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What is 1st line for PrEP? When should one test for HIV antibodies (and if prophy is dc'ed)?
Truvada (Emtricitabine 200mg/tenofovir 300mg) once daily
Test q90d for HIV antibodies
What drug is given to HIV-infected mothers during labor and delivery?
Zidovudine (FYI dec risk from 23% to 3-4% alone)
For all HIV tests, at what HIV RNA amount of copies is considered "undetectable"?
What is the change in log of HIV RNA that is considered clinically significant?
>3-fold or ~0.5 log
What 5 scenarios would warrant use of HIV RNA testing? For those with baseline HIV RNA levels, what is the rec'd frequency of testing?
- 1. Acute HIV infx
- 2. Newly diagnosed HIV infx, q2-4 weeks (NMT 8 wks) for signif dec
- 3. Diagnosed but w/o therapy, q3-6 months
- 4. While on therapy, q3-6 months (checking for increase or therapy failure)
- 5. Whenever theres a clinical event or decrease in CD4 count
Who should be screened at a certain time for HIV? (2) Who should be screened annually? (5)
At any time: All patients 13-64yo, pregnant women
Annually: IVDU, unprotected sex, MSM, treated for STD's, recipients of blood transfusions from 1975-1985
What are the "normal" values of CD4 count? What percentage change in CD4 is considered clinically significant?
>30% change in CD4
In a year, how much does CD4 count decrease on average for untreated HIV pts? How about CD4 changes on average for treated HIV patients with potent ART's? How often should CD4 be monitored?
Untreated: CD4 DEC by 50-80/mm3 yearly
Treated: CD4 INC by 50-100/mm3 yearly
Monitor q3-6mons, w/or w/o therapy
What is the objective definition of AIDS? (2)
- 1. Lab confirmation of HIV
- 2. CD4 count<200microL OR CD4<14%
What is the general amount of time before primary HIV infection occurs? What is the tx for acute HIV infx?
Within 2-4wks, primary HIV infx occurs
No tx rec'd for acute HIV infx
What are 4 immunizations that are recommended for HIV-infected pt's? Not with CD4<200
1. Flu vaccine annually
2. Pneumococcal vaccine (FYI: 1 dose of Pneumovax 23, 1 dose of Prevnar 13 8wks to 1yr after, then a 2nd dose of Pneumovax at least 5yrs after 1st dose)
3. Hepatitis B (Engerix B, Recombivax-HB)
4. Hepatitis A (Havrix, Vaqta) (FYI combo is TwinRix A/B)