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27 Cards in this Set
- Front
- Back
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Best ways to prevent HIV/? |
1.) latex condom 2.) circumcision 3.) preexposure prophylaxis |
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How should preexposure prophylaxis be approached in regards to preventing HIV? What tests should be done? What drugs should be used? |
Preexposure prophylaxis should be used for anyone who is at substantial risk of acquiring HIV. i. anyone in an ongoing relationship w/ an HIV+ partner ii. anyone who is not in a mutually monogomous relation ship w/ an HIV- partner and is either gay or bisexual man who has had anal sex w/out a condom 1. need documented HIV antibody 2. use tenofovir 300 mg plus emtricitabine 200 mg daily 3. test every 90 days for HIV antibody |
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In regards to HIV RNA tests what does less than 200 copies/mL mean? What do changes greater than three fold mean? |
It is considered undetectable Changes greater than three fold are considered clinically significant |
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What is HIV RNA testing an important part of HIV treatmen? |
HIV RNA or viral load, is an important result to monitor the effectiveness of treatment after initiation of ART (antiretroviral therapy) Test every 3-6 mos generlaly speaking If there is a change in CD4 count then one should test HIV RNA |
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What does the CD4 T-cell count measure? |
measurement of immune function; it is used to determine the timing of ART, opportunistic infection prophylaxis, disease progression, and survival |
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What is a normal CD4 value? What is considered a significant change in CD4 count? |
500-1300 cells/mm3 changes greater than 30% are significant |
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What are the different case definitions for HIV? Stage 1 Stage 2 Stage 3 (AIDs) Stage unknown |
Must have laboratory confirmation of HIV and: Stage 1 - no AIDs-defining condition i. CD4 greater than 500/uL or; CD4 percentage of > 29 Stage 2 - no AIDs-defining condition i. CD4 count 200-499/uL or CD4 percentage 14-28 Stage 3 (AIDs) OR documentation of an AIDs-defining condition i. CD4 count of <200/uL or CD4 percentage <14 Stage unknown i. lab results confirming HIV+ status ii. no info on CD4 count or percentage |
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What vaccines should HIV+ pts receive? |
***no live vaccines if CD4 less than 200 cells/mm3 influenza annually pnumococcal - once ideally before CD4 < 200 HepB HepA |
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What are the drug classes of HIV meds? |
Reverse transcriptase inhibitors (RTIs) i. nucleoside NRTIs ii. nucleotide and nonnucleoside NNRTIs Protease Inhibitors (PIs) Entry Inhibitors Integrase inhibitors (INSTIs) |
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What ART should be added to pregnant women to help prevent maternal-fetal transmission? |
zidovudine |
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What ART should be avoided in women? |
efavirenz in women of childbearing age to prevent exposure during 1st trimester ***teratogenic*** |
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What drug should be given to infants born to mothers who are HIV+ after labor? What else should be given if the mother wasn't given any ART? |
zidovudine 4 mg/kg/dose q12h for 6 weeks if no ART given to mother during pregnancy then add nevirapine 8-12 mg/dose at birth, 48 hrs, and 96 hrs after second dose |
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What is the preferred regimen for occupational postexposure prophylaxis? |
raltegravir plus tenofovir/emtricitabine |
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What some nucleoside RTIs (NRTIs)? major toxicities? |
abacavir - hypersisitivity (reaction can be fatal; d/c immediately) didanosine - pancreatitis - peripheral neuropathy emtricitabine - diarrhea, nausea, headache, rash, hyperpigmentation lamivudine - minimal toxicity stavudine - peripheral neuropathy - increased LFTs - pancreatitis zidovudine - bone marrow suppression - GI intolerance - nail pigmentation - myalgia |
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what are some nonnucleoside and nucleotide RTIs (NNRTIs) |
delavirdine efavirenz - avoid in first trimester *teratogenic etravirine nevirapine rilpivirine - PPI use contraindicated tenofovir |
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What are some protease inhibitors? |
atazanavir darunavir - endocrine disturbances such as hyperglycemia, fat redistribution fosamprenavir indinavir - nephrolithiasis lopinavir/ritonavir nelfinavir ritonavir sawuinavir tipranavir |
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What are some entry inhibitors and integrase inhibitors? |
efuvirtide maraviroc dolutegravir elvitegravir raltegravir |
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For pts who are antiretroviral-naive who should have combination ART therapy initiated? |
i. Any pts who is HIV+ regardless of CD4 or viral load with the following conditions: a. pregnancy b. history of AIDs defining illness c. HIV-associated neuropathy d. HIV/HepB coinfection ii. HIV+ w/ the following CD4 counts a. CD4 less than 350 (strongest recommendation) b. CD4 350-500 (lower strength rec) c. CD4 > 500 (lower strength rec) iii. Any HIV+ person at risk of transmitting HIV to sexual partners |
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What is the optimal ART for a treatment-naive pt? |
two NRTIs in combo w/ a third active drug from NNRTI, PI booseted w/ ritonavir, or an INSTI i. NNRTI-based regimen add: - efavirenz/tenofovir/emtricitabine ii. PI based regimen - atazanavir/ritonavir plus tenofovir/emtricitabine iii. INSTI based regimen - dolutegravir/abacavir/lamivudine (only for pts who are HLA-B* 5701 negative - dolutegravir/tenofovir/emtricitabine - elvitegravir/cobicistat plus tenofovir/emtricitabine; only for pts w/ pre ART CrCl >70 ml/min - raltegravir/tenofovir/emtricitabine |
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What is a good combo ART that is NNRTI based? |
i. NNRTI-based regimen add: - efavirenz (NNRTI) - tenofovir/emtricitabine |
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What is a good combo ART that is PI based? What else needs to be used? |
ii. PI based regimen - must be PI boosted - atazanavir/ritonavir plus tenofovir/emtricitabine - darunavir/ritonavir plus tenofovir/emtricitabine |
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What is a good combo ART that is INSTI based? |
iii. INSTI based regimen - dolutegravir/abacavir/lamivudine (only for pts who are HLA-B* 5701 negative - dolutegravir/tenofovir/emtricitabine - elvitegravir/cobicistat plus tenofovir/emtricitabine; only for pts w/ pre ART CrCl >70 ml/min - raltegravir/tenofovir/emtricitabine |
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What are two recommended NNRTI based regimen best for pts w/ viral load < 100,000 copies and CD4 > 200> |
efavirenz/abacavir/lamivudine ***(since this includes abacavir only good for pts who are HLA-B* 5701 negative) rilpivirine/tenofovir/emtricitabine ***(PPIs contraindicated since rilpivirine present - decreased serum rilpivirine) |
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What is PI based regimen is best for pts w/ viral load < 100,000 copies and CD4 > 200? |
atazanavir/ritonavir plus abacavir/lamivudine |
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What are some virologic failures that may require a cahnge in therapy? |
a. not achieving HIV RNA less than 200 copies/ml b. two consecutive HIV RNA levels more than 200 copies/ml after 24 wks of therapy c. HIV RNA levels more than 200 copies/ml after initial suppression to undetectable levels |
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What are some immunologic failures? |
no specific definition, however, some studies have used: a. failure to increase the CD4 count above 350 cells/mm3 in 4-7 yrs b. failure to increase 50-100 cells/mm3 above the baseline CD4 count during first year of therapy |
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What what HIV RNA level is resistance testing most accurate? |
most accurate if HIV RNA > 1,000 copies/mL If HV RNA is > 500 but < 1,000 still consider resistance testing |
