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HIV-MICRO, HIV - Micro Acquisition of Rx If < 300% pov level -VA AIDS Drug Assistance Program, HIV - Micro HAART Tx when CD4 (not 500) or HIV RNA,000, HIV - Micro From mom 2 mill kids worldwide born to HIV moms -esp. sub-saharan africa, HIV - Micro Prevention Strategies From avoidance of infx TO - prevent spread by HIV pt -discuss prevention strategies w/ pt: Screen for risk behaviors, discuss, (+) reinforcement of safe behavior, refer for substance abuse, facilitate partnere notification, treat STDs Holow bore needles-stay away, HIV - Micro African Americans 1 in 50 AAs infx w/ HIV AIDS-leading cause of death 25-44yo AAs 5.5x more than white M, 12x WF incidence, HIV - Micro HAART Side Effects - NRTIs AZT: anemia, fatigue d4T: periph neuropathy, lactic acidosis ddI: panc'titis, periph neuropathy Abacavir: hypersens syndrome, can ->death 3TC: minimal -long term Tx->mitochondrial toxicity ->periph neuro, myopathy, lactic acidosis NNRTIs Nevirapine: rash, Stevens-Johnson syndome, severe hep Efavirens:mild rash, neuropsych rxns (lethary, vivid dreams, drugged feeling) -don't use in pregnancy PIs-GI ADRs Add ritonavir to any - shut down CYP450 -use less of original PI (boosted PI), HIV - Micro HAART Early Tx risks: Lipodystrophy -depletion & accum Start Tx w/ pt ready to commit++ AZT post-xposure prophylaxis, HIV - Micro Care '03 1.1 mill HIV (+) in US 30% unDx 33% Dx, no care 37% Dx w/ care 40,000 new cases/year 39% wait 1 yr from Dx to get Tx, HIV - Micro Testing EIA Western Blot (if 2 of 3 EIA from same sample (+)) -(+)-any 2 of 3 bands (p24, gp41, gp120/160) Can be in window period (no Igs yet), but RNA (+) -"seroconverting", HIV - Micro Africa #1 killer in Africa Derived from SIV (bush meat)