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
