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Clin Med2- Hematology > HIV - collins > Flashcards

HIV - collins Flashcards

(59 cards)

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1
Q

what year were routine HIV screenings recommended

A

2006

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2
Q

what year was PrEP(pre-exposure prophylaxis) approved

A

2012

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3
Q

what are the risk factors for HIV

A

concomitant STDs
alcohol and drug use
sexual intercourse (receptive anal intercourse»other modes)
Needles

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4
Q

what is the etiology of new HIV diagnoses

A

68% Male-to-male sexual contact
23% heterosexual contact
6% IVDU

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5
Q

What are the symptoms of HIV

A

often asymptomatic
can have acute retroviral syndrome (50-70%)
- mild=vague flu-like illness
- severe= meningitis, encephalitis, thrombocytopenia

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6
Q

what are HIV screenings and when are they done

A

CDC recommends at least one time screening for all pts 13-64
at least once yearly for high-risk patients
more frequently might be preferred for high risk patients

screening completed via “opt-out” testing
- pts notified HIV screen will be completed with routine blood work
- testing is the default - must elect NOT to be tested

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7
Q

what are HIV tests

A

Nucleic acid tests (NATs) - detect HIV RNA
Antigen/antibody testing - detects HIV p24 antigen AND HIV IgM and IgG
Antibody only testing - detects HIV IgM and IgG

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8
Q

what is the window period

A

time between acute infection and ‘detectable’ infection

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9
Q

What is the Nucleic Acid Test (NAT)

A

expensive
most acute HIV or indeterminate test - no HIV abx yet
Detectable 10 days post-exposure
positive = presence of HIV RNA

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10
Q

when are the treatments for HIV recommended

A

initiate in any pt age >18 regardless of CD4 count
initiate immediately on diagnosis(or ASAP)
should obtain baseline/screening labs on initiation of treatment

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11
Q

what baseline/screening labs should be obtained on the initiation of treatment for HIV

A

Viral load (HIV RNA)
CD4 count
HIV genotyping
BMP/CMP for baseline (liver and kidney function)
lipids
CBC
Glucose
Urinalysis
Pregnancy testing

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12
Q

what co-infections screening should be obtained for HIV

A

STI (syphilis, chlamydia, gonorrhea; + trichomonas in F)
Latent TB
Hep A and B
HCV
Coccidiodimycosis

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13
Q

What is the first line treatment for HIV

A

ART (anti-retroviral therapy)
generally a 3 drug combo (1InSTI + 2 NRTIs)

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14
Q

What is the second line treatment for HIV

A

2NRTIs+ 1 from another class (PI, NNRTI, II)

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15
Q

what is INSTI

A

integrase inhibitors

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16
Q

What is PI

A

Protease Inhibitors

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17
Q

what is NRTI

A

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors

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18
Q

What is NNRTI

A

Non-Nucleoside Reverse Transcriptase Inhibitors

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19
Q

What are the side effects of HIV treatments

A

N/V/D
Difficulty sleeping
Dry mouth
Headache
Rash
Dizziness
Fatigue
Fever
Osteopenia/osteoporosis
Peripheral neuropathy
Pancreatitis
Hepatitis
Anemia
Neutropenia
Nephrotoxicity

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20
Q

what is the goal of HIV treatment

A

virologic suppression
Defined as < 50 copies/mL
takes about 24 weeks to achieve

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21
Q

what should rise with Virologic suppression

A

CD4 count
check every 6 months for first 2 years
then, if suppressed, check yearly

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22
Q

What is Immune Reconstitution Inflammatory Syndrome (IRIS)

A

occurs after initiation of ART (higher risk if worse disease)
secondary to rapid increase in CD4 count - can now mount inflammatory response
appearance of worsening opportunistic infections
must rule out new or worsening opportunistic infections

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23
Q

what is the treatment of IRIS

A

supportive +/- steroids if severe

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24
Q

what are reasons to adjust ART

Study These Flashcards
A

side effects
toxicity
simplify regimen for compliance
virologic failure (HIV RNA >200 on 2 consecutive occasions)

25
what is the best way to prevent HIV
no vaccine available prevention: cessation of IVDU/needle sharing, safe sex practices (regular screenings, condom use, limited partners, avoid concurrent ETOH/drug use), sex education, ART as prevention
26
What is PrEP
pre-exposure prophylaxis indicated for any high risk patients who request - inconsistent condom use, recent PEP or STI, HIV + partner, needle sharing
27
how is PrEP taken
once daily oral (truvada or Descovy(not indicated in vaginal sex)) IM injection (cabotegravir) every 2 months monitoring every 3 months for screenings
28
what are the oral PrEP medications
Truvada (tenofovir DF and emtricitabine) Descovy (tenofovir A and emtracitabine) - not indicated for receptive vaginal sex
29
what are the IM injection PrEP medications
Cabotegravir (apretude) every 2 months - good option if patient preference and if troubles with adherence
30
what needs to be monitored every 3 months with PrEP use
HIV screening Pregnancy screening ready for SUD treatment? clean needle access creatinine STIs Annual HCV screening
31
What is PEP
Post-exposure prophylaxis for prevention of HIV in negative pts AFTER EXPOSURE to HIV must be started within 72 hours of exposure
32
how is PEP adminitered
Orally for 28 days Tenofovir DF + emtracitibine (truvada) daily AND either Raltegravir (BID) or dolutegravir (daily
33
What are screenings needed prior to the administration of PEP
HIV rapid test (if HIV + DONT start PEP) pregnancy test LFTs BUN/creatinine STI screen (if sex related exposure) Hep B screen HCV screen requires repeat HIV screening at 30d and 90d to rule out seroconversion
34
what are the complications of HIV
may have fever, weight loss, night sweats (can occur w/o OI) wasting syndrome - loss of muscle > fat neuropathy arthritis, rhematologic diesases, osteopenia/osteoporosis CAD progression to AIDs - OI or Opportunistic diseases
35
What is AIDS
acquired immunodeficiency syndrome late-stage HIV (mean time of about 10 years between initial HIV infection and AIDS)
36
what defines AIDS
CD4 count less than 200 cells/mcL OR Presence of an 'AIDS defining' infection/malignancy (OI)
37
prior to ART, what was the most common OI in aids patients
Pneumocytis jirovecii (PCP) CD4 < 200 symptoms are similar to pneumonias - cough, SOB, hypoxia, fever
38
what is present of PCP pneumonia x-ray
diffuse or perihilar infiltrates on CXR used to be called pneumocysitc carinii
39
how is PCP pneumonia diagnosed
sputum testing
40
how is PCP pneumonia treated
TMP-Sulfa (Bactrim) x 21 days
41
what is toxoplasmosis
CNS infection CD4 <100 ssx: HA, focal neuro deficits, seizures, AMS Ring-enhancing lesion (Contrast enhancing) on CT usually setting of + Serologic tests (IgM, IgG)
42
what is the treatment of Toxoplasmosis
pyrimethamine + sulfadiazine X 6 weeks +/- leucovorin OR TMP-Sulfa (Bactrim) - prophylaxis
43
What is Mycobacterium Avium Complex (MAC)
infection with Mycobacterium avium and Mycobacterium intracellular CD4 <50 - rare since ART improvements pulmonary infection in health individuals (elderly, pre-existing lung dz) Disseminated MAC in HIV + patients (fever, night sweats, weight loss, fatigue, SOB, abd pain, diarrhea, anemia)
44
how is MAC diagnosed
sputum culture (+ acid fast bacillus (AFB))
45
how is MAC treated
clarithromycin (or azithromycin) + ethambutol + rifampin
46
What is Cryptococcal Meningitis
Infection with Cryptococcus (usually neoformans) fungal infection sx: headache and fever (Meningeal irritation less likely)
47
How is Crytococcal meningitis diagnosed
+ serum cryptococcal antigen (CRAG) + india ink stain CSF
48
what is the treatment of cryptococcal meningitis
IV liposomal Amp B + flucytosine X 2 weeks then Fluconazole 400mg X 8 weeks, then Fluconazole 200mg X 1 Year
49
what is CMV retinitis
infection of the retina with cytomegalovirus rule out all HIV + pts with visual changes perivascular hemorrhages and white fluffy exudates - not cotton wool spots
50
What are Opportunistic diseases in AIDS
HIV-related encephalopathy Invasive cervical cancer Kaposi's sarcoma Lymphomas Progressive multifocal leukoencephalopathy(PML) Wasting. syndrome
51
What is Kaposi's sarcoma
infection with Kaposi's sarcoma herpes virus (KSHV) - aka HHV-8 most commonly CD4 < 200 purplish macules, papules or nodules can present anywhere on skin/MM
52
how is Kaposi's sarcoma diagnosed
biopsy
53
how is kaposi's sarcoma treated
ART if not widespread Add chemo if ART is widespread
54
What are the typical first line HIV treatment regimens
Bictegravir + Tenofovir + emtricitabine (BIC/TAF/FTC) Doultegravis + abacavir + lamivudine (DTG/ABC/3TC) Doultegravir OR Raltegravir + tenofovir/emtricitabine (DTG/TAF/FTC or 3TC)
55
what does the india ink stain test
Cryptococcus neoformans
56
What is the prophylaxis treatment for TB
if not active disease (negative CXR) - start isoniazid (INH)
57
what is the prophylaxis treatment for cocidiodomycosis
fluconazole if positive screening
58
what is the prophylaxis treatment for PCP
trimethoprim-sulfamethoxazole (Bactrim) 80/400mg or 160/800mg
59
what is the prophylaxis treatment for toxoplasmosis
Bactrim 160/800mg

Clin Med2- Hematology (8 decks)

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