Flashcards in HIV Course Deck (12)
Which gender is more likely to be infected with HIV? There are more _____ infected than _______
Females; males, females
Which group is more likely to acquire HIV?
Male-to-male sexual contact, at least 75% new infections(over heterosexual, injection drug use, MSM and injection drug use combined)
In the time course of the HIV infection, when could anti-HIV Abs appear? What happens during the clinical latency period? When can we see constitutional symptoms? Can you make a diagnosis of HIV based on the CD4 count?
Virus is proliferating in CD4 cells that have been infected, maybe creating syncytia and creating virions;
when CD4 cells and immune system lose control and viremia recurs, perhaps at 8 years after primary HIV infection;
What do you begin to see at a certain CD4 count? What is that count?
Kaposi's sarcoma (HIV in conjunction with HHV)
1. Pneumocystitis jirovecii pneumonia (classified as fungus and can respond to bactrim, a sulfa drug)
2. Non-Hodgkin's lymphoma (could see lymphadenopathy)
3. Esophageal candida (AIDS defining diagnosis!!!: thrush, oral hairy leukoplakia)
5. Chronic herpes (face)
6. Cerebral toxoplasmosis (mass effect, multiple ring-enhancing lesions on MRI/CT, typically involves basal ganglia)
7. Progressive Multifocal Leukoencephalopathy (JC virus)
8. CMV retinitis
9. Mycobacterium avium complex (straight pink things that fill up the macrophages);
At around 500 CD4 T cells, what do you see? What would you try to target?
Skin disease (seborrheic dermatitis) and nodular prurigo (papulopruitic eruptions centered around hair follicles);
target the HIV
At around which CD4 count do you see pulmonary TB? How does the TB typically arise?
300-400; typically is reactivated with a low enough CD4 count
What are some goals of antiretroviral therapy?
1. Suppress HIV-1 replication (lower viral load and impede HIV spread)
2. Prevent/delay destruction of immune system
3. Achieve normal survival while maintaining a tolerable life
When is it indicated to initiate therapy of chronic infection?
If symp, with CD4 T cell count and plasma HIV RNA at any value, TREAT;
if asymp with AIDS, CD4 less than 350, TREAT;
if asymp, >350 CD4, >100,000 copies of plasma HIV RNA, some clinicians might treat;
if asymp, >350, <100,000, DEFER THERAPY
Benefits to treating someone with CD4 > 500 cells/ul?
At the very least, DISCUSS treatment with the patient
List concerns of early therapy?
1. ARV-related toxicities
2. Non-adherence to ART
3. Drug resistance
What are the different types of ARV medications (6)?
5. Fusion inhibitors
6. CCR5 antagonist