HIV Flashcards
What is Aids defined as ?
The outcome of chronic HIV infection and consequent depletion of CD4 cells.
Defined as CD4 count <200 cells/microL
or
the presence of any AIDS defining condition regardless of the CD4 count.
According to the WHO, name some populations that are most at risk for HIV
Men who have sex with men
Transgender people
People who inject drugs
Sex workers
Heterosexuals
Healthcare workers – needlesticks (3 per 1000)
How is HIV trasnmitted?
Blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk
____ type of T cell is most relevant to HIV/AIDs
CD4 helper T cells
Why is it HIV hard to treat?
reverse transcriptase is error prone so the virus is constantly mutating
_____ are increased in blood smear of patients with HIV
monocytes
What is the first stage of HIV known as?
acute retroviral syndrome
What are some s/s of acute retroviral syndrome?
Nonspecific viral syndrome (fever, chills, diaphoresis, pharyngitis, lymphadenopathy, myalgias/arthralgias, cephalgia, fatigue)
What PE should you do if you suspect HIV?
HEENT, lymph, abdomen, skin
What labs should you order if you suspect HIV?
HIV testing, CBC, CMP, UA, Screen for additional STDs
Who should be tested for HIV?
Known or suspected sexual or hematologic exposure
Those with promiscuous sexual history (heterosexual or homosexual)
Known drug abuse, especially IVDU
Accidental needlestick
Pregnancy
Recent sexually transmitted infection
CDC recommends routine screening ages 13 - 64 years at least once in their lifetime
Name some of the HIV tests?
Serum HIV enzyme-linked immunosorbent assay (ELISA)
HIV rapid antibody test - screening test; 10-20 min
Serum Western Blot
T/F: All patients positive for HIV should be offered ART, regardless of their CD4 count
TRUE
How often should you check the CD4 count and HIV viral load?
Monitor CD4 counts every 3 - 6 months in patients taking ART consistently
What is the PrEP drug?
Truvada
If an HIV positive women becomes pregnant, what things do you want to consider?
Initiation of ART if HIV positive
likely C-section delivery based on viral load
Avoidance of breastfeeding if HIV+
Start zidovudine (Retrovir)
What is the protocol if a healthcare worker is exposed to HIV?
HIV antibody testing and HIV viral load at baseline, 6 weeks, 3 months, and 6 months
ART ASAP and continued x 4 weeks
tenofovir 300mg plus emtricitabine 200mg (combo drug - Truvada) plus dolutegravir (Tivicay) or raltegravir (Isentress) = triple therapy*
_____ is found in 5% of all HIV positive patients
TB
80% of secondary syphilis rashes occur where?
on the palms and soles of the hands and feet
What are the recommended vaccines that need to be up to date on a patient with HIV?
Pneumococcal vaccine
Inactivated influenza vaccine annually in season
Hepatitis A vaccine
Hepatitis B vaccine
Tdap vaccine
HPV vaccine for patients <45 years of age
Haemophilus influenzae type b vaccine
Do not administer ____ vaccines to a HIV positive pt
LIVE vaccines
What is the primary goal of ART?
suppression of HIV replication
What is the recommended medication therapy schedule like?
Combination therapy with at least three medications from two different classes to avoid resistance → combination is termed HAART (highly-effective antiretroviral therapy)
What are some classes of ART therapy?
Entry inhibitors
Fusion inhibitors
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Nucleoside and nucleotide reverse transcriptase inhibitors (NRTI)
Integrase inhibitors
Protease inhibitors
