HIV/Aids

Question 1

HIV/AIDS

Answer 1

Immunodeficiency disorder in which HIV uses T4 (CD4) cells as a receptor and reservoir for HIV.

Question 2

Epidemiology of HIV/AIDS

Answer 2

Epidemiology: Modes of transmission similar to those of hep, specifically blood, semen, vaginal secretions, and breast milk.
1. Blood
2. Anal
3. vaginal

Question 3

Signs and symptoms of HIV/AIDS

Answer 3

Like any other virus, flu like symptoms.
Fever, night sweats, weight loss.
Think seroconversion (the provess of converting from HIV-negative to HIV-positive, takes approx 3 weeks to 6 months).
More of a constellation of S/S than any single one that is suspicious for AIDS.
AIDS occurs when T4 (CD4) count is <200 and/or when an ooprtunistic infection is presentin an HIV-positive patient.

Question 4

Lab/diagnostics for HIV/AIDs

Answer 4

• ELISA and western blot are not longer indicated as these test can produce false negative results.
• Preferred test is an antigen/antibody combo HIV-1/2 immunoassay.
  -If this test is negative then the pt is considered negative for HIV.
  -If the test is postive then move onto a test called HIV-1/2 antibody differentiation immunoassay. This test confirms the results of the combination assay and provides info as to whether the pt is infected with HIV 1 or HIV 2 or both. If this test is negative but sufficient concern exists for HIV infection, sondier ordering HIV RNA PCR test (checks viral load, a high numebr correlates with progression of HIV. Ideally should be zero or undetectable).

Question 5

Management of HIV/AIDS

Answer 5

1.) Prevention of opportunistic infections.
-Most common opportunistic infection/killer of aids pts is peumonia, primarily pneumocystis pneumonia (Pneumocystis jirovcii). Treat with bactrim (TMP-SMX). Also bactrim for toxoplasmosis prevention.
-Azithromycin for Mycobacterium avium.
-Monitor for cytomegalovirus.
2.) Antiretroviral treatment (ART)
-Combo therapy is standard.
-Recommends starting ART at the time of HIV positive diagnosis, regardless of CD4 count.
-Monitor for dangers of drug resistance, must be taken exactly as prescribed!
3.) Referral to an HIV specialist

Question 6

Pre-exposure prophylaxis (PrEP)

Answer 6

Federal guidlines suggest PrEP for people who are HIV-negative and have:
1.) Had anal or vagnial sex in the past 6 months who have:
-A sexual partner with HIV or
-Not consistently using condoms or
-Been diagnosed with an STI in the past 6 months.

2.) Recommended for people who inject drugs and
-Have an injection partner with HIV or
-Share needles, syringes, or other equipment to inject drugs.

3.) Considered for people who have been prescribed nonoccupational post-exposure prophylaxis (PEP) and:
-repeat continued risk behavior
-Have used multipel courses of PEP

Question 7

Agents of PrEP

Answer 7

• Truvada
  -Recommend to prevent HIV for all people at risk through sex or IV drug use.
  -Can cause significant renal and bone density effect due to high plasma concentrations.
• Descovy
  -Recommended to prevent HIV for people at risk through sex, EXCLUDING vaginal sex (not studied)
  -Improved renal and bone safety due to decrease in plasma levels but has more intracellular concentrations; smaller doses are needed.