Flashcards in Ortoski: High-yield Stuff Deck (98):
Geography associated with HIV?
More men or women, which race?
Men more than women, African American predominance
Top 3 modes of acquisition of HIV?
1. M to M sexual contact
Around what time was there more treatment, so fewer cases of HIV?
Since HIV causes inflammation, what are 2 areas of issue?
Cardiac and cancer
HIV is the BLANK leading cause of death currently
6th- Used to be leading in early 90s in the 25-45 age group
Reducing viral load reduces what?
Nucleoside reverse transcriptase inhibitor
Non-nucleoside reverse transcriptase inhibitor
d4t, ddl, ddc, AZT
Does AZT have a lot of SE?
Lowest CD4 count ever
No prior drug exposure
Found in minority- not detectable
Below level of detection- less than 20
Where is HIV 1 found?
Where is HIV 2 found?
Africa- Less easily transmitted
Major group worldwide
How many subgroups or clades?
Group M Subgroup B
Americas, Japan, Austrailia, Carribean, Europe
Group M Subgroup C
S. Africa, India
Typical transmission modes?
2. Vertical (mother to child)
4. IV drug use
If mother's viral load is undetectable, is it less likely to transfer to fetus?
1. 3+ nights in prison
3. Other STD
What should be emphasize?
Routine voluntary testing
What test is the best and confidental?
What is needed for a + result?
2 ELISA screening followed by 1 Western Blot for CONFIRMATION
What test is done for infants?
DNA test (newborns have positive antibodies no matter what from mom)
When is DNA test done?
After 1 month and after 4 months
What does the 4th generation ELISA have?
What is required for an AIDS diagnosis?
Positive serology and a CD count under 200 and/or AIDS defining illness
CD4+ Under 200
Prevent PCP pneumonia
CD4+ Under 100?
CD4+ Under 50?
What is used to test kidney and liver function?
Dosing for Hep B vaccine?
Give HIV pt. 40mcg (normal is 20mcg)
When can you give MMR?
Is CD4 is over 200
Greater than 500 CD4 cells, asymptomatic, acute phase, PHI
CD4- 200-500, Early symptomatic
CD4- 50-200, Late symptomatic, full blown AIDS
Fewer than 50 CD4 cells- Advanced AIDS
What measures extent of immune system damage?
What does viral load measure?
Plasma HIV RNA level...higher means more CD4 destruction
What is most popular viral RNA assay?
What test does everyone infected get immediately?
What % of infections are resistant to at least 1 drug because the index patient was resistant to the drug?
What is best bang for buck?
Genotyping (can also use trophile/trophism test)
R5 Viruses, CCR5 CoReceptor, Macrophages, Early
X4 Viruses, CXCR4 CoReceptor, T-cells, Late, Faster to AIDS?
M: AA found in wild tpye
184: AA (codon) position
V: AA substitution/variant
We only have drugs that kill what trophism?
M184V mutation, what drugs won't work?
Lamivudine and Emtricitabine
K103N mutation, what drugs will work?
All of the 1st generation NNRTIs
4 types of Anti-retroviral treatment?
1. Reverse Transcriptase Inhibitors: Nucleoside RTI (NRTI), non-Nucleoside RTI (NNRTI), Nucleotides
2. Protease Inhibitors: PI
3. Entry Inhibitors: Attachement inhibitors, chemokine receptor inhibitors, fusion inhibitorsa
4. Integrase inhibitors
True or False: ART is recommended for ALL HIV infected persons regardless of CD4 count
Is monotherapy okay?
1 exception to monotherapy?
Pregnant woman that normally will accept no treatment, but is willing to take AZT at the time to prevent the baby from contracting the virus
Can you piece drugs together?>
NO...ALL OR NONE
-Start all drugs or stop all drugs at the same time
Diagnosis of AIDS?
AIDS defining illness and/or CD4 count below 200
All protease inhibitors are taken with what?
What is ritonavir?
A boosting agent for P450... not a viral killer anymore and helps with one-a-day dosing of others
HS/HLAB*5701, CAD risk, Danger with Rechallenging?
Ziagen or ABACAVIR
Less use with AE, hyperchromic macrocytic anemia
If virus has M184V mutation, what won't work?
Lamivudine and emtricitabine
Neurological AE short lived, depression issues, low genetic barrier?
Associated with CAD
Reyataz and Crixivan
Entry inhibitors (CCR5)?
Injection SC only, painful, cellulitis?
Use with R5 virus only?
Work in nucleus?
Now indicated first line with low AE?
Isentres (integrase inhibitor)
Are there dietary restrictions with these drugs?
Does adjustments to avoid AE in?
1. ED Medication
Can you use Simvastatin?
What 3 combos can be used to initiate?
1. NNRTI and 2 NRTI
2. PI (preferably boosted with ritonavir) and 2 NRTI
3. INSTI and 2 NRTI
(non nuc or PI pr INSTI PLUS 2 NUCs)???
What are 2 components of lypodystrophy?
Toxoplasmosis brain scan related to an HIV case
-CD4 count under 100 and positive antibodies for Toxo
Palmar or plantar rash?
What do newborns born to an HIV+ Mom get the first 6 weeks of life?
-This is started 8-12 hours after birth and discontinued at 6 weeks (DNA BLD)
When is PCP prophylaxis initiated for a baby born to HIV + mom?
At 6 weeks
What is given for pre-exposure prophylaxis for dischordant couples that have an accident?
Do all states require pretest counseling or signed release?
Efavirenz (Sustiva- CNS effects)
2 protease inhibitors- Reyataz and Crixivan
Undetectable mean irradicated
What is used to assess efficacy of therapy?
Best efficacy is how many drugs?
Pregnant women should at least take what?
Combo therapy should be started and stopped...
ALL OR NONE