HIV/AIDS

Question 1

PrEP concepts

Answer 1

for people without HIV at high risk (sexually active men, transgender women, sexually active/IVDU)

2 meds from 2 different classes

descovy, Truvada

Cabotegravir - injection alternative or for kidney disease

HIV, STI, creatinine testing before and during therapy

Question 2

PrEP AE

Answer 2

nephrotoxicity (use injectable if renal impair)
decrease in bone mineral density
increased cholesterol
altered fat metabolism
GI effects

Question 3

PrEP drug interactions

Answer 3

statins, antivirals, anticonvulsants, aminoglycosides, NSAIDs, hep C meds

Question 4

nPEP

Answer 4

nonoccupational post exposure prophylaxis

<72 hours after high risk exposure

28 day course of 3 drug antiretroviral regimen

Question 5

HIV symptomatology

Answer 5

CD4 > 500 : oral/skin problems

CD4 200-499 : fever, diarrhea, weight loss, worsening derm/mucosal problems, shingles, candiasis, ITP, recurrent sinus/pulm infections

AIDS : CD4<200 or AIDS defining illness

Question 6

HIV testing recommendation

Answer 6

age 13-64 test once, higher risk tested yearly

reportable disease

screening ELISA, followed by HIV differentiation assay

Question 7

AIDS best case scenario labs

Answer 7

low viral load
high CD4

Question 8

ART hospital mgmt

Answer 8

continue meds in hospital!

if suppressed viral load and CD4 >500 and is admitted for non-HIV reason, may not need ID

consult ID for: new dx, acute opportunistic infection, advanced HIV/AIDS w undifferentiated illness, need for ART modification

Question 9

ART drug interactions

Answer 9

statins, FLUTICASONE (adrenal suppression), atypical antipsychotics, PPIs (some agents), St. Johns wort, antiarrhythmics, oral contraceptives

CYP 450 inhibitor

Question 10

opportunistic infx for CD4 < 500

Answer 10

M. TB

candida, HSV, cutaneous zoster

Question 11

opportunistic infx for CD4 < 200

Answer 11

PJP, candida, cryptococcal

AIDS-associated malignancies: Kaposi sarcoma, NHL

Question 12

opportunistic infx for CD4 <50

Answer 12

disseminated Mycobacterium avian complex, CMV, toxoplasmosis

AIDS-associated wasting, AIDS-associated dementia

Question 13

PJP prevention

Answer 13

for CD4 <200

TMP/SMZ QD or 3x/week first line

Question 14

toxoplasmosis prevention

Answer 14

CD4<100

TMP-SMZ

Question 15

disseminated mycobacterium avium complex (MAC) complex

Answer 15

CD4<50

azithromycin or clarithromycin

Question 16

long term comorbidities of HIV

Answer 16

CV disease
renal disease
bone disease

cancer
liver disease
neurocognitive dysfunction
hypotestosteronism
DM (A1 not accurate)
lung disease
hearing impairment

Question 17

statins CI in HIV

Answer 17

lovastatin, simvastatin

Question 18

HIV - associated renal disease (HIVAN)

Answer 18

dx with biopsy

prone to ESRD and AKI

steroids & ACEI & cyclosporine (peds)

Question 19

HIV - associated bone disease

Answer 19

vitamin D supplementation

DEXA scan @ 50

biphosphonates

Question 20

older adult considerations

Answer 20

kidney, metabolic, CV, cognitive, liver health

monitor closely for toxicities, AE

Question 21

most common resp pathogens in HIV

Answer 21

PJP
S. pneumoniae
H. flu
M. TB