and regimen should have contain TDF/TAF AND 3TC

37
Q

What is the definition of treatment failure in HIV

A

Clinical: new or recurrent WHO stage 6 months after ART (Or TB-WHO Class 3)
Immunological: Fall of CD4 to baseline, persistent CD4 below 100
Virological failure: VL>1000 after 6 months of ART

38
Q

definition of primary ppx

A

use of drugs to prevent infection before it has happened (i.e. PCP, toxoplasma)

39
Q

secondary ppx definition

A

use of drugs to prevent relapse of a previously seen infection

40
Q

If clinical screening for TB is negative, what to do with ART and ppx

A

IPT should be offered for at least 6 months, but 36 months is recommended

41
Q

What vaccines are recommended in HIV

A

HBV, Influenza; sometimes pneumonia HPV HAV Meningococcus ; live attenuated vaccines are contraindicated unless CD4 is preserved

42
Q

22 year old woman with 1 week of headaches and fever, no weakness or seizure. HIV is positive. lumbar puncture shows 15 WBC, protein is 75, 100% LM, Glu is normal

A

Cryptococcoal meningitis

43
Q

Management of cryptococcal meningitis

A

liposomal amphotericin B plus 14 days of flucytosine plus fluconazole

44
Q

What is the length of conslidation therapy in crypto meningitis

A

8 weeks of fluconazole 800mg , then maintenance therapy is fluconazole 200mg ; postpone ART

45
Q

Toxoplasma gondii : prevelance, acquired through, how to test, Treatment

A

Prevalence is high in Europe and Africa; usually oral ingestion but symptoms are usually from reactivation of latent infection, so test for IgG toxo; Focal neuro deficits, CT with ring enhancing lesion; treat with pyrrimethamine and sulfadiazine (or high dose bactrim), then 2ndary ppx

46
Q
A

Toxoplasmosis

47
Q

PML: Caused by what, CD4?, Sx, Findings on MRI, how to diagnose, how to treat

A

progressive multifocal leukoencephalopathy (PML); caused by JC virus , CD4 is <100, Subacute motor cognitive and visual symptoms, focal signs; white matter lesions on MRI, no mass effect, no enhancement; JC Virus will be + PCR in CSF, Start ART

48
Q

22year old woman with 1 week of decreased vision, floaters in the left eye. HIV positive.

A

CMV Retinitis

49
Q

Most common cause of retinitis in HIV? How to test? What do the lesions look like? Tx?

A

CMV Retinitis, CMV IgG+, 2/3rds have unilateral lesions, cheese and ketchup lesions; PO Valganciclovir + intravitreal GCV Injections (if sight threatening); PO valganciclovir for non-life threatening

50
Q

difference between CMV and Toxo retinitis

A

In toxo: Encephalitis coexists in 50% of AIDS patients; photophobia floaters and decr visions are similar in both; uveitis is more common in Toxo; lesions are BILATERAL in toxo (unilateral, ketchup and cheese in CMV)

51
Q

TB manifestations in HIV -CXR

A

early HIV: Upper lobe cavities
Advanced HIV: Miliary, pleural effusion, miliary pattern, disseminated disease

52
Q

PCP: full name, CD4?, sx, CXR, Tx

A

Pneumocystis jirovecii , CD4<200, gradual onset fefver dry cough, dyspnea; Pneumothorax, diffuse interstitial infiltrates ; treat with TMP?SMX and if PaO2 <70, steroids

53
Q

Third most common OI in endemic areas with a similar presentation to histo (fungal)

A

Talaromyces marneffei in SE Asia

54
Q

How do you treat oral candida

A

2 weeks of clotrimazole , nystatin suspension (topical)
PO: Fluconazole x 2 weeks

55
Q

What is oral hairy leukoplakia and how do you treat

A

caused by EBV, Raised lesion in the lateral borders of the tongue, hairy appearance, does not rub off; tx with ART

56
Q
A

cystoisospora (secretory diarrhea, eosinophilia), Cyclospora (secretory diarrhea), Cryptospordium (secretory diarrhea), microsporidium (diarrhea, cholangitis, hepatitis, sinusitis)

57
Q

HIV Neuro:
1. Strength OK but slow mentation
2. Cauda equina
3. Pain in feet, decreased DTRs
4. Seizures, focal decifits
5. Subacute progressive deficits
6. ICP Elevation

A
  1. HIV dementia
  2. CMV Radiculitis
  3. Sensory neuropathy
  4. Toxo
  5. PML
  6. Crypto
58
Q

Most common non viral STD in HIV

A

Trichomoniasis-Treat with flagyl

59
Q

In HIV, what mimics KS?

A

Bartonella, skin bone liver-bacillary angiomatosis

60
Q

Treatment of visceral leish in HIV

A

Liposomal amphotericin and miltefosine

61
Q

Woman 21year old has white patches in the mouth and papular pruritic eruption with no CD4 available. What WHO Stage? What tx?

A

Oral thrush: Stage 3
Tx: Start ARTs

62
Q

What to know about HIV2?

A

They are not susceptible to NNRTI
There is a lower risk of transmission
They are mostly found in some areas of Western Africa
The prevelance is NOT increasing

63
Q

RIsk of acquiring HIV after needle stick, not on ART.

A

<1% (approx 0.3)

64
Q

Patient with pulmonary TB in HIV. What WHO stage?

A

Stage 3-start ARTs immediately

65
Q

Which PI is associated with lower risk of metabolic side effects?

A

Atazanavir

66
Q

Patient has a chronic middle ear infection, discahrge from the ear, chronic sinusitis. What WHO stage?

A

Stage 2

67
Q

Patient admitted for acute weakness of one side of hte body-responding to bactrim. What WHO stage?

A

stage 4-toxo

68
Q

Patient with herpes zoster HIV, what WHO stage

A

stage 2

69
Q

Patient with KS in HIV. What WHO stage?

A

stage 4

70
Q

What NOT to use with liver problems

A

nevirapine

71
Q

Avoid what in anemia

A

zidovudine

72
Q

Avoid what with renal problems

A

tenofovir

73
Q

Avoid what in TB

A

Efavirenz

74
Q

What are the best meds to use in chronic HBV

A

Tenofovir + lamivudine or Emtricitabine

75
Q

What are the side effects of dolutegravir

A

hepatotoxicity if pre -existing liver disease, sleep disturbances, CNS problems, weight gain

76
Q

What is definition of viral failure in HIV treatmetn

A

persistently detectable viral load >1000 copies/mL after 6 months of ART

77
Q

What is the definition of clinical failure in HIV?

A

Occurrence of new or recurrent WHO stage 4 condition

78
Q

risks for developing IRIS

A

Low CD4, high TB burden (can give RIPE+Steroids)

79
Q

patient on ART x 3 years , no OIs. Then develops recurrence of prurigo, zoster, weight loss. Next steps?

A

Stage 2 WHO->make sure adherence and then can switch but is not necessary in stage 2

80
Q

how do you diagnose HIV in low resource settings

A

2 or 3 positive RDTs successfully performed

Tropical Medicine (19 decks)

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