Hiv

Front 1

What is the incidence/prevalence of HIV/AIDs in Kansas and the US?

Back 1

Prevalence in Kansas: 3,000

Incidence in Kansas: 150

Prevalence in US: 1.2 million

Incidence in US: 50,000

Front 2

Recognize the acute phase/primary symptoms of an HIV infection

Back 2

Nausea, Fatigue, Malaise, Arthralgia, Headache, Loss of Appetite/Weight Loss, Rash, Fever, Lymphadenopathy, Neuropathy, Pharyngitis, Mouth Sores, Thrush, Enlarged Liver/Spleen

Front 3

When does this acute retroviral syndrome occur?

Back 3

Up to 90% of persons develop an acute retroviral syndrome, usually within 2-4 weeks of acquiring the virus.

Front 4

Recognize when a patient goes form being HIV positive to having AIDS

-What opportunistic infections may be a clue?

-Wha laboratory studies would assist in this diagnosis?

Back 4

Cryptococcal meningitis, pneumonia, histoplasmosis, toxoplasmosis, exra-pulmonary TB, and dissemiated herpes, GI infection

CD4 count and viral load screening, Rapid HIV anti-body with P24 antigen test, HIV RNA quantitative test

Front 5

Understand that there is testing available to diagnose the disease, assess the disease progression, monitor therapy, and check for resistant strains of the virus.

Back 5

Rapid HIV 1 and 2 antibody test and P24 antigen test

All HIV positive tests discriminated by a HIV1 and HIV 2 test

Western Blot Test,

Viral Load, CD4, and RNA quantitative test - monitor/progression

Front 6

Have knowledge of what populations need tested for HIV and what strategies are used to identify patients with HIV.

Back 6

-Highest risk: MSM, transgender women having sex with men, reported needle sharing, partner with known or unknown HIV infection, those practicing unsafe sexual practices, pts with newly diagnosed STD's, those who present with aseptic meningitis, women who are pregnant and/or breastfeeding

-Higher % among blacks vs white in US population

-Test everyone ages 15-65; test annually for those at risk

Combination HIV 1/2 antibody and p24 test will identify HIV infection 1-2 weeks earlier than antibody test alone; results usually available in 1-2 days

Front 7

Be able to describe the laboratory studies needed in a newly diagnosed patient with HIV

Back 7

CBC with differential

Lipids: triglycerides, HDL, LDL, cholesterol

G6PD

Serum Chemistries (BUN, creatinine, Albumin level)

Urinalysis (RBC, WBC, Proteinuria),

Confection/comorbidity screening (CXR, STD screening, TB skin test, Pap smear, Chlamydia, Gonorrhea, Syphilis)

Quantiferon

Hep A, B, and C testing

Front 8

Know when to initiate therapy in HIV and AIDS patients (per Dr Sweet's update)

Back 8

Per Dr Sweet - Treat everyone with HIV/AID independent of their CD4 count/viral load. Antiretrovial therapy to all diagnosed cases.

Includes pregnant women, patient's with HIV-associated nephropathy, and patients with hepatitis B virus infection that requires treatment for which there is a definite recommendation to initiate therapy

Other consideration include certain acute opportunistic infections, rapidly declining CD4+ cell counts (>100cells/mm3/year) and higher HIV-1 RNA (>100,000 copies/ml)

Front 9

Understand the recommendations for initiation of treatment, be able to prescribe an appropriate drug regimen.

Back 9

Initiation for Treatment:

-Reduce HIV related morbidity and prolong the duration and quality of survival

-restore and preserve immune function

-achieve maximal and durable suppression of plasma HIV viral load

-Prevent HIV transission

Drug Regimen: Achieving viral suppression requires the use of ART regimens with 3 drugs from 2 or 3 different classes.

Front 10

How do you initiate post-exposure prophylaxis?

Back 10

Initiate immediately within 2 hours of exposure

- Baseline HIV RNA testing of the source patient and PEP continued until results of plasma HIV RNA assay are acquired

-Baseline HIV testing of person exposed with repeat testing at 4 and 12 weeks

- 3 drugs from 2 classes (Tenofovir and emtricitabine + either raltegravir or dolutegravir as PEP regimen)

Front 11

Have knowledge of the recommendations for pregnant women with HIV

Back 11

She should receive a combination of ARV regimen to reduce the risk of perinatal transmission of the HIV

Reducing HIV RNA to undetectable level lowers the risk of transmission

IV AZT administered to HIV-infected women with Viral Load > 1,000 copies/ml near delivery but not required for those already receiving ARV regimens who have VL < 1,000 copies/ml consistently during pregnancy and near delivery

Front 12

What is recommended for the infant of and HIV mother?

Back 12

6 weeks of neonatal AZT chemoprophylaxis is generally recommended for all HIV-exposed neonates to reduce perinatal transmission of HIV.

Front 13

Maternal - to Fetal HIV transmission:

Back 13

Pregnant women should be treated for HIV infection, regardless of virology or immunologic status, and infants exposed to HIV in utero should receive ARV post-exposure prophylaxis and undergo HIV diagnostic testing at 14-21 days, 1-2 months, and 4-6 months of age. HIV-infected infants should undergo HIV genotype resistance testing and initiate ART in the first year of life regardless of CD4 cell count, viral load, or clinical status.

Front 14

Have knowledge of the different class of medications used to treat HIV: MOA and side effects:

Back 14

Fusion Inhibitors (FIs): prevent virus particle from attaching to the host cell membrane, blocking entry in to CD4 T cells.

Front 15

Chemokine co-receptor 5 anatagonists (CCR5 antagonists)

Back 15

specifically block access of the virus to the CD4 receptor. Other classes of ARV agents inhibit enzymes needed for HIV replication.

Rash

Front 16

Neucleotide reverse transcriptase inhibitors (NRTIs) and non -nucleoside reverse transcriptase inhibitors (NNRTIs)

Back 16

Interrupt the reverse transcription of viral RNA into double-stranded HIV DNA within the host cell.

CNS effects, Hepatotoxicity, Rash, SJS/TEN, Myopathy

Front 17

Integrase strand transfer inhibitors (INSTIs)

Back 17

block the action of the enzyme required for HIV DNA to combine with host cell DNA in the cell nucleus

Myopathy

Front 18

Protease Inhibitors (PIs)

Back 18

block the splicing of HIV messenger -RNA into smaller units and the formation of new viral proteins

bleeding problems, GI problems, SJS/TEN, Rash, Nephrotoxicity

Front 19

Understand the findings in the PrEP studies and the recommendations for PrEP. (iPrEx, IPERGAY, PROUD)

Back 19

iPrEx participants are men and transgendered women who have sex with men; age 18 and over at time of enrollment; in good health; HIV-1 uninfected and at high-risk for sexual acquisition of HIV, as defined by having any of the following in the 6 months prior to screening: anal sex with 4 or more male partners; a diagnosis of a sexually transmitted disease; history of transactional sex activity; or condoles anal sex with a partner who was HIV infected or of unknown infection status. Transactional sex was define by exchange of good, food, shelter, or money.

Front 20

Understand the findings in the PrEP studies and the recommendations for PrEP (iPrEx, IPERGAY, PROUD)

Back 20

PrEP: Prophylactic treatment to prevent HIV transmission

An individual who in not infected with HIV takes ARV agent(s) before potential HIV exposure (at risk population described in prior slide)

2012 FDA approved TDF/FTC as PrEP for those at high risk of transmission

91% reduction in transmission seen in study done with PrEP use

***pt must have HIV test prior to use, no s/s of HIV, no contraindicating medications, normal renal function, and no HBV infection or immunity***

IPERGAY/PROUD - studies done that showed PrEP use with TDF/FTC reduced the transmission rate of HIV.

Front 21

What are the recommendations for initiation of treatment

Back 21

Protect immunity

Prevent Transmission

Suppress viral load

Prevent Death