HUMAN IMMUNODEFICIENCY VIRUS (HIV)

Plus de détails

Aids

par Scaleny Dakk

disruptive behaviour

par blisz chan

DOWN SYNDROME

par aileen Galindo

Aortic Stenosis

par Tommy Kovitwanichkanont

TREATMENT

co-morbidity considerations

weight gain concerns

AVOID INSTI+TAF

Psychiatric illiness

AVOID rilpivirine

AVOID efavirenz

Hyperlipidemia

use TDF

High cardiac risk

AVOID abacavir & PI

Hep B

use TENOFOVIR

AVOID abacavir

treatment naiive

start ASAP

use backup method for the 1st 6 months or until viral load is undetectable

2 drug regimen

dolutegravir (INSTI) + lamivudine (NRTI)

***ONLY USE IF VIRAL LOAD < 500,000, NO HBV AND GENOTYPIC RESULTS AVAILABLE

3 drug regimen- preferred

NRTI + NRTI + INSTI (or NNRTI*) *generally dont use NNRTI if viral load > 100,000 copies and/or CD4<200

TAF/TDF w/ emtricitibine/lamivudine + doultegravir

abacavir/lamivudine + dolutegravir

TAF/emetricitabine + bictegravir

Natural PATHO

HIV LIFE CYCLE

lyses

maturation

budding

assembly

translation

transcription (mRNA-->DNA)

DNA migrates to nucleus to be INTEGRATED into host DNA

reverse transcription (RNA ---> DNA)

uncoating

fusion

secondary binding of HIV to co-receptors CCR5 or CXCR4

HIV binds to CD4 receptors

HUMAN IMMUNODEFICIENCY VIRUS (HIV)

TESTS TAKE ABOUT 2-3 WEEKS BEFORE THEY CAN DETECT A NEW HIV INFECTION

clinical presentation

often presents with OI or cancer

asx

sx

WEIGHT LOSS NIGHT SWEATS

if you see these sx think of either B-cell lymphoma, TB, or HIV

may be asx

STAGES OF INFECTION

no tx--> 3 year life expectancy

prone to OI

CD4 < 200

preventable w/ tx

chronic

U=U

undetectable viral load = untransmittable HIV

HIV reservoirs

asx/clinical latency

acute

high viral load

flu-like sx or symptomatic

GOALS

want a high CD4 count and a low viral load

CD4 count

> 500 copies/mL

viral load

undetectable

< 200 copies/mL

transmission

exchange of bodily fluids

highest risk sex act = receptive anal lowest risk sex act = insertive anal/vaginal

what does the virus look like?

retrovirus

RNA

single stranded

enveloped

how to distinguish HIV vs. AIDS

AIDS

indicator conditions

cancer

opportunistic infection (OI)

examples

MAC CMV Encephalopathy Fungal infections

CD4 COUNT < 200

immune system cant keep infection in check

severe infection

HIV

acute and chronic phases

infection