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Questions and Answers
Which of the following is included in the preferred combination regimens for HIV treatment?
The NACO regimen includes Emtricitabine.
False
What is the preferred regimen for HIV treatment known as TED composed of?
Tenofovir disoproxil, Emtricitabine, Dolutegravir
The TLD regimen involves Tenofovir disoproxil, Lamivudine, and _______.
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Match the following drug regimens with their characteristics:
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What is the treatment for Cytomegalovirus (CMV) infection?
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Mycobacterium avium complex (MAC) commonly involves the pulmonary system.
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What are the symptoms of Mycobacterium avium complex (MAC)?
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For HIV patients with a CD4 count of less than 50, prophylaxis treatment consists of __________.
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Match the drug class with its respective drug:
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What does a positive result in the 4th Generation Combined Antigen Antibody Assay prompt you to check next?
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If the 4th Generation Combined Antigen Antibody Assay returns a negative result, a person can be confirmed to have HIV.
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What is the CD4 count at which opportunistic infections such as oral hairy cell leukemia or tuberculosis may occur?
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A CD4 count of _____ is associated with the onset of HZV.
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Match the following CD4 counts with the corresponding opportunistic infection:
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What characterizes the primary infection phase of HIV?
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The immune system completely destroys the HIV virus during the primary infection phase.
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What is the main characteristic of the accelerated virus replication phase?
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Antibodies are typically detectable in the blood _____ weeks after HIV infection.
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Match the HIV detection method with the timeline of its detection:
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What happens during the 'rapid CD4+ T cell turnover' phase?
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The CD4+ T cells are a critical component of the adaptive immune response.
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What continues to happen during the clinical latency period of HIV infection?
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HIV activates the immune system through _____ and HIV envelope-mediated cell signaling.
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Which symptom is associated with the decline in CD4+ T cells over time in untreated HIV infection?
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Study Notes
HIV Treatment Regimens
- Preferred 3-drug combination: Tenofovir disoproxil (300 mg OD) + Emtricitabine (200 mg OD) + Dolutegravir (50 mg OD)
- NACO regimen/TLD regimen: Tenofovir disoproxil (300 mg OD) + Lamivudine (300 mg) + Delavirdine (50 mg OD)
- Needle stick injury prophylaxis: TED regimen (Tenofovir disoproxil, Emtricitabine, Dolutegravir) for 4 weeks, ideally started within 72 hours
- Common Side Effect: Bone toxicity with tenofovir
Events Following Primary HIV Infection
- Primary Infection: Characterized by massive viremia (viral spread) and wide dissemination to lymphoid organs
- Immune System Destruction: Rapid destruction of the immune system after primary infection
- Partial Immunologic Control of Virus Replication: Immune system attempts to partially control virus replication
- Accelerated Virus Replication: Immune control is insufficient, leading to increased viral replication
- Rapid CD4+ T cell Turnover: Immune cells are actively dying
- Trapping of Virus and establishment of chronic, persistent infection: Chronic infection phase with progressive immune system damage
- Immune activation mediated by cytokines and HIV envelope-mediated aberrant cell signaling: Virus activates the immune system, further damaging it
- HIV Specific Immune Response: Immune system fights the virus with specific immune responses
Detection of HIV Components
- Antibodies: Appear in the blood 3-6 weeks after infection
- HIV RNA: Detected as early as 12 days, or within the first week after infection
- p24 levels: Detected 16 days, 2–3 weeks post infection
HIV Treatment Information
-
CMV (Cytomegalovirus):
- Can cause retinitis progressing to colitis, esophagitis, and pneumonitis
- Painless progressive loss of vision
- Asymmetric bilateral (B/L) involvement with perivascular hemorrhage and white fluffy exudate
- Treatment: IV Ganciclovir for 3 weeks
-
MAC (Mycobacterium avium complex):
- Average CD4 count at diagnosis is less than 10
- Highly disseminated disease
- Symptoms: Fever, night sweats, weight loss, and lymphadenopathy (swollen lymph nodes)
- Pulmonary involvement is uncommon
- Treatment: Clarithromycin and Ethambutol
- Prophylaxis (for CD4 count less than 50): Azithromycin
- All HIV patients must be treated.
HIV Drugs
- CD4 receptor inhibitors: Ibalizumab (IV)
- Coreceptor inhibitors: Maraviroc (Oral)
- Fusion inhibitors: Enfuvirtide (s/c)
- Integrase inhibitors: Dolutegravir, Raltegravir
- Protease inhibitors: Ritonavir, Nelfinavir, Atazanavir
-
Reverse transcriptase inhibitors:
- Nucleoside reverse transcriptase inhibitors (NRTI): Abacavir, Lamivudine, Emtricitabine
- Non-nucleoside reverse transcriptase inhibitors (NNRTI): Nevirapine, Efavirenz, Delavirdine
- Nucleotide reverse transcriptase inhibitors: Tenofovir, Disoproxil
4th Generation Combined Antigen Antibody Assay
- Currently in use.
-
Interpretation:
- Negative: No HIV
-
Positive:
- Look for specific antibodies against HIV 1/2.
- If antibodies are negative, test for HIV RNA load
Opportunistic Infections in HIV
- CD4 count 600: Lymphadenopathy/thrombocytopenia
- CD4 count 500: HZV (Herpes Zoster Virus)
- CD4 count 400: Kaposi sarcoma (At any CD4 count)
- CD4 count 300: Oral hairy cell leukemia/TB (Tuberculosis)
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Description
This quiz explores the preferred HIV treatment regimens, including the common drug combinations used and their side effects. It also discusses the events following primary HIV infection and the immune response to viral replication. Test your understanding of these critical aspects of HIV management.
