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27 Cards in this Set
- Front
- Back
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What is the fourth generation HIV test? |
Combines an immunoassay for HIV antibody with a test for HIV p24 antigen - this improves the ability to etst for early HIV infection because p24 antigen is detectable a week before antibody is preesent - may help diagnose as early as 2 weeks after infection - No longer recommended western blot - Assay has specificity of 99.6% |
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What is the testing algorithm? |
After a positive HIV 1/2 antigen/antibody combination assay, follow the test with HIV1/HIV2 differentiation immunoassay - This detects either HIV1 or HIV2 When samples are negative for HIV1 or 2 antibody, will perform HIV-1 nucleic acid amplification test (NAAT), is this is positive --> acut einfeciton
There are also rapid HIV tests - such as salivary samples which are available for clinci and home use |
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Who should be tested for HIV? |
Those at risk Any patient between the ages of 13and 65 - Those at high risk (multipile sexual partners, prostitution, injection drug users and their sexual partners should have repeat esting annually and some every 3-6 months - Universal testing in pregnant women |
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What are the manifestations of CMV disseminated? |
Esophagitis, colitis, hepatitis, retinitis, polyradiculitis, can also present as encephalitis |
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How is CMV identified? |
Either by CMV histopathologic studies or NAAT Treat with oral valganciclovir or ganiciclovir |
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What are the manifestations and treatment of mooluscum contagiosum |
Poxvirus that causes mulitple small papules on face and trunk - usually responds to immune resconsitution |
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When should treatment be started fro HIV? |
STart when patient is ready - regimens now are better tolerated and there is evidence that the higher the CD4 count and lower viral load, better overall outcomes |
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What are the booster drugs? |
Ritonavir and cobiscistat - are not antiretrovirla drugs, they inhibit the etabolism of other drugs to improve therapeutic drug leves while requiring less frequent dosing - Cobiscistat is coforumlated with elvitegravir, an integrase inhibitor, as well as protease inhibitors darunavir and atanavir Ritonavir is given with mnost protease inhibitors |
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What is an ideal initial HIV treatment: |
1. Tenofovir and emtricitabine or 2) Abacavir and lammivudine as dual NRTI backbone3. Add on ritonavir boosted protease inhibitor darnavir, or the integrase inhibitors raltegravir, dolutegravir or cobicistat boosted elvitegravir- These regimens are effective and have low toxicity |
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How is resistance testing achieved? |
Genotypic: looking for specific mutations associated with resistance to specific drugs OR phenotypic (assessing whether HIV can replicate in the presence of achievable leves of specific drugs - Genotypic testing is cheaper and faster, but phenotypic test results can be easier to interpret esp for PIs that have complicated patterns of resistance involving multiple mtuations - Do before chosing a drug regimen and when treatment failure occurs - Successful resistance testing requires a viral load > 500 copies |
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How should pregnant patients with HIV be tested? |
Avoid breastfeeding because transmission can happen even w/ undetectable viral load |
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What are the NRTIs? What are the SEs? |
STEAL Stravudine - neuropathy, lipodystrophy, lactic acidosis, HLD Tenofovir - nausea, kidney disease and fanconi's syndorme, decreased bone density. Does have HBV activity. Emtricitabine - minimal toxicity, HBV activity ----------- Abacavir - hypersensitivity (test to r/o HLA B56701 before prescribing) Lamivudine - Minimal toxicity, HBV activity Didanosine: Nausea, neuropathy, pancreatitis and lactic acidosis |
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What are the NNRTs? |
NEER Nevirapine: Hypersensitivity, rash, hepatitis Etravirine: nausea/rash Efavirenz: neuropsychiatric symptoms: dizziness, somnolence, sleep disturbance, vivid dreams, rash HLD Rilpivarine: Rash, HA insomnia - requires food and gastric acid for absorption - avoid PPI |
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What are the protease inhibitors? |
Darunavir - causes nausea/diarrhea/rash Fosamprenavir: same Atazanavir: nausea, hyperbili, kidney stones, rash, requires acid for absorption Lopinavir: nausea/diarrhea, HLD, insulin resistance Saquinavir: nausea/diarrhea, HLD, QT prolongation Tipranavir: nausea/diarrhea, HLD, rash, hepatitis, intracranial hemorrhage |
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What is the CCR5 antagonist? |
Maraviroc - hypersensitivity, epatitis |
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What are the Integrase inhibitors? |
Generally well toelrated Dolutegravir - elevated Cr, insomnia, HA Elviegravir: nausea/dairrhea Raltegravir: rash, myopathy |
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What are the SEs of the boosters? |
Cobistat: Elevated Cr (not recommended if CrCl < 70) Ritonivir: nausea/diarrhea, HLD, insulin resistance and lipodystrophy |
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What is the process of postexposure prophylaxis? |
Start HAART as soon as possible Treat for 4 weeks Test immediately, at 6 weeks, 12 weeks and 6 months Ppx w/ three drugs- recommded empiric is tenofovir, emtricitabine and raltegravir unless you know resistance of HIV patient |
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What is the FDA approved regimen for pre-exposure prophylaxis? |
Tenofovir-emtricitabine taken once daily Test for pregnancy prior to starting any woman |
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When should antivirla therapy begin? |
W/in 48 hours of symptom onset which reduces symptom duration, admisisonrates and incidence and severity of complications - When treatment is required, tamiflu and zanamivir are active against influneza A/B - All hospitalized patients should receive Tamiflu, even if 48 hours or more has elapsed since disease onset; treat for 5 days but can be longer in immunocompromised patiets |
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When should patients take pre- and post exposure ppx |
Treat for duration of exposure and up to 10d after |
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What are the complications of VZV in adults? |
Pneumonitis Acute cerebellar ataxia Encephalitis Hepatitis Secondary bacterial skin infections Nonimmune pregnant womena re particular prone to penumonitis in the second and third trimesters - Neonatal infeciton can occur if infected 5 days before and 2 days after delviery |
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What dermatomes are most often affeted by VZV? |
Thoracic Trigeminal Lumbar Cervical |
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What are the syndromes of complciations of herpes zoster? |
Ramsay Hunt syndrome: pain in vesicles in the external ear canal, ipsilateral peripehral facial palsy and altered/absent taste 2. Herpes zoster opthammicus - can develope when first brnach of the trigmenal nerve is invovled 3. Other complciations include: transverse myelitis, meningoencephalitis/encephalitis, GBS and stroke, |
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What si the treatment for VZV? |
Acyclovir Valacyclovir Famiciclovir If started w/in 72 hours of onset of VZVG rash, accelerate the resolution of lesiona nd decrease new lesion formation and viral shedding Also lessin the severity of acute zoster pain |
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What is the post-exposure prophylaxis for VZV? |
Within 3-5 days of exposure --> vaccination VZV immune globulin, when given within 4-10 days of exposure, is recommended for post-exposure ppx of immunocompromised adults and pregnant women who do not have immunity Zoster vaccine reduces incidence and severeity of postherpetic neuralgia |
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What is used to treat CMV? |
Ganiciclovir Valgan Second line: foscarnet and cidofovir |
