HIV/AIDS Flashcards
1
Q
HIV Treatment
A
- ARVS to prevent progression
- near normal life expectancy if adherent
2
Q
What are significant risk factors for AIDS?
A
- non-adherence to ARVS (resistance)
- inability to maintain close follow up
- social barriers to care
- Comorbidities (mental illness, addictions, Hep b and C)
3
Q
Natural history of HIV infection
A
- Transmission (semen, blood)
- Infection
- CD4 cells targeted
- acute infection (cell death by HIV and CD8 activation)
- chronic infection (more CD4 apoptosis, thymocytes reduced)
- Acute seroconversion (weeks)
- asymoptomatic
- or acute retroviral syndrome (flu like)
- initial decline CD4, then recovery
- Latent phase (years)
- gradual decline in CD4
- asymptomatic or generalized lymphadenopathy
- Early symptomatic phase
- cutaneous manifestation (zoster, fungal nail infections, oral candiasis, leukoplakia, sebhorreic dermatitis)
- weight loss
- URTIs
- anemia, leukopenia, thrombocytopenia
- Advanced phase (CD4 < 200)
- systemic sx
- AIDS defining illnesses
- HIV wasting syndrome
4
Q
Effective treatment for HIV
A
- treat at any stage
- ARV offered regardless of CD4 count
*
5
Q
Advanced Phase HIV
A
- CD4 < 200
- AIDS defining illnesses
- Respiratory infections (TB, PJP, pneumonia)
- GI tract
- HIV wasting syndrome
6
Q
Early Phase HIV
A
- Cutaneous
- zoster, leukoplakia, fungal nail infections, candiasis
- weight loss
- URTIs
- anemia, leukopenia, thrombocytopenia
7
Q
AIDS defining illnessnes
A
- AIDS:
- CD4 < 200 or
- HIV encephalopahy
- CMV retinitis vision loss
- PJP pneumonia
- cervical ca
- Kaposi’s sarcoma
- lymphoma
- CNS toxoplasmosis
8
Q
Immune Reconstitution Syndrome
A
- Happens with Inititiation of ART
- immune system recognizes previously acquired opportunistic infection
- overwhelming inflammatory response —> can be fatal
- Start prophylaxis BEFORE ART
- Septra for PJP if CD < 200
- Azithro for mycobacterium avium if CD4 < 100
9
Q
Hep C and HIV
A
- Co infection common
- Hep C –> cirrhosis progression shorter, more likely if HIV also
- Interferon alpha, ribavirin treatment less successful if HIV infection
- social factors make adherence difficult
10
Q
Opioid prescribing
A
- contract
- grounds for termination of contract if diversion, dose escalation etc
- required periodic random urine screening
- consult chronic pain specialist who also manages addictions if needed
11
Q
HIV comorbidities
A
- COPD, CHF, PVD ESRD
- ART toxicity with longer term use
- Psychiatric comorbidities
- Addictions
- metabolic bone disease (ART, HIV, smoking, etc)
- Malignancies (HIV and non HIV related)
- higher neurocognitive disorders (ART and HIV related)
- Frailty
12
Q
ART toxicity
A
- Renal CKD
- Neurocognitive functioning
- cardiovascular disease
- liver disease
13
Q
Side effects of ART
A
- Peripheral neuropathy
- IHD
- nephrotoxicity
- neurotoxicity
- depression
- sleep disturbances
- N/Vx
- xerostomia
14
Q
DRUGS INTERACTIONS and ART
A
- Protease inhibitors most troublesome
- MANY
- opioids (codeine fewest interactions)
- steroids (dex = decreased exposure to most ART drugs)
- SSRIs (duloxetine and venlfaxine safe)
- TCA
- antipsychotics
- benzos
Ativan and tylenol safe
15
Q
Pros and Cons of stopping ART at EOL
A
- Pros
- keeps viremia at bay
- keeps symptom burden lower (cognition, peripheral neuropathy, fatigue, weight loss)
- Cons
- pill burden
- cost
- drug interactions with PC meds
- drug side effects
Discuss with patient, depends on goals and values. Stop if unable to take PO meds
