HIV and aids
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| HIV is managed via what type of therapy? | Antiretroviral therapy, also known as HAART (highly active antiretroviral therapy).
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| this category of HIV drugs become triphosphorylated and become involved with the process of DNA production. these drugs interfere with and ultimately inhibit reverse transcriptase, causing chain termination. | NRTIs
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| list some of the NRTIs | didanosine, lamivudine, tenofovir, zidovudine, emtricitabine
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| what is the MOA of NNRTIs? | they do not mimic naturally occuring nucleutides. they directly inhibit reverse transcriptase
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| list the NNRTIs | Efavirenz, Nevirapine
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| what is the MOA of protease inhibitors? | prevent viral protein products from being cleaved to form functional structures. they funciton to prevent the use of HIVs main protein product, gag-pol-env.
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| list some protease inhibitors | ritonavir, atazanavir, darunavir, indinavir, nelfinavir
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| what is the MOA of fusion inhibitors | they prevent fusion of HIV virus particle with outer membrane of the host target cell, preventing infection of the cell by the virus. this is done via binding to gp41 on virus and preventing virus to cell fusion.
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| list the fusion inhibitor | efuvirtide
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| what is the MOA of integrase inhibitors | inhibit HIV1 integrase, preventing integration and insertion of HIV DNA into human DNA.
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| list the integrase inhibitors | raltegravir, elvitegravir.
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| what is the MOA of hte CCR5 antagonists | work to block the CCR5 co-receptor that is located on white blood cells targeted by HIV. by blocking the CCR5 co-receptors, these drugs effectively prevent viral entry into the cell. they are haptotoxic, increase risk for infections and malignancies, MI
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| what is the CCR5 antagonist? | maraviroc
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| what is the goal of HIV therapy? | inhibit viral replication, reduce viral load, reduce development of drug resistance.
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| when should HIV therapy be started? | anyone who is HIV+ and has the following: has aids defining illness, CD4 count <350, HIV associated nephropathy, current hepatitis B or C infection, pregnant.
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| when therapy is started, what should be used? | 2NRTI+ 1NNRTI, or 1 PI or 1 II or 1 CCR5 antagonist. the last option is preferred.
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| what is the rule with HIV treatment and pregnancy | HIV+ pregnant women at or beyond 12 weeks gestation should get ART therapy regardless of whether they meet the criteria or not. But starting HIV therapy before 12 weeks increases feta lteratogenicity, and so is considered on a patient by patient basis.
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| when is a C section performed in HIV+ women? | when HIV RNA>1000 copies/ml
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| what is the prophylaxis treatment for HIV for the infant after delivery? | 6 weeks Zidovudine
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| is breast feeding in HIV+ women contraindicated? | yes
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| what is acute retroviral syndrome and should it be treated? | it's the mononucleosis like syndrome that occurs in the first weeks of HIV infection. it represents the acute stage of HIV, and may be treated in attempt to reduce viral load as much as possible. this trmt is optional.
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| is there HIV prophylaxis available? | yes. it is a daily pharmacologic regimen of tenofovir+emtricitabine. intended to be used in comnbination with other non-pharmacologic methods for reducing HIV transmission. only to be used in HIV- individuals but have a high rate of HIV transmission
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| is there post exposure prophylaxis available after occupational exposure? | yes-called PEP. for those who have percutaneous or mucous membrane exposure to contaminated blood, body fluid, semen, vaginal fluid, or other normally sterile fluid or tissue. zidovudine+lamivudine OR emtricitabine+tenofovir
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| is there a post-exposure prophylaxis after non-occupational exposure | yes-for patients at risk of HIV acquisitionthrough non-occupational exposure or an HIV+ source within 72 hours or less before medical evaluation. treatment duration is 28 days
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| prophylaxis and treatment of opportunitstic infections and relevant complicating infections: | .
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| this is the drug of choice for CMV retinitis treatment; it is given intravenously. oral valgancyclovir is given afterwards, daily for 2-3 weeks. primary prophylaxis is not recommended. | ganciclovir
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| this is drug combo is the DOC, used together, for the treatment of cryptococcal meningitis. | Amp B + Flucytocine. Once patient is clinically stable, they are switched to Fluconazole.
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| these two drugs are used together to treat Mycobacterium avium complex (MAC). | clarithromycin and ethambutol
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| how does ethambutol work? | works by inhibiting cell wall synthesis in mycobacterial specific species. it affects renal tubules, so can be nephrotoxic, and also can cause optic neuritis.
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| prophylaxis against MAC is gained via what two drugs? | azithromycin or clarithromycin
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| this is a sulfa drug, and the sulfa potion competes with PABA for dihydropteroate synthetase, blocking folate synthesis, trimethoprim portion inhibits folate utilization. it is the DOC to treat infection with pneumocystis | trimethoprim sulfamethaxazole.
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| TMP-SMX is used for the prophylaxis against what? | toxoplasmosis, it can also be an optional alternative treatment for toxoplasmosis
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| is prophylaxis against coccidiodomycosis recommenede? | no. serologic testing is instead advised for HIV+ patients who live in endemi careas to determine if and when they become exposed.
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| what is the DOC for treating mild coccidoides immitis infection? | fluconazole or itraconaole. sever pulmonic infection or disseminated infectin is treated with amphotericin B.
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| what is the DOC for prophylaxis of mild to moderate histoplasmosis? | itraconazole
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| what is the DOC for severe disseminated histoplasmosis? | liposomal amphotericin B.
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| which vaccine must be administered to HIV patients? | polysaccharide pneumoccoccal vaccine (PPSV) specifically, PCV 13. those with CD4 counts >200 should also get PPV23 at least eight weeks after getting PCV13.
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| this must be given annually to all HIV+ patients. | inactivated influenza vaccine. The live attenuated vaccine is contraindicated in this population. MMR should also be administered.
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| this is required for all HIV+ patients who have never been expose dor have never been vaccinated. | HBV vaccine.
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| what is another vaccine recommended for all HI infected patients, but only when their CD4 count is >200 | VZV vaccine
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| this is given to all HIV+ patients less than 26 years old. | HPV
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| this is the treatment of choice for hepatitis C for all patients (regardless of HIV status); same combo is administerd to patients with acute HCV infection in order to proactively prevent its evolution to chronic hepatitis C | interferon and ribavarin.
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