Term
| What is the development and prognosis of an HIV-1 infection without treatment? |
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Definition
1) Primary/Acute lasts 2-6 weeks
2) Latency is variable (8-10 years) (length is correlated with viremia level)
** Shorter in children
3) Death occurs 18 months after cinical AIDS is diagnosed (<200 cells/uL or occurrence of opportunistic disease) |
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Term
| How do you diagnose HIV-1? |
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Definition
1) ELISA for HIV-1 Ab (sensitive but false positives)
2) West blot (REQUIRED)
3) Neonatal may be false for ELISA, so use serum p24 antigen or RCR for DNA or RNA |
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Term
| What Nucleoside analog reverse transcriptase inhibitors (NRTIs) are available for HIV? |
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Definition
All these involve 5'-phosphorylation, bogus substrate and chain termination.
Lets All Take Emily to the Zoo
1) Lamivudine (3TC)
2) Abacavir (ABC)
3) Tenofivir (TDF)
4) Emtricitabine (FTC)
5) Zidovudine (AZT or ZDZ)
6) Combinations: Combivir (AZT/3TC) |
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Term
| What non-nucleoside analog reverse transcriptase inhibitors (NNRTIs) are available for HIV? |
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Definition
Non competitive inhibition by binding hydrophobic pocket and "freezing" enzyme
1) Efavirenz (EFV)
2) Nevirapine (NVP) |
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Term
| What side effects are associated with NNRTI use? |
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Definition
Efavirenza (CNS and rash) and Nevirapine (Rash and Hepatitis)
1) CNS (EFZ)
2) Rash (EFZ and NVP)
3) Hepatitis (NVP) |
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Term
| What side effects are associated with NRTI use? |
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Definition
1) Zidovudine (AZT= bone marrow suppression)
2) Tenofivir (TDF= renal insufficiency)
3) Abacavir (ABC= Hypersensitivity) |
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Term
| What protease inhibitors (PIs) are used to treat HIV? |
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Definition
Compete with substrate to bind Protease
"avir"
RNA FoLD
1) Ritonavir (r) (only booster)
2) Nelfinavir (NFV)
3) Atazanavir (ATV)
4) Fosamprenavir (fAPV)
5) Lopinavir/Ritonavir (LPV/r)
6) Darunavir (DRV) |
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Term
| What fusion inhibitors are available to treat HIV? |
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Definition
Efuvirtide; (T-20)
Binds gp41 and blocks coil-coil interaction (SubQ-may cause nodules) |
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Term
| What integrase inhibitors can be used to treat HIV? |
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Definition
Raltegravir; RAL
Prevent proviral integration (given with 2NRTIs) |
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Term
| What benefits are associated with ART therapy? |
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Definition
1) Increase CD4 count
2) Delay AIDS progression
3) Decrease risk for complications wit chronic immune activation (CV, metabolic, cancer)
4) Survival |
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Term
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Definition
1) Symptomatic for HIV or AIDS
2) T cell < 500cells/cumm
3) HIV associated nephropathy
4) HepB patients who will be started on anti-Hep B therapy
5) Pregnant women |
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Term
| What 3 drug combinations are utilized for ART (generically) |
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Definition
1) 1NNRT + 2NRTI (Efavirenz + Zidovudine/Abacavir)
2) 1PI +2NRTI (Nelfinavir + Lamuvidine/Tenofivir)
3) 1 Integrase + 2NRTI
(Raltegravir + Abacivir/Emtricitabine) |
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Term
Which phase of HIV-1 pathogenesis is occurring 2-4 weeks after transmission and what clinical/lab features define it?
How do you diagnose it? |
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Definition
Acute Retroviral Syndrome (looks like mono)
Diagnose with HIV-1 DNA/RNA PCR because ELISA is negative until 4-6 weeks
1) Fever, lethargy, malaise, myalgia, headache, sore throat, rash, lymphadenopathy, neck stiffness
2) Labs may see lymphopenia, neutropenia and hepatitis. |
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Term
| What oral manifestations should you look for in chronic HIV-1 and how do you treat? |
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Definition
| Oral Candidiasis treated with topical (nystatin or clotrimazole) or systemic (fluconazole, amphoterocin, caspofungin) |
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Term
| What Cutaneous manifestations should you look for in chronic HIV-1 and how do you treat? |
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Definition
Viral
1) HSV-1 or HSV-2-painful ulcers with raised margins in mouth and perianally
Treat with Acyclovir (oral usually)
2) VZV (Shingles)- Usually unidermatomal
Treat with high-dose Acyclovir (oral and analgesics (IV if disseminated) |
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Term
| What GI manifestations should you look for in chronic HIV-1 and how do you treat? |
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Definition
Hepatobiliary Disease (Mycobacterium Avium Complex)
Infiltrates in portal triad and liver parenchyma diagnosed with blood cultures (look for ALT/AST and hepatomegaly)
Treat with 2/3 in combination such as Tetracyclines (Clarithromycin/Azythromycin), Rifabutin, Ethambutol and Aminoglycosides (Amikacin) |
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Term
| What Pulmonary manifestations should you look for in chronic HIV-1 and how do you treat? |
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Definition
1) Pneumocystis jiroveci Pneumonia
Treat with TMP/SMX, steroids, Atovaquone and PRevent with TMP/SMX for T-cell counts <200 mm3 (AIDS).
2) M. tuberculosis (risk 50 times higher than normal pop)
- Treat with 4-drug regimen (INH/RIF/PYR/ETH) for 2 months and 2-drug regimen (INH/RIF) for 4 months
XDR-TB on the rise in South Africa (50% mortality) |
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Term
| What is the diagnostic/treatment/preventative measures taken in a suspected case of P. jirovici in an HIV-1 patient? |
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Definition
Can be re-activation of latent form with insidious onset of fever, dyspnea and NONproductive cough.
1) Bilateral interstitial infiltrates (not focal) on X-ray
2) Organisms detected in sputum or BAL by silver stain.
Treat with Bactrim, atovaquone, and steroids and prevent with Bactrim if CD4 counts are <200mm3 |
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Term
| A patient arrives in your clinic and he is HIV + with a + PPD test. What do you do? |
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Definition
| You are worried about latent TB, and give INH for 9 months regardless of age. |
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Term
| What CNS manifestations should you look for in chronic HIV-1 and how do you treat? |
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Definition
Toxoplasmosis with reactivation from latent cysts in brain.
- Look for mental status change, headache and focal neurological signs and look for MULTIPLE RING-ENHANCING lesions on CT with contrast
- Treat with Sulfadiazine/pyrimethamine or Clindamycin/pyrimethamine |
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Term
| What malignancies should you look for in chronic HIV-1 and how do you treat? |
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Definition
1) Kaposi's Sarcoma (KS) with focal, vascular nodules in skin or other organs (HHV-8 or KSHV)
- Treat with ART, systemic IFN-a, radiation and chemo
2) Non-Hodkin's Lymphoma-B cell neoplasm at extranodal sides (especially CNS) that is less common and usually occurs when CD4<50
- Try to treat with radiation or without systemic chemotherapy |
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Term
| What coincident manifestations should you look for in chronic HIV-1t? |
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Definition
1) Oral- Candidiasis
2) Cutaneous- HSV-1/2 and VZV
3) GI- Mycobacterium Avian Complex (MAC)
4) Pulmonary- P. jirovici and M. tuberculosis
5) CNS- Toxoplasmosis
6) Cancer- Kaposi's (HSV-8) and Non-Hodkin's Lymphoma |
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Term
| What are the most effective preventative measures against HIV? |
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Definition
1) Obstacles include silence of infection, human libido and lack of vaccine
2)
- Education
- Behavioral Modification
- Barrier protection
- Regular testing
- Curcumcision
- Prophylaxis (pre and post)
- Screen pregnant women and substitute for breast feeding. |
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