IC18a PR3151 HIVAIDS Flashcards
(57 cards)
describe HIV and what it does to the body (general)
lentivirus group of the retrovirus family
attacks the CD4 t cells
causes AIDS in the long term
Describe the mode of transmission of HIV
through specific fluids: genital fluids, blood, breast milk:
- sexual intercourse
- sharing of infected syringes and needles
- Mother-to-child transmission
- transfusion w/ contaminated blood
What patient populations/types should be tested for HIV?
1) individuals with unprotected sex with multiple sex partners
2) male-male sexual intercourse
3) intravenous drug users
4) recipient of multiple blood infusions
5) commercial sex workers
6) pregnant women
7) testing for STIs
8) sexual assault victims
What are the two diagnosis methods for HIV?
serum antibody detection
-Western blot
-enzyme immunoassay
hiv rna detection and quantification (viral load)
-PCR
What are the presentation stages for HIV?
1) acute infection
2) asymptomatic
3) persistent generalised lymphadenopathy
4) aids and related infections
What is the clinical presentation of HIV during the acute (primary) infection stage?
2-3 weeks of symptoms: fever, malaise, rash, swollen lymph nodes
What is the clinical presentation of HIV during the asymptomatic stage?
asymptomatic for many years
What is the clinical presentation of HIV during the persistent generalised lymphadenopathy stage?
> 3 months of persistent unexplained lymph node swelling at neck, groin, underarms
What is the clinical presentation of HIV during the AIDs and related conditions stage?
AIDS = CD4 < 200/mm3
symptoms of: fever, unexplained weight loss, diarrhoea, swollen lymph nodes
multi-organ involvement
aids defining conditions:
- lymphoma, kaposi sarcoma, pneumocystis pneumonia, aids dementia complex, cytomegalovirus.
what are the primary goals of antiretroviral therapy?
Reduce HIV-associated morbidity and mortality
Prolong the duration and quality of survival
Restore and preserve immunologic function
Maximally and durably suppress plasma HIV viral load
Prevent HIV transmission
what are the two surrogate markers for HIV?
cd4 and viral load
CD4 surrogate marker useful for?
used to measure the
1) subsequent disease progression
2) immune function
3) response to treatment
4) when to START or STOP prophylaxis to opportunistic infections, e.g., pneumocystic pneumonia prophylaxis when cd4 <200/mm3
how often to recheck cd4 after treatment initiation?
measure 3-6 months after
every 12 months after adequate
viral load surrogate marker useful for?
assessing the response to treatment
how often to check for viral load?
2-4 weeks after treatment initiation
6-8 weeks thereafter
(should take 8-24 weeks for viral suppression)
once viral suppression is reached, can be tested every 3-6 months
when to start hiv art?
initiate as soon as possible regardless of cd4 count to reduce mortality and morbidity AND prevent HIV transmission
what are the benefits of earlier ART?
maintain high cd4 count and potentially irreversible damage to the immune system
decrease risk for hiv associated complications that can occur at cd4+ counts >350/mm3 e.g., TB, non-hodgkin lymphoma, kaposi sarcoma, peripheral neuropathy, hiv associated cognitive impairment
Decreased risk of non-opportunistic conditions, including cardiovascular disease, renal disease, liver disease, and non–AIDS-associated malignancies and infections
Decreased risk of HIV transmission to others, which will have positive public health implications
>350, some of these opportunistic infections MAY occur, so treat ear
what are the LIMITATIONS of earlier ART?
Development of treatment-related side effects and toxicities
Development of drug resistance because of incomplete viral suppression, resulting in loss of future treatment options
Transmission of drug-resistant virus in patients who do not maintain full virologic suppression
Less time for the patient to learn about HIV and its treatment and less time to prepare for the need for adherence
Increased total time on medication, with a greater chance of treatment fatigue
Increased cost
factors to consider before starting ART regimen
Regimen selection should be individualized and should be based on a number offactors, including:
Patient’s understanding of HIV
Cost and availability
Adherence issues, convenience
pill burden
dosing frequency
food and fluid considerations
Virologic efficacy
Potential adverse effects (comorbidities, drug interactions)
Childbearing potential
Genotypic drug resistance testing 19
what is the life cycle of HIV?
free virus -> binding and fusion –> infection –> reverse transcription –> integration –> transcription –> assembly –> budding –> maturation
What are the two recommended ART regimens?
2 NRTI + 1 INSTI
- tenofovir + emtricitabine + bictegravir (TEB)
- tenofovir + emtricitabine + dolutegravir (TED)
- abracavir + lamivudine + dolutegravir (ALD)
1 NRTI + 1 INSTI
- tenofovir + dolutegravir
when is dual therapy (INSTI + NRTI) for ART not recommended?
1) for patients w/ HIV RNA >500,000 copies/ml
2) HBV coinfection
3) ART to be started before HIV genotypic resistance testing results or HBV testing are available
what are the NRTI drugs?
tenofovir (tin of ears)
emtricitabine (electricity bone)
abacavir (abc cadaver)
zidovudine (zombie divin)
lamivudine (lamb voodoo)
what are the advantages to using NRTI?
renal elimination
little concern for drug interactions
