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HIV/AIDS
Clinical Medicine Module 3
99
Medical
Graduate
06/10/2009

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Cards

Term
Number of people infected with HIV
Definition
35 million people
Term
Number of new infections in 2008
Definition
2.5 million
Term
Number 1 killer in Africa of all causes
Definition
AIDS
Term
Number of people in US infected by HIV
Definition
1 million
Term
% undiagnosed HIV pts in US
Definition
20%
Term
% undiagnosed HIV pts in US that are MSM
Definition
over 50%
Term
globally, percentage of undiagnosed HIV pts
Definition
80%
Term
globally, % pts who do not know if partner is infected
Definition
90%
Term
1 out of every how many black americans is infected w/HIV
Definition
1 out of 50
Term
AIDS is the leading cause of death of what demographic?
Definition
african american women btwn ages of 25-34 and men 35-44
Term
older blacks are how many times more likely than whites to be HIV (+)
Definition
10-50 times more likely
Term
% of women not concerned about contracting an STD
Definition
84%
Term
What demographic is least likely to consider themselves at risk of HIV?
Definition
those at highest risk- women 18 to 24, those w/multiple sexual partners, and those whose current partners have had multiple sex partners
Term
% of high risk women who relied on monogamy for protection against STD's
Definition
49%
Term
% Transmission to child with current antiretrovirals
Definition
0-2% each year
Term
Estimated number of children born each year to HIV infected women in resource poor settings
Definition
2 million
Term
% HIV/AIDS cases in eastern va
Definition
eastern 39%
Term
% BMSM who aggreed to be tested that were HIV+. % who were unaware they were HIV+. % who perceived themselves to be at low risk of ever becoming infected.
Definition
16%, 93%, 42%
Term
In 2006, more new AIDS cases among BMSM were diagnosed in what area than all other census areas combined
Definition
south
Term
many of the people interviewed said it mattered a great deal if they thought they might be harmed or rejected because of what factor?
Definition
disclosure. fear and terror often shaped their decisions
Term
what is the epicenter of this (HIV) epidemic?
Definition
college population
Term
% of those infected with HIV who do not know that they are positive
Definition
25%
Term
% who first test positive for HIV within 1 yr of an AIDS diagnosis
Definition
39%
Term
main barriers to care for HIV
Definition
shame, stigma, denial
Term
how many and what percentage of HIV infections in the us in 2008 are undiagnosed?
Definition
335,000 (30%)
Term
how many HIV infected pts in 2008 were diagnosed but receiving no care
Definition
363,000 (33%)
Term
What percentage delayed seeking primary care for more than 1 yr after learning they were HIV+
Definition
39%
Term
from where was HIV-1 derived?
Definition
HIV-1 was derived from the chimpanzee simian immunodeficiency virus (SIV) as an accidental innoculation during the preparation of "bush meat"
Term
what does RT-polymerase chain rxn assay ms?
Definition
HIV RNA
Term
What does an undetectable viral load mean?
Definition
undetectable means that the amt of virus in the blood is less than the lower limit of detect of the test used. (HIV RNA < 400 or < 50/mmcubed)
Term
Does undetectable mean the patient is uninfected or cured?
Definition
no
Term
Does undetectable mean safer sex practices can be forgotten?
Definition
no
Term
What occurs in a pt with an undetectable virus load if antiretrovirals are missed?
Definition
the virus will return rapidly
Term
How has the number of new HIV infections progressed since 1988?
Definition
remained the same
Term
In what population is HIV screening recommended?
Definition
for pts aged 13-64 yrs in all health-care settings after the pt is notified that testing will be performed unless the pt declines (opt-out screening)
Term
How frequently should high risk pts be screened?
Definition
high risk persons
Term
according to new guidelines for HIV testing, should separate written consent for HIV testing be required?
Definition
no
Term
according to new guidelines for HIV testing, should prevention counseling be required?
Definition
no
Term
Up to what percent of initial positive EIA'S may not be confirmed w/a western blot?
Definition
70%
Term
what is the cdc definition of positive western blot?
Definition
any 2 ands positive of 3: p24, gp41, or gp120/160
Term
How should testing proceed with EIA negative results?
Definition
no further tests
Term
How should testing proceed with EIA positive results?
Definition
2 of 3 from same sample (+), then western blot performed
Term
How is a western blot with no bands interpreted?
Definition
negative
Term
206 pts with indeterminate wb were followed for 6 mos or longer. how many seroconverted?
Definition
6 (3%) seroconverted, all had recent HIV risk factors
Term
What is the window period?
Definition
time from infection to the development of Ab's, usually 1-3 mos, 95-99% will have positive test by 6 mos
Term
Ab tests are negative, what is 100% sensitive and almost always >50,000?
Definition
HIV RNA by PCR
Term
What does ELISA require?
Definition
western blot confirmation (high risk of false positives in low prevalence population)
Term
unless recent risky behavior, most people with what EIA and what WB are really HIV (-)
Definition
EIA +, WB indeterminate
Term
for pts in the "window period" or with a seroconvertin illness, will HIV RNA generally be positive or negative?
Definition
positive
Term
HIV positive means what?
Definition
infected with HIV
Term
When does AIDS occur?
Definition
when CD4<200 or an AIDS defining illness is dx
Term
what type of pneumonia often occurs when CD4 lymphocytes are between 100-250
Definition
pneumocystis jiroveci
Term
almost all cases of PCP occur when?
Definition
when CD4 < 200
Term
What are the clinical signs of PCP?
Definition
fever, non-productive cough. doe. may be subacute w/symptoms for weeks prior to onset.
Term
increased ldh could indicate what disease in an aids pt?
Definition
pcp- non-specific, may be normal in 20%
Term
an aids pt shows a cxr with diffuse bilateral interstitial infiltrates are most common, but may be normal (15-20%) or atypical (20%)
Definition
pcp
Term
what does a cxr show with pcp?
Definition
diffuse bilateral interstitial infiltrates are most common, but may be normal in (15-20%) or atypical (20%)
Term
what might oxygen desaturation with exercise (may be normal at rest) indicate in an aids pt?
Definition
pcp
Term
with what cd4 count is cmv manifested
Definition
cd4 almost always <50
Term
how is pcp tx in aids pts?
Definition
TMP-SMX DS (bactrim, septra) one tab qd for cd4<200, prior pcp or thrush
Term
how is mac tx in aids pts?
Definition
azithromycin 1200mg, once a week or (biaxin 500 mg, bid for cd4<50)
Term
What are 5 screening studies for HIV pts?
Definition
RPR, annual. Pap smear, 6 mos then annual. PPD (no anergy testing), annual, if at risk. screen for hcv, hepb, and hepa. toxoplasma IgG.
Term
what is the most common cause of death in aids pts?
Definition
pcp
Term
what are 4 immunizations for hiv?
Definition
pneumovax: all pts, booster every 5 yrs. hep b, all pts w/neg HBcAb. influenza, all pts, annually. hepA: hep c pts who are not immune to hepA.
Term
what immunizations should be avoided in hiv pts?
Definition
avoid all live virus vaccines (MMR, varicella, yellow fever)
Term
for 1255 pts w/cdr<100, deaths due to aids decreased 70% from jan 1994 to june 1997 (improved survival with haart). what 3 opportunistic infections decreased during the same period? use of haart increased from what percents during the same period?
Definition
PCP, MAC, and CMV decreased by 83% during the same period. use of HAART increased from 2% to 82% during the same period.
Term
what % did excess mortality/1,000 person decrease before and after 1996?
Definition
94% reduction
Term
by 2004-06 what percent of excess mortality was observed for the *first 5 yrs* following hiv seroconversion for those infected sexually?
Definition
no excess mortality
Term
assuming hiv pts can access and adhere to a std combination antiviral regimen, we can anticipate that most hiv-infected individuals will have their life expectancy decrease by what amount?
Definition
no decrease; normal life-expectancy
Term
what are DHHS preferred ARV'S?
Definition
NNRTI based plus 2 nrtis (truvada); pi based.
Term
How do antiretrovirals work?
Definition
either prevent new infections of cd4 cells by inhibiting *reverse transcriptase* or the development of new viruses by inhibiting the *protease* enzyme
Term
hopkins cohort found risk progression to AIDS or death was what percent in those who started with a cd4 >350 vs. what percent for those who started between 200-350
Definition
1.5% vs. 12%
Term
what are the risk factors for cvd when the baseline cd4<350?
Definition
1.8
Term
what occured with efavirenz in march 2005?
Definition
pregnancy category changed from category c (risk of fetal harm cannot be ruled out) to category d (positive evidence of fetal risk)
Term
what has a boosted pi (protease inhibitor)?
Definition
combining a small dose of ritonavir (potent inhibitor of cyp 3a4) to inhibit the metabolism of the other pi
Term
What are the side affects of the pi atazanavir?
Definition
increased indirect bilirubin; no lipid effects
Term
What are the side effects of the pi kaletra (lopinavir/ritonavir)
Definition
diarrhea, increased lipids
Term
what are the side effects of the pi ritonavir (norvir)
Definition
nausea, diarrhea, drug interactions (potent inhibitor of cyp 3a4) increased lipids, esp triglycerides
Term
lipodystrophy: where is fat depletion located?
Definition
usually subcutaneous. face, buttocks, arms and legs (veins more prominent)
Term
Lipodystrophy: where does fat accumulation occur?
Definition
visceral fat accumulation. buffalo hump. breast enlargement. bilateral symmetrical lipomatosis.
Term
with >95% adherence, what is the virologic sucess?
Definition
90%
Term
with 80-95% adherence, what is the virologic sucess?
Definition
53%
Term
with <80% adherence, what is the virologic sucess?
Definition
13%
Term
what are the problems with structured tx interruption?
Definition
rapid decline in cd4 w/ the return of wild type (improved fitness of wild type). transient benefi in salvage, mutants return quickly.
Term
with what sti is HM?
Definition
cmv retinitis, cd4=5
Term
for GART compared to controlls 11% and 10%, more where undetectable at which months, respectively?
Definition
3 mos, 6 mos.
Term
HIV RNA was what log less than controls at 3 and 6 mos, respectively?
Definition
0.27 adn 0.21 log (0.3 log is considered a clinically significant difference)
Term
How can HIV medications and related care be obtained for people who make less than 300% of poverty limit (~$27,000 for a single person)?
Definition
all meds free through the Va AIDS drug assistance progam (ADAP). all outpt HIV related care can be provided for free w/*Ryan White CARE Act* funds, $5 million annually to Norfolk EMA.
Term
what was founded at EVMS in 1994 to provide HIV care throughout SE VA regardless of payor source?
Definition
Center for the Comprehensive Care of Immune Deficiency (C3ID)
Term
what s an anion surfectant developed as a contraceptive spermicide, disrupts viral membrane, but also caused vaginal inflammation/ucleration?
Definition
nonoxynol-9
Term
what has antiretroviral incorporated in vaginal gel?
Definition
tenofovir gel
Term
what is the risk of occupational hiv infection?
Definition
0.29% risk
Term
Efavirenz (sustiva) is not recommended for which populations?
Definition
women w/high pregnancy potential (want to conceive or not using effective contraception)
Term
what is contraindicated with ritonavir?
Definition
simvastatin (zocor) adn fluticasone (advair, flonase)
Term
of 57 documented occupational infections from 1981-2002, how did 41 of these infections occur?
Definition
41 hollow bore needles
Term
what decreased hiv transmission from needlestcks by 79%?
Definition
AZT postexposure prophylaxis
Term
is the following postexposure prophylaxis old or new? basic: azt+3tc and expanded: add a third drug
Definition
old
Term
is the following postexposure prophylaxis old or new? basic: azt or viread + either 3tc or emtriva and expanded: kaletra
Definition
new
Term
HIV was undetectable in lymph node implants when AZT was initiated within how long after exposure in 10 out of 10 mice?
Definition
withing 2 hrs
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