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Flashcards in HIV Deck (31):
1

At which rate does the CD4 count fall? What is the normal CD4?

From normal 600-1000 falls at a rate of 50-100/year if untreated

2

Transmitted by

IUD
sex (vaginal transmission is 1:3000-1:10000, anal 1:100)
Transfusion (before 1985)
Perinatal (25-30%) without prophylaxis
Needle stick injury(1:300)

3

PCP appears under which CD4 count?

4

Infections occurring under 200/uL are

PCP
varicella zoster
Herpes simplex
TB
Oral and vaginal candidiasis
Bacterial pneumo

5

Best initial test to dx HIV, confirmed with

ELISA
Confirmed with western blot

6

What dx test to use in infants?

PCR or viral culture (false positive ELISA cause maternal HIV antibodies are present for up to 6 mo aftr delivery)

7

How to test response to tx?

PCR RNA viral load

8

When is PCR RNA viral load relevant?

Infants
Measure response to tx
Detects treatment failure
Goal of tx is to drive it down to undetectable levels (

9

Before starting medications which test should be done?

Viral resistance testing

10

Viral resistance testing (genotyping) is done when? Why?

Before initiating tx
Decreases likelihood of starting meds to which pt's virus is resistant
Guides choice of medication

11

When is HIV treatment initiated?

CD4100000/uL or
Opportunistic infection occurs

12

Initial drug regimen

Emtricitabine, tenofovir and efavirenz

13

How to detect tx failure?
What to use then?

Rising viral load raises
CD4 count decreases or fails to raise

Alternative drug regimens: 3 drugs from 2 classes

14

Nucleoside and nucleotide reverse transcriptase inhibitors

Zidovudine
Didanosine
Stavudine
Lamivudive
Emtricitabine
Abacavir
Tenofovir

15

Side effects of zidovudine?

Macrocytic anemia

16

Side effects of didanosine?

Neuropathy and pancreatitis

17

Side effects of stavidine?

Neuropathy and pancreatitis

18

Side effects of tenofovir

Renal toxicity

19

Non nucleoside reverse transcriptase inhibitors

Efavirenz
Etravirine
Nevirapine

20

Protease inhibitors

Ritonavir
Saquinavir
Nelfinavir
Amprenavir
Fosaprenavir
Lopinavir

21

Side effects of protease inhibitors

Hyperlipidemia and hyperglycemia

22

Side effect of indinavir

Kidney stones

23

If the patient is resistant to multiple classes of first line agents, we use

Entry inhibitors: enfuvirtide, maraviroc
Integrase inhibitor: raltegravir

24

When to do postexposure prophylaxis?

All significant needle stick injuries if hiv status is known
Sexual exposures
Bites
Give 4 weeks of combination tx (no need if exposure to urine and stool)

25

Side effects of abacavir

Hypersensitivity, Steven Johnson reaction

26

Side effects of tenofovir

Renal insufficiency

27

If the patient is pregnant but the CD4 count is high, should you start/continue tx?
Which drug is teratogenic?

Yes
Efavirenz

28

After delivery can you stop medications?

Yes, if the t cell count is >500

29

If a baby is born from an hiv positive mom, what is the tx?

Zidovudine during delivery (intrapartum) and for 6 weeks after to prevent transmission.
If baby is hiv + (less than 1%) HAART

30

At which viral load should you perform cesarian section?

>1000uL

31

How long does it take after infection to have clinical manifestations of HIV?

5-10years