HIV Flashcards
How is HIV transmitted?
Sexual activity
Blood product transfusions
IV drug use
Needle stick injury/exposure to body fluids
Transplacental viral spread from mother to fetus
What does HIV do?
impairs the immune system = <CD4 T lymphocytes –> allow opportunistic infections/malignancies to form
What are the markers of HIV progression/severity?
CD4 T lymphocyte and viral load
What is the relationship between CD4 T lymphocytes and viral load in HIV?
As HIV RNA copies (viral load) increases, the CD4 T lymphocyte decreases
What is the treatment strategy for HIV?
Treat with 3 drugs from two different classes
Usually = 2 (NRTs) reverse transcriptase inhibitors, 1 integrase (common)/protease inhibitors
What are the drug targets for HIV?
Entry/fusion inhibitors
Reverse transcriptase inhibitors
- Nucleoside (NRTI)
- Nucleotide (NtRTI)
- Non-nucleoside (NNRTI)
Integrase inhibitors
Protease inhibitors (maturation inhibitors)
What are the HIV goals of treatment?
Individual health benefits = reduce associated morbidity/mortality, improve QoL
Reduce transmission (population goal)
Prevention of HIV transmission from infected mother to child
When should HIV treatment be started?
Treatment-naïve patients w/ opportunistic infection = start once patient is stable (generally 2wks)
Those w/ TB = once treatment started, continue w/out interruption unless oral therapy C/I or in toxicity
When initiating treatment, patient should be willing/able to commit to lifelong therapy + understand benefits/risk
What should be done prior to starting HIV treatment?
Assess general health, assess prophylaxis/treatment for opportunistic infections
Assess hep B/c coinfection, screen STIs
Assess cardiovascular risk factors, diabetes
Test for resistant HIV strains
Ensure patient is ready to start treatment
What is HAART?
Highly active anti-retroviral treatment (start w/ 3 drugs, can drop to two later for maintenance treatment)
first line therapy for HIV = 2 NRTIs and 1 INSTI
What is cobicistat used for in HIV treatment?
Its not actually playing a tole in treatment
It (along w/ ritonavir) is a cytochrome P450 inhibitor used to inc plasma concertation of protease inhibitors and INSTI
What monitoring is required for HAART?
CD4 checked 4-6 wks after initiation then every 3 months, viral load fall below 50 copies after 3-6 months, CD4 inc 100-200
CV risk
- lifestyle factors, BP, weight, fasting blood lipids, blood glucose
How is HAART toxicity checked?
haematology, serum electrolytes, creatinine, liver function test
How is the risk of HIV exposure assessed?
The nature of exposure w/ its estimated risk/exposure
risk that the source is HIV positive, if status is unknown
Factors associated with the source and exposed individual
Describe when post exposure prophylaxis for HIV should occur
Effective only if commenced w/in 72 hrs of exposure, no conclusive evidence that it works
There is also re exposure prophylaxis = ongoing treatment that provides protection against HIV
