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Flashcards in HIV therapeutics Deck (73)
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1

significance of HIV-1 and HIV-2 strains

-HIV-1 more common in the west
-some ARVs are not active against HIV-2

2

how long does it take 4th gen Ab/Ag HIV test to detect invection

within 4 weeks of infection

3

what to do if you get a negative Ab/Ag test result

test second time 3 months after the first test to confirm

4

main tests to do in HIV positive patients

viral load
CD4 T cell count
resistance testing (genotypic assays)

5

viral load looks at what

current level of virus in the blood

6

when to do viral load in untreated patients

at baseline
monitoring is optional

7

when to do viral load in treated patients

-immediately before starting ART
-2-4 weeks after start or change in ART, then q4-8 weeks until suppressed
-every 3-4 months when stable, may consider 6 months

8

goal of therapy in terms of viral load measurements

-0.5-1 log drop
-undetectable amounts of virus within 12-24 weeks

9

when to do CD4 in untreated patients

-baseline
-then every 3-6 months

10

when to do CD4 after initiating or modifying ART

every 3-6 months during first 2 years or if CD4 is still under 300

11

when to do CD4 after 2 years of ART with suppressed viral load

-if 300-500 then every 12 months
-if over 500 then its optional

12

what constitutes an adequate response to ART in terms of CD4 test

-30% change in absolute count
-50-150 increase in 1st year, 50-100 per year afterwards

13

drug class HIV is most resistant to

NNRTI's
single mutation can be enough for resistance

14

signs and symptoms of HIV infection

-mononucleosis like illness of non-specific signs and symptoms that present 1-4 weeks after exposure
-40-90% are symptomatic

15

opportunistic infections that can appear when CD4 count is 200-500

kaposi sarcoma
oropharyngeal candidiasis

16

opportunistic infections that can appear when CD4 count is <200

pneumocystis jiroveci pneumonia
disseminated histoplasmosis
coccidioidomycosis

17

opportunistic infections that can appear when CD4 count is <100

toxoplasmosis
cryptococcosis
cryptosporidiosis
esophageal candidiasis

18

opportunistic infections that can appear when CD4 count is <50

cytomegalovirus (eye infections)
mycobacterium avium complex

19

most common opportunistic infection in HIV

pneumocystis jiroveci pneumonia

20

surprising benefits of ART

-decrease in transmission to sexual partners
-decrease in perinatal transmission

21

who should be on ART

all HIV infected individuals regardless of CD4 count

22

things to treat before starting ART if possible

substance abuse
psychiatric disorders

23

immune reconstitution inflammatory syndrome (IRIS)

-exacerbation of an opportunistic infection that occurs as a result of ART initiation

24

when does IRIS usually occur

within 4-8 weeks of initiating ART

25

how do we manage IRIS that occurs

NSAIDS
corticosteroids

26

prophylaxis for mycobacterium avium complex

CD4 <50
clarithromycin or azithromycin

27

prophylaxis for pneumocystis jiroveci pneumonia

CD4 <200
Bactrim DS

28

prophylaxis for toxoplasmosis

CD4 <100 and Toxo is IgG positive
Bactrim DS

29

adverse effects of TDF

-nausea/gas
-renal insufficiency
-osteomalacia

30

adverse effects of TAF

-nausea/gas
-low renal/bone toxicities