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Step III
Step III - HIV
Question | Answer |
---|---|
In what scenarios would you start HIV therapy | CD count <350, needle stick, pregnant pt, symptomatic pts regardless of viral load or CD count |
What are the different HAART regiments | 2 NRTI + PI; 2 NRTI + NNRTI; NRTI + NNRTI + PI |
What do protease (-) drugs end in | -NAVIR |
What do NRTI drugs usually end in | -VUDINE |
Name the NRTI drugs that do not end in –VUDINE | Didanosine, Zalcitabine, abacavir, emtricitabine |
Name the NNRTI drugs | Efavirenz, nevirapine, delavirdine |
As a class, what is the AE of NRTI drugs | Lactic acidosis |
As a class, what is the AE of PI drugs | HYPER-glycemia, lipidemia, LFTs |
As a class what is the AE of NNRTI | Nothing |
MC AE of Indinavir | hyperbilirubinemia > Kidney stones |
MC AE of Zidovudine | Anemia, leucopenia, GI |
MC AE of Didanosine | Pancreatx, peri-neuropathy |
MC AE stavudine | Peri-neuropathy |
MC AE of abacavir | Rash |
Which NRTI has the best efficacy in reducing viral load | Abacavir |
MC AE of Efavirenz | neurologic; somnolence, confusion, or psychiatric disturbance |
What is the treatment for needlestick injury from HIV+ pt | HAART x1mos |
What other types of exposure to HIV+ would warrant HAART tx | Mucosal surfaces and unprotected sex |
What do you do for a pregnant HIV+ pt who is already on HAART | Continue HAART |
What do you do with a patient who is HIV+, pregnant and not on HAART | Find CD count. If <350, start HAART, if >350 w/ low viral load, do HAART in 2nd and 3rd trimester to avoid transmission to fetus |
When CD count < 200 prophylaxis against what should be initiated using what drug | PCP; TMP/SMZ |
If pt has a rash using TMP/SMZ for prophylaxis against PCP what can you switch to | Atovoquone or dapsone |
Dapsone can not be used as PCP prophylx if pt has this deficiency | G6PD |
When CD count < 50 prophylaxis against what should be initiated using what drug | MAI; azithromycin PO qweek |
Pt HIV+ c/o SOB, dry cough, inc LDH, hypoxia. Dx | PCP |
Best initial test for PCP pneumonia | XR |
What does CXR in PCP pneumonia pt look like | Inc B/L interstitial markings |
Most accurate test for dx of PCP pneumonia | Bronchoalveolar lavage |
Tx of PCP pneumonia | IV TMP/SMZ |
Pt has PCP pneumonia and develops rash from IV TMP/SMZ. What can you use next | IV pentamidine |
What other drug should be added to PCP pneumonia tx if dz is severe (pO2 <70, Aa > 35) | Steroids |
What best initial test for dx toxoplasmosis | CT w/ contrast |
At what CD count would you suspect Toxo infection | CD < 100 |
How do you tx toxo | Pyrimethamine + sulfadiazine/Clindamycin x2wks ; repeat CT scan |
Pt suspected of having toxo and put on tx. Repeat CT head shows lesion unchanged in size. What should you do and dx | Brain biopsy; Lymphoma |
Pt with CD < 50. What bugs/dz are you thinking | MAI, CMV, PML |
Pt CD<50 c/o blurry vision. Dx | CMV |
Tx of CMV | Ganciclovir/foscarnet/cidofovir |
Maintenance tx for CMV | Lifelong PO valganciclovir |
Pt CD <50 c/o fever, HA. Dx | Cryptococcus |
Pt CD<50 c/o fever, HA. Next best step | LP to look for inc WBCs |
Best initial test for Cryptococcus | India ink stain (low sens) |
Most accurate test for Cryptococcus | Cryptococcus Ag (high sens + spec) |
Tx for Cryptococcus | Amphotericin IV then Fluconazole PO lifelong |
Pt CD <50 w/ focal neuro abnormalities. Dx | PML |
Best inicial test for PML | CT head or MRI |
What do you tell the pt dx w/ PML about tx | There is non. It will resolve when CD count rises |
Pt CD <50 w/ weight loss, fever, fatigue, anemia +/- inc alk phos and GGTP. Dx | MAI |
Diagnostic testing for MAI from most sens to least sens | Liver bx > bone bx > blood cx |
Tx for MAI | Clarithro + ethambutol |