HIV Flashcards
(72 cards)
1
Q
what contributed to the decline of HIV/AIDs
A
safer sex programs
greater outreach to high-risk populations
2
Q
who are the populations at risk of HIV/AIDS
A
- men who have sex with men
- transgender people
- people who inject
- sex workers
- heterosexuals
- healthcare workers
3
Q
what are the ways HIV can be transmitted
A
- blood
- semen
- pre-seminal fluid
- rectal fluids
- vaginal fluids
- breast milk
- in utero
- during birth
NOT in saliva, sweat, tears, vomit, urine, nasal secretions
4
Q
what has the highest and lowest HIV transmission rates
A
- anal receptive intercourse
- blood transfusion
5
Q
describe the 6 steps of how HIV invades a cell
A
- fusion of HIV to host cell surface
- HIV RNA and viral proteins enter host
- viral DNA formed by reverse transcriptase
- viral DNA transported across nucleus and integrates into host DNA
- new viral DNA is used as genomic RNA and to make viral proteins
- new viral DNA and proteins move to cell surface and a new, immature HIV forms and is released
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
7
Q
what are the 3 steps of transferring of virus from DCs to CD4+ T cells
A
- DCs capture and bind HIV
- HIV traffics within DC
- HIV is transferred to CD4+ T cells via trans-infection
8
Q
what are the 4 stages of HIV infection
A
- viral transmission/HIV acquisition
- acute HIV infection/acute retroviral syndrome (symptomatic)
- chronic HIV infection
- can be asx
- often follows early symptomatic HIV infection
- AIDS - advanced HIV infection
9
Q
what must happen in order to be considered AIDS
A
CD4 ct <200 cells/uL OR presence of AIDS defining condition
10
Q
a CD4 ct of <50 cells/uL means ?
A
advanced HIV infection
11
Q
4 step stages of acute HIV infection
A
- viral penetration of mucosal epithelium
- infection of submucosal CD4 T cells, dendritic cells, and monocytes
- spreads to lymph nodes
- HIV viremia
12
Q
acute retroviral syndrome can be asx for an average ____
A
10 years
13
Q
s/s of acute retroviral syndrome
A
- nonspecific viral syndrome - fever, chills, diaphoresis, pharyngitis, lymphadenopathy, myalgias/arthralgias, cephalgia, fatigue
- spontaneous resolution
- infection latent until progression to AIDS
14
Q
who should be tested for HIV?
A
- known or suspected sexual or hematologic exposure
- sexually active people
- known drug abuse, especially IVDU
- accidental needle stick
- pregnancy
- recent STI
CDC recommends routine screening ages 13-64 at least once
15
Q
7 HIV tests
A
- serum HIV ELISA
- HIV rapid antibody test (10-20min)
- serum western blot
- serum p24 antigen
- serum HIV DNA PCR
- CD4 ct
- serum viral load (HIV RNA)
16
Q
if the HIV test comes back positive, what are the next steps?
A
- confirm with western blot
- another ELISA
17
Q
other testing for HIV
A
- pregnancy
- serum hepatitis B serology
- serum hepatitis C serology
- CBC w/ diff
- BMP or CMP
- UA, LFTs, fasting plasma glucose, lipid profile
- human leukocyte antigen-B*5701 testing
- order only when prescribing abacavir if positive - PPD, CXR
18
Q
how to do lab monitoring for HIV pts
A
- offer ART regardless of CD4 ct
- monitor CD4 cts every 3-6 months
- monitor HIV viral load every 3-6 months
19
Q
what is used for pre-exposure prophylaxis (PrEP)
A
tenofovir (truvada, drug class NRT1)
20
Q
what is the prevention of perinatal transmission of HIV
A
- HIV testing of all pregnant women
- initiation of ART if HIV positive and likely C-section delivery based on viral load
- avoid breast feeding
21
Q
what are the associated diseases of HIV? what are the tx of choice?
A
- TB - isoniazid + pyridozine (w/ sputum cx)
- syphilis - PCN
22
Q
usual presentation of TB
A
upper lobe consolidations/cavitary lesions
+/-mediastinal or hilar adenopathy
23
Q
how do you screen for syphilis
A
- rapid plasma reagin (RPR)
- venereal disease research laboratory (VRDL) test every 6 months
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
25
if someone presents with nonpruritic, maculopapular rash on their palms and soles, what type of syphilis do they have?
secondary
26
5 additional measures to prevent HIV
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
27
what is the perinatal HIV tx
1. ART (if HIV positive)
2. zidovudine (retrovir)
28
if a healthcare worker got exposed via need stick, what are the next steps
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
29
what is started in all patients regardless of CD4 ct and must be tested for resistance before initiating
antiretroviral therapy (ART)
30
what is HAART
highly-effective antiretroviral therapy
combo therapy with at least 3 meds from two different classes to avoid resistance
31
what are the 6 classes of antiretroviral therapy
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
what antiretroviral therapy class has most of its agents complicated by peripheral neuropathy and often components of fixed dose antiretroviral combos?
nucleoside reverse transcriptase inhibitor
33
what antiretroviral therapy class stops the conversion of HIV RNA to HIV DNA by blocking reverse transcriptase
NRTIs
- nucleoside
- nucleotide
NNRTIs
34
what antiretroviral therapy class commonly leads to renal failure
nucleotide reverse transcriptase inhibitor
35
what must you monitor when taking nucleotide reverse transcriptase inhibitor
creatinine
usually leads to renal failure
36
what antiretroviral therapy class is usually well-tolerated and does not need special monitoring
NNRTIs
37
what antiretroviral therapy class blocks new HIV from maturing, therefore suppressing HIV replication
protease inhibitors
38
what antiretroviral therapy class is usually used to "boost" other regimens
protease inhibitors
39
what antiretroviral therapy class blocks HIV envelope from fusing with the CD4 membrane
entry/fusion inhibitors
40
what antiretroviral therapy class is used as add-on therapy for pts with multidrug resistance
entry/fusion inhibitors
41
what antiretroviral therapy class slows HIV replication by blocking HIV integrase enzyme needed for viral multiplication
integrase inhibitors
42
4 things to monitor for antiretroviral therapy
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
5 tx goals for HIV
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
3 definitions for AIDS
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
14 AIDS defining conditions
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
complaint of unpleasant taste or mouth dryness with pseudomembranous or erythematous plaques
mucocutaneous candidiasis - oral candidiasis
47
usually seen as an inguinal rash
tinea cruris - fungal rash of mucocutaneous candidiasis
48
caused by Epstein-Barr virus that leaves white lesions on the lateral aspect of the tongue
oral hairy leukoplakia
49
small, grouped vesicles on penile shaft, labia, perianal skin, or buttocks
genital herpes
50
common manifestation of HIV that leaves painful, vesicular lesions occurring along dermatome
herpes zoster/shingles
51
often seen in children
umbilicated fleshy papules
molluscum contagiosum
52
most common cause of pulmonary disease in HIV infected pts
CAP
- p. pneumonia
- h. flu
- p. aeruginosa
53
most common opportunistic infection with AIDS
AIDS defining condition
fever, cough, dyspnea, hypoxemia
CXR -diffuse or perihilar infiltrates
pneumocystis jiroveci penumonia
54
common AIDS complication
AIDS defining condition
dysphagia, or difficulty swallowing
commonly diagnosed via EGD
esophageal candidiasis
55
AIDS defining condition that leaves purplish, nonblanching lesions
kaposi's sarcoma
56
decreased caloric intake - anorexia, N/V
malabsorption
increased metabolic rate
disproportionate loss of muscle mass
wasting syndrome
57
spread by inhalation
encapsulated budding yeast found in soil and pigeon poop
gram stain of CSF with budding, encapsulated fungi
cryptococcal meningitis
58
rapidly progressive visual loss with retinal perivascular hemorrhages and white fluffy exudate
most common retinal infection in AIDS pts
cytomegalovirus retinitis
59
most common space-occupying lesion in HIV affect pts leading to HA, focal neurologic deficits, altered mental status, seizures, causing CNS damage
toxoplasmosis
60
if the CD4 <200 what could be the opportunistic infection
pneumocystis
61
if the CD4 <150 what could be the opportunistic infection
histoplasmosis
62
if the CD4 <100 what could be the opportunistic infection
1. toxoplasmosis
2. cryptococcus
63
if the CD4 <50 what could be the opportunistic infection
mycobacterium avium complex (MAC)
64
why monitor CD4 cts every 3-6 months?
- reflects degree of immune dysfunction
- reflects efficacy of therapy
65
why monitor HIV load every 3-6 months
- assesses level of viral replication
- provides prognostic information about disease progression
- reflects efficacy of therapy
66
Post-exposure prophylaxis for sexual and drug use exposures to HIV, and needlesticks is offered within ?
72h of exposure
67
how do you choose antiretroviral therapy?
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
which ART is metabolized by cytochrome P450 system → high potential for drug interaction
protease inhibitor
68
which ART allows for more rapid decrease in viral load versus other regimens
integrase inhibitors
69
May flare as part of Immune Reconstitution Inflammatory Syndrome
Kaposi's sarcoma
70
Causes disseminated infection in late-stage HIV (CD4 count <50/mcL), with persistent fever, weight loss, usually a positive blood culture
MYCOBACTERIUM AVIUM INFECTION
71
Starts as pulmonary nodules and/or infiltrates that spread to CNS
CRYPTOCOCCAL MENINGITIS
