HUMAN IMMUNODEFICIENCY VIRUS (HIV)
how to distinguish HIV vs. AIDS
HIV
infection
acute and chronic phases
AIDS
immune system cant keep
infection in check
severe infection
CD4 COUNT < 200
indicator conditions
opportunistic infection
(OI)
examples
MAC
CMV
Encephalopathy
Fungal infections
cancer
what does the virus look like?
enveloped
single stranded
RNA
retrovirus
transmission
exchange of bodily fluids
highest risk sex act = receptive anal
lowest risk sex act = insertive anal/vaginal
GOALS
viral load
undetectable
< 200 copies/mL
CD4 count
> 500 copies/mL
want a high CD4 count and a low viral load
STAGES OF INFECTION
acute
flu-like sx or symptomatic
high viral load
chronic
asx/clinical latency
HIV reservoirs
U=U
undetectable viral load = untransmittable HIV
AIDS
preventable w/ tx
CD4 < 200
prone to OI
no tx--> 3 year life expectancy
clinical presentation
acute
may be asx
sx
WEIGHT LOSS
NIGHT SWEATS
if you see these sx think of either
B-cell lymphoma, TB, or HIV
chronic
asx
AIDS
often presents with OI or cancer
TESTS TAKE ABOUT 2-3 WEEKS BEFORE THEY CAN DETECT A NEW HIV INFECTION
HIV LIFE CYCLE
HIV binds to CD4 receptors
secondary binding of HIV to co-receptors CCR5 or CXCR4
fusion
uncoating
reverse transcription (RNA ---> DNA)
DNA migrates to nucleus to be INTEGRATED into host DNA
transcription (mRNA-->DNA)
translation
assembly
budding
maturation
lyses
Natural PATHO
HLA 5701*B
hypersensitivity reaction
related to abacavir
test b4 rx
TREATMENT
treatment naiive
3 drug regimen- preferred
NRTI + NRTI + INSTI (or NNRTI*)
*generally dont use NNRTI if viral load > 100,000 copies and/or CD4<200
TAF/emetricitabine +
bictegravir
abacavir/lamivudine +
dolutegravir
***ONLY USE IF HLA*501B IS (-)
AND NO HBV (abacavir)
TAF/TDF w/ emtricitibine/lamivudine + doultegravir
2 drug regimen
dolutegravir (INSTI) + lamivudine (NRTI)
***ONLY USE IF VIRAL LOAD
< 500,000, NO HBV AND GENOTYPIC RESULTS AVAILABLE
start ASAP
use backup method for the 1st
6 months or until viral load is undetectable
co-morbidity considerations
Hep B
AVOID abacavir
use TENOFOVIR
High cardiac risk
AVOID abacavir & PI
Hyperlipidemia
use TDF
Psychiatric illiness
AVOID efavirenz
AVOID rilpivirine
weight gain concerns
AVOID INSTI+TAF
use TDF