1. HIV Infection and AIDS 2007 Family Practice Board Review Miguel G. Madariaga, MD Assistant Professor of Medicine University of Nebraska Medical Center
5. Case definition of HIV infection C3 B3 A3 < 200 mm 3 (<14%) C2 B2 A2 200-499 mm 3 (14 to 28%) C1 B1 A1 > 500 mm 3 (>29%) AIDS indicator condition (Category C) Symptomatic, but not with AIDS indicator condition (Category B) Asymptomatic (Category A) CD4 cell categories
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11. Resistance testing I doubt you have to remember funny numbers, but M184V is a “popular” mutation
22. Interclass adverse effects Symptomatic treatment Treat osteoporosis Surgery? XR followed by MRI if symptoms present Any agent Osteopenia, osteonecrosis Switch antiretrovirals Liver function tests every 3-6 months Nevirapine, efavirenz, stavudine, zidovduine, didanosine, tipranavir Hepatitis Check for associated metabolic complications Cosmetic treatment? Consider switching antiretrovirals Question patient Imaging not recommended routinely Stavudine, zidovudine, protease inhibitors (lipoatrophy) Efavirenz (lipohyperthrophy) Lipodistrophy Use insulin sensitizing agents Consider switching antiretrovirals Fasting glucose every 3-6 months Mainly protease inhibitors Insulin resistance Use National Cholesterol Educational Program guidelines Consider switching antiretrovirals Fasting lipid profile every 3-6 months Stavudine Protease inhibitors (except atazanavir) Hyperlipidemia Treatment Testing Agents Toxicity
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24. Class and specific adverse effects Discontinue medication Never rechallenge Abacavir Hipersensitivity Discontinue medication Didanosine, zalcitabine, stavudine Peripheral neuropathy Discontinue medication Didanosine, zalcitabine Pancreatitis Erythropoietin, switch agent Zidovudine Bone marrow supression, especially anemia Discontinue medication NNRTI Rash including Steven Johnson’s syndrome Symptomatic PI, NRTI GI toxicity Treatment Agents Toxicity
25. Class and specific adverse effects Actually not adverse effects, but some physicians and patients get excited about them (they are “markers” of adherence) Reassure patient Atazanvir Indirect hyperbilirrubinemia (Gilbert’s syndrome) Reassure patient Zidovudine Macrocytosis without anemia Good hydration Avoid other nephrotoxic agents Indinavir (stones), tenofovir Nephrotoxic Avoid during pregnancy Efavirenz Teratogenicity Consider switching agent Efavirenz CNS toxicity Treatment Agents Toxicity
The clear benefits of HAART have been tempered by problems with demanding dosing regimens, drug toxicities, and the emergence of viral resistance. Another difficulty with the use of HAART emerged soon after its introduction. Practitioners observed that, shortly after initiating HAART, some patients had clinical deterioration, even while the markers of HIV viral replication and CD4+ T-lymphocyte counts were improving. These patients appeared to have gained a striking capacity to mount an inflammatory response against microbes that had either established a subclinical infection or had been previously treated prior to starting HAART. This entity, which carries such labels as immune reconstitution disease (IRD) or immune reconstitution inflammatory syndrome (IRIS), has now been described for a wide variety of both infectious and non-infectious diseases