Term
|
Definition
- Sexual
- Mucocutaneous
- Mother to child - up to 90% during last 2 months
- Perinatal - breastfeeding, zidovudine can prevent.
**Blood transfusion and IVDU are by far the riskiest |
|
|
Term
| What can increase the risk for HIV transmission? |
|
Definition
- Patient factors - Stage, viral load, STDS (ulceration diseases)
- Recipient factors - non-circumcision, deletion of CCR5 are naturally resistant |
|
|
Term
| What are the tests used to detect HIV antibiodies? |
|
Definition
- ELISA - standard screening to detect ANTIBODIES, positive 2-6 weeks after infection
- Western blot - confirms ELISA. more false(+) than false(-)
- Rapid HIV - invasive |
|
|
Term
| What are the tests used to detect HIV RNA? |
|
Definition
- Nucleic Acid Amplification Test/NAAT - positive 7-10 days after infection. Not reliable for HIV-2. Sensitive for HIV1
- p24 assays - positive 2-3 weeks after infection |
|
|
Term
| What can cause inaccurate HIV testing results? |
|
Definition
- False negative - recent exposure, retest in 3 months. Dilution due to transfusion, Infants
- False positive - recent Flu vaccine, SLE, HIV vaccine trial, infants |
|
|
Term
| What is required to be defines as stage 1 or 2 of HIV? |
|
Definition
- Stage 1 - CD4 of 500, % of 29
- Stage 2 - CD4 200-499 or 14-28% |
|
|
Term
| What is required to be defined as having AIDS? |
|
Definition
- CD4 count <200
- CD4 count <14%
- an AIDS defining illness: esophageal candidiasis, herpes w/ chronic ulcers for 1 month, Kaposi sarcoma, M. tuberculosis, pneumocystis pneumonia |
|
|
Term
| What are the 3 stages of HIV infection? |
|
Definition
- Primary - 5 days to 3 months after exposure, abrupt onset. Feels like the flu, diagnosis can be missed
- Clinical latency - asymptomatic, replicates in the lymph nodes. Can last 10 years
- Advanced - Constitutional sx develop and opportunistic infections develop |
|
|
Term
| What initial lab values are needed in an HIV patient? |
|
Definition
- CD4 count
- Plasma HIV RNA
- Resistance testing
- CBC and complete metabolic panel
- Lipid panel
- Toxoplasmosis IgG
- PPD
**Screen for HLA-B*5701 for abacavir hypersensitivy
**Screen for corecepter tropism for maraviroc |
|
|
Term
| What vaccines are given to an HIV patient? |
|
Definition
- No live viruses if CD4 < 200
- Flu vaccine annually
- Pneumococcal once
- TdaP
- Hep A and B |
|
|
Term
| What is considered an adequate response to an HIV therapy? |
|
Definition
- An increase of 50-150 per year
- Check x2 at baseline, then every 3-6 months
**Goal of HIV RNA is below limits of detection: < 50 copies |
|
|
Term
| What is NOT recommended for resistance testing? |
|
Definition
- After 4+ weeks of discontinuation
- if HIV < 500 copies |
|
|
Term
| What are considerations before starting HIV therapy? |
|
Definition
- Symptoms
- CD4 count
- HIV load
- Patient readiness - active alcohol/substance abuse, depression, lack of faith, disease not advanced, concern for AE |
|
|
Term
| At what CD4 count is initiating HIV therapy recommended? |
|
Definition
CD4 < 350
ALL pregnant women
ALL at risk for transmitting to their sexual partners |
|
|
Term
| When should more rapid initiation of HIV therapy be considered? |
|
Definition
- Pregnancy
- AIDS defining illness
- CD4 < 200
- Rapid decline in CD4
- Viral load > 100,000
- HIVAN - nephropathy
- Hepatitis B or C |
|
|
Term
| When should HIV therapy be deferred? |
|
Definition
- personal factors - but not in a low CD4 count
- Barriers to adherence
- comorbidities |
|
|
Term
| What are the preferred regimens for treatment naive patients? |
|
Definition
- Atripla = Efavirenz + Tenofovir + Emtricitabine
- Atazanavir/Ritonavir + Tenofovir/Emtricitabine
- Darunavir/Ritonavir + Tenofocir/Emtricitabine
- Raltegravir + Tenofovir/Emtricitabine |
|
|
Term
| What HIV therapies also have activity against Hep B? |
|
Definition
| Tenofovir, Emtricitabine, and lamivudine |
|
|
Term
| What are the advantages/disads to nNRTI initial therapy/Atripla? |
|
Definition
- Less toxicity, saves PIs and IIs for future use
- Low genetic barrier, cross resistance, potential drug interactions. |
|
|
Term
| What are the advantages/disads to initial therapy with protease inhibitors? |
|
Definition
- Higher barrier to resistance, preserve nNRTIs and IIs for future
- Metabolic complications, GI intolerance, drug interactions |
|
|
Term
| What HIV therapies should NEVER be offered? |
|
Definition
- NRTI monotherapy
- boosted PI monotherapy
- Dual-NRTI
- FTC + 3TC - Emtricitabine + Lamivudine, as they are isomers
**Use 2 classes at once, not 1 |
|
|
Term
| What are reasons to change HIV therapies? |
|
Definition
- Virologic failure - Not achieving HIV < 400 copies by 24 weeks or <50 copies by 48 weeks.
- Immunologic failure - Failure to increase CD4 by 50-100 during first year, or above 350 in 4-7 years. |
|
|
Term
| What is post exposure prophylaxis for HIV? |
|
Definition
- Manage exposure site - wash wound thoroughly and refer to doctor
- Assess individual and exposure source
- Basic 2 drug therapy if a solid needle and asymptomatic/low HIV RNA
- Expanded 3 drug therapy for everything else
**Basic - Truvada or Combivir
**Expanded - Truvada/Combivir + Kaletra. ALWAYS FOR 28 DAYS |
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