AHD

Question 1

What is AHD

Answer 1

AHD according to WHO is defined as CD count less than 200 cells/mm3 or WHO clinical stage 3 or 4 event in adults, adolescents and children above 5yrs
Children below 5years are with HIV are considered to have AHD

Question 2

List the common OIs associated with AHD from the commonest

Answer 2

1. Tuberculosis
2. Cryptococcal meningitis
3. Pneumocystis Jirovecci Pneumonia
4. Toxoplasmosis
5. Histoplasmosis
6. Severe Bacterial infections

Question 3

Statistical relationship between TB and HIv

Answer 3

In 2019, 11% of TB cases diagnosed in Nigeria were co-infected with HIV

Question 4

Factors responsible for persistent high burden of TB among PLWHIV

Answer 4

1. Low ART coverage
2. Low uptake of TPT
3. Sub optimal case finding and diagnosis of active TB

Question 5

What are the components of AHD

Answer 5

1. Screening and diagnosis of AHD and associated OIs
2. Prophylaxis treatment against common OIs associated with AHD
3. Pre emptive treatment of OIs associated with AHD
4. Diagnosis and treatment of confirmed OIs
5. ART initiation
6. Intensive adherence counseling
7. Vaccination

Question 6

What are the diagnostic tools for TB

Answer 6

TB LAM - Urine
LF LAM
Gene xpert - sputum, stool, CSF, cold abscess

Question 7

Diagnostic for cryptococcal meningitis

Answer 7

Cryptococcal Antigen Assay - whole blood, serum, plasma
Lumber puncture and CSF cryptococcal Antigen Assay
CSF opening pressure
CSF with India ink

Question 8

Prophylaxis for Cryptococcal meningitis

Answer 8

Tab Fluconazole 100mg daily for 8weeks when (I) CD4 count is less than 200cells and (ii)CrAg screening not available;(iii) no evidence of invasive cryptococcal meningitis

When CrAg screening is positive but no evidence of invasive cryptococcal meningitis

Tab Fluconazole 800mg for 2weeks, then 400mg for 8weeks then maintain with 200mg per day

Question 9

Prophylaxis of choice in PLWHIV and the for Tuberculosis

Answer 9

Tuberculosis

1. 6H- Isoniazid 300mg daily for 6months 6H
2. 3HR- Isoniazid 300mg and Rifampicin 600mg daily for 3months
3. Isoniazid 300mg and Rifapentine 600mg daily for 1month
4. 3HP- Weekly Isoniazid 900mg and Rifapentine 900mg for 3months (12doses)

Question 10

Drugs of choice for prophylaxis for
PCP, Toxoplasmosis, Severe Bacterial infections
Cryptococcal meningitis

Answer 10

Cotrimoxazole

Fluconazole