9.27 Clinical Correlates of AIDS – Flashcards
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| How many new infections of HIV are there each year? |
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| 40,000 |
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| What is the prevalenc of HIV infection? |
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| 650,000-900,000 |
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| How many people die with HIV each year? |
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| 60,000 |
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| How many adults were living with US at the end of 2008? |
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| 1.2 million adults |
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| How many undiagnosed HIV+ people are there? |
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| 236,400 (20%) |
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| How do males get HIV? |
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| 74% MSM, 14% heterosexual contact, 8% IVDU 4% MSM and IVDU |
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| How do females get HIV? |
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| 85% heterosexual contact 15% IVDU |
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| Of men with HIV, what is the racial breakdown? |
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| 46% black, 31% white, 20% hispanic/latino |
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| Of women with HIV, what is the racial breakdown? |
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| 65% black, 17% white, 16% hispanic |
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| How many people in LA have HIV and AIDS? |
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| 17,555 and 54% have AIDS (9,283) |
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| How are Baton Rouge and New Orleans ranked among large metropolitan areas in US AIDS case rates? |
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| baton rouge is 2nd; new orleans ranked 9th |
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| How can IVDU prevent getting HIV? |
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| new needles, bleach kits, drug rehabilatation |
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| What retrovirals are given to pregnant women? |
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| AZT to HIV + mothers during pregnancy and at delivery. AZT are given to their infants after delivery |
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| What is the HIV post exposure prophylaxis for healthcare workers? |
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| AZT/3TC/lopinavir-ritonavir |
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| What is the risk of HIV transmission with needlestick injury? |
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| 1/300 |
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| What do you do if you've been exposed to pt's bodily fluids as a healthcare worker? |
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| wash site with soap and water, report incident, draw blood on patient (2 purple top tubes; oraquick, hep B and C) Go to urgent care center 5th floor UMOB or ED after hours |
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| What is clinical component A of HIV? |
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| asymptomatic, acute HIV, persistent generalized lymphadenopathy (PGL) |
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| What is clinical component B of HIV? |
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| symptomatic, AIDS-related complex (ARC) |
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| What is clinical component C of HIV infection? |
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| AIDS-indicator conditions, including pulmonary TB, recurrent bacterial pneumonia, invasive cervical cancer |
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| What is immunlogic compnoent level 1? |
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| more than or equal to 500 CD4 t cell count |
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| What is immunologic omponent level 2? |
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| 200-499 T cell count |
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| What is immunologic component 3? |
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| <200 T cell=immunologic AIDS |
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| How do you define AIDS? |
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| HIV + AIDS indicator condition OR HIV + CD4 <200 |
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| What are the general manifestations of primary HIV infection? |
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| fever, pharyngitis, LAD, arthralgia, myalgia, lethargy/malaise, anorexia/weight loss |
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| What are the neuropathic manifestations of HIV/AIDS? |
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| headache/retro-orbital pain, meningoencephalitis, peripheral neuropathy, radiculopathy, brachial neuritis, guillain-barre syndrome, cognitive/affective impairment |
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| What are the dermatologic manifestations of primary HIV infection? |
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| erythematous maculopapular rash, diffuse urticaria, desquamation, alopecia, mucocutaneous ulceration |
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| What are the GI manifestations of primary HIV infection? |
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| oral/oropharyngeal candidiasis, N/V/D |
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| What is the differential diagnosis of primary HIV infection? |
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| epstein-barr mononucleosis, CMV, toxoplasmosis, rubella, viral hepatitis, secondary syphilis, disseminated gonococcal infection, primary herpes simplex virus infection, other viral infection, drug reaction |
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| What are some examples of clinical category B HIV diseases? |
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| bacillary angiomatosis, candidiasis, cervical dysplasia, or carcinoma in situ, constitutional symptoms (fever, diarrhea, for over a month), immune thrombocytopenic purpura, peripheral neuropathy |
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| CSF stained with india ink will show what pathogen? |
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| crytococcus |
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| What is MAC? |
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| disseminated mycobacterium avium complex |
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| What is the differential diagnosis of brain mases in HIV infected people? |
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| toxoplasmosis (ring-enhancing, multiple, mass effect, IgG present), primary CNS lymphoma (ring enhancing or homongenous, single or multiple, mass effect), progressive multifocal leukoencephalopathy (nonenhancing, usually multiple, lesions confined to subcortical white matter, no mass effect) |
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| How do you clinically manage HIV+ patients? |
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| pneumococcal vaccine every 6 years, TB skin test every year, Pap smear every 6 months, hep B and A if seronegative, flu vaccine very year, STD screening and tx |
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| WHen do you give prophylactic treatment for PCP? |
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| CD4<200, thrush, or prior PCP |
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| When do you give prophylactic treatment for toxoplasmosis? |
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| CD4<100 |
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| When do you give prophylactic treatment for MAC? |
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| CD4 <50 |
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| When do you give prophylactic treatment for CMV? |
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| CD4 < 100, screening eye exam |
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| Before starting ARV therapy, what labs do you get? |
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| baseline CBC, CMP and lipid panel hep A, B, and C serologies CD4 T cell count, plasma HIVRNAviralload genotypic resistance testing, viral tropism assay prior to initiating a CCR5 antagonist. HLA-B5701 testing prior to initiating Abacavir |
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| When do you start ARV therapy? |
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| AIDS defining conditions. CD4 <350, or between 350 adn 500, pregnant women, HIV associated nephropathy (HIV AN), HBV coinfected treat for HBV. |
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| T/F Patients must commit to ARV for the rest of their life once they start. |
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| true |
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| What combination therapy do you start with? |
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| 2 NRTIs plus 1 NNRTIs OR 2 NRTIS plus PIs OR 2 NRTIs plus INSTIs |
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| What is PIs? |
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| protease inhibitors |
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| What is INSTIs? |
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| integrase strand transfer inhibitors |
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| What is the single most important indicator of AIDS progression? |
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| CD4 count |
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| How do you determine an adequate response to ART? |
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| CD4 increase 100-150 cells/microliter/year |
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| How often do you monitor CD4s in HIV patient on therapy? |
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| check at baseline x 2 and at least every 3-6 months |
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| How do you determine response to ART usuing HIV RNA? |
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| HIV RNA below limit of detection <40 to <80 copies/mL |
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| How often do you monitor viral load on HIV patients on ARV? |
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| check at baseline x2, immediately before starting ART, 2-8 weeks after start or change of ART, every 3-4 months with stable patients |
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| What is Maraviroc/selzentry? |
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| CCR-5 co receptor antagonist for those infected with CCR5 tropic HIV-1 |
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| What is raltegrair (isentress)? |
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| HIV integrase strand transfer inhibitors (integrase inhibitors) |
