HIV management Flashcards
(40 cards)
What is seen on P.E of a HIV patient?
- kaposi sarcoma (painless purplish spots on the skin)
- oral thrush (candidiasis- Painful swallowing)
- CXR (pneumocystic pneumonia)
- syphilis
What occurs with blockade of integrase? What do integrase inhibitor drugs end in?
- virus can’t be inserted into host cell genome
- -gravir
What does the CCR5 inhibitors do?
- blocks the HIV from “using” the CCR5 receptor to enter the cell
What is bad about monotherapy with ZIdovudine?
- did not improve survival
- —-reduce viral load
How effective is Dual NRTI therapy?
- improves survival by 33%
Define triple drug therapy
-combination of minimum 3 drugs from 2 classes of drugs from which the virus is susceptible.
What is the purpose of the anti-retroviral therapy ?
- reduces viral load to UNDETECTABLE
- restores immunocompetence
- reduces morbidity and mortality
How to prevent drug resistance?
- ADHERENCE to therapy (taking the drug every day!)
- give drugs according to patient’s lifestyle, tolerability
- depends on pharmacokinetics, drug-drug interaction, RX interruptions
CNS side effects of HAART?
mood, psychosis (efavirenz)
Skin S/E of HAART?
rash, hypersensitivity, Stevens-Johnsons (abacavir, nevirapine)
Bone s.e of HAART?
- osteromalacia (tenofovir)
How may protease inhibitors affect drug-drug interactions?
- these are potent Liver enzyme inhibitors
What does preventive medicine involve for HIV pts ?
- STI screening
- CVS risk and smoke cessation
- Hep A/B, Flu, HPV vaccination
- harm reduction (moving away from injecting drugs)
What psychosocial issues may a HIV pt face?
- adjustment d.o
- survivor’s guilt
- feeling of isolation
- relationships
- spirtual
What does partner notification and disclosure (by the doctor) involve?
- a voluntary process
- —-required years of trust
- Can be either: partner referral, provider referral and conditional referral
Barriers to partner notification?
- fear of: REJECTION, ISOLATION, VIOLENCE
- STIGMA > discrimination
- CONFIDENTIALITY
How to prevent HIV transmission?
- SEXUALLY TRANSMITTED: condom use is effective
- not sexually transmitted when HIV pt is on HIV treatment
- STI screening and RX
- sero-adaptive sexual behaviour —-RISK IS MORE IF HE INSERTS
- disclosure
- post-exposure prophylaxis
- pre- exposure prophylaxis
Why is STI screening important for HIV prophylaxis?
- HIV -ve pt exposed to STI is VULVNERABLE to HIV
Conception options for : HIV+ male, HIV- female
(SEX as normal just PrEP for non-HIV pt) Treatment as prevention
(+/- timed condomless sex)
?HIV PrEP for female partner
Conception option for
HIV+ female, HIV- male
Treatment as prevention
(+/- timed condomless sex)
? Self-insemination
?HIV PrEP for male partner
How to prevent Mother to child transmission?
- give PEP for 4 weeks after neonate is born
- exclusive FORMULA feeding (unknown if breast feeding is infective)
- if undetected Viral load—–then VAGINAL delivery
- C-section if otherwise
- HAART during preg.
How effective is it to tell people to abstain?
- not effective
- does not work
BEST HIV strategies at an individual level?
- condom programmes
- behaviour change interventions (support people to have sex)
- CONDOM program
- PEPSE
- circumcision (reduces HIV risk by 60 % )
- PrEP
Best HIV prevention strategies at a community level?
- needle exchange
- testing and rx of
STIs - rx as prevention
