HIV ! dx + mx Flashcards
(18 cards)
HIV seroversion presentation
symptomatic in 60-80%, presents as a glandular fever type illness
increased symptomatic severity -> assoc with poorer long-term prognosis
typically occurs 3-12wks after infection
clinical features of HIV seroconversion
sore throat
lymphadenopathy
malaise, myalgia, arthralgia
diarrhoea
maculopapular rash
mouth ulcers
rare - meningoencephalitis
diagnosing HIV
combination tests (HIV p24 antigen + HIV antibody)
- if positive - repeat to confirm diagnosis
testing for HIV in asymptomatic patients
done 4weeks after possible exposure
- after initial negative result in asymptomatic patient, offer a repeat test at 12weeks
how early can the p24 antigen be detected
2-3weeks after exposure
method used for diagnosing neonatal HIV + for screening blood donors
HIV RNA
when should HIV patients start ART
as soon as diagnosed
(rather than waiting for CD4 count)
Antiretroviral therapy (ART)
combo of at leaft 3 drugs;
- 2 NRTI
- PI or NNRTI
this combo decreases viral replication + reduces risk of viral resistance emerging
nucleoside analogue reverse transcriptase inhibitors (NRTI) examples
zidovudine - anaemia, myopathy, black nails
abacavir
didanosine - pancreatitis
tenofovir - renal impairment, osteoporosis
nucleoside analogue reverse transcriptase inhibitors (NRTI) side effects
peripheral neuropathy
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
examples + side effects
nevirapine
efavirenz
side effects
- P450 enzyme interation
- rashes
Protease inhibitors (PI) examples
indinavir
nelfinavir
ritonavir
Protease inhibitors (PI) side effects
diabetes
hyperlipidaemia
buffalo hump
central obesity
P450 enzyme inhibition
key side effect of ritonavir
(protease inhibitor (PI))
potent inhibitor of P450 system
mode of delivery in pregnant HIV patients
vaginal delivery if viral load <50 at 36weeks
a zidovudine infusion should be started four hours before beginning the caesarean section
factors which reduce vertical transmission of HIV in pregnant mums to babies
maternal antiretroviral therapy
mode of delivery - c-section
neonatal antiretroviral therapy
infant feeding - bottle feeding
neonatal antiretroviral therapy
zidovudine
- if viral load <50
otherwise - triple ART
therapy should be continued for 4-6wks
oxygen desaturation on exercise
pneumocystis jivrocci
