HIV

Question 1

What is the most common type of HIV in the US?

Answer 1

HIV-1, subtype B

Question 2

Which individuals currently have the highest rate of infection?

Answer 2

Men having sex with men
***Gay, bisexual, and category of “other” men (especially young black men) who have sex with men—are most seriously affected by HIV

Question 3

Which race has the highest burden of HIV in the US?

Answer 3

black race (African-Americans)

Question 4

Who should be tested for HIV?

Answer 4

Patients with high-risk behaviors should be tested annually.
All pregnant women should receive universal screening.
Test everyone, ages 13–64, at least one time
Test all patients who present for new STI complaint.
Test all patients who are being treated for TB.

Question 5

What is “opt out” testing?

Answer 5

In many healthcare settings, people are offered an HIV test on an ‘opt-out’ basis. This simply means that the healthcare worker suggests that it would be good idea to take a test, and that it will be carried out unless the patient asks for it not to be done

Question 6

what signs/symptoms and lab results can you see in patient with acute HIV (early signs)?

Answer 6

probable signs: fever, fatigue, rash, headache, lymphadenopathy, pharyngitis, myalgias/arthralgias.
Possible symptoms: nausea, vomiting, diarrhea, night sweats, aseptic meningitis, oral ulcers, genital ulcers, .

Question 7

When are patients with HIV highly contagious?

Answer 7

During the first 4-6 weeks after becoming infected
Due to burst of viremia
HIV antibody will be negative.
Duration is two to three weeks and resolves spontaneously

Question 8

What are lab results seen with acute HIV?

Answer 8

thrombocytopenia
leukopenia
elevated liver enzymes (ALT and AST)

Question 9

What are crucial markers to look for with new HIV infection?

Answer 9

Crucial markers are presence of rash and/or oral ulcers.

Question 10

Which test can be ordered in patient that we suspect HIV infection on but antibody is negative?

Answer 10

HIV RNA (viral load)

Question 11

Which test should we perform on HIV-unknown women so intrapartum antiretrovirals can be given?

Answer 11

rapid HIV testing

Question 12

What is the most common test for HIV?

Answer 12

Most common is antibody test ELISA, confirmed by Western blot.

Question 13

Which test do you perform on newborn who has been exposed to HIV?

Answer 13

Best test: HIV DNA PCR.

Question 14

Antibody retesting can be done after _________ of age.

Answer 14

18 months

Question 15

Which medication do we give to a baby that has been exposed to HIV?

Answer 15

Zidovudine 2 mg/kg/dose 4x/day, within 8-12 hours after birth.
Continue for six weeks.

Question 16

All infants born to HIV-positive mothers should start on PCP prophylaxis at _______ of age and stay on until HIV is ruled out completely.

Answer 16

six weeks

Question 17

How would a baby likely present to the ED with acute HIV?

Answer 17

Asymptomatic within first six weeks of life.
First symptom usually lymphadenopathy, followed by enlarged liver and spleen, failure to thrive, encephalopathy, and low birth weight.
Over time, diarrhea, pneumonia, thrush, and opportunistic infections.
Prior to these symptoms, may see recurrent bacterial infections (ear infections, pneumonia)
Over time, cardiac hypertrophy/CHF, anemia, malignancies.
FTT and irritability common in HIV-positive children

Question 18

For laboratory monitoring which test do we use in children under the age of 5?

Answer 18

Use CD4 percentage lab test for children under five years old.
Check CD4 percentage every three to four months.

Question 19

What is the goal of antiretroviral medicine?

Answer 19

Reduce plasma HIV RNA to below detectable level, and normalize immune status
***use 3 drugs from at least 2 different categories

Question 20

Does contraception interact with antiretrovirals?

Answer 20

YES

Question 21

What are “early signs” of HIV in adults?

Answer 21

Generalized lymphadenopathy, unexplained weight loss, recurrent respiratory infections (sinus infections, bronchitis, pneumonia)
Shingles, oral sores, angular cheilitis
Rashes such as pruritic papules, seborrhea, fungal nail infections

Question 22

What are “later signs” of HIV in adults?

Answer 22

Unexplained chronic diarrhea
Persistent fever
Persistent oral candidiasis (thrush)
Oral hairy leukoplakia
Pulmonary tuberculosis
Joint infections
Unexplained anemia, neutropenia, chronic thrombocytopenia

Question 23

What are “AIDS” defining illnesses?

Answer 23

Opportunistic infections (Kaposi's sarcoma)
HIV encephalopathy
Lymphoma
Invasive cervical carcinoma
Nephropathy and cardiomyopathy

Question 24

What is the treatment for postexposure prophylaxis?

Answer 24

Use of ART recommended for a few days