HIV - Testing and Clinical Management

Question 1

Diagnosis is important because

Answer 1

15% undiagnosed in UK

Late diagnosis means they are are likely to die and transmit to others

Question 2

Aids defined by

Answer 2

CD4 count < 200

Question 3

Case 1 - thrush

Answer 3

Thrush 
Candidiasis
Fungal infection 
Unusual in healthy adults 
Risk factors are antibiotics and the immunocompromised

Question 4

Shingles

Answer 4

Affects dermatomes
Reactivation of varicella zoster virus
Painful blistering rash, malaise

Question 5

Late HIV infection

Answer 5

PCP - type of bacteria not common in early infection

Pneumocystis carinii pneumonia

Question 6

How to gain consent for test

How to test

Confirmed test = 99.9% PPV

Answer 6

Verbal consent and documentation

Sent clotted blood to lab
4th generation test
Uses antibody and antigen to bind to respective body
Window period of 1 month

Question 7

What to do next?

Answer 7

Call specialist for advice

Result - given face to face

Contact tracing - sexual partners etc

Question 8

Other ways to test

Answer 8

Point of care - finger prick, mouth swab, saliva
Antibody only
Antigen only
HIV RNA PCR - viral load

Question 9

Kaposi’s sarcoma

Caused by

Symptoms

Answer 9

Human herpesvirus 9
AIDS confirming condition
Spindle cells on biopsy

Referral to oncology

Question 10

Hairy leukoplakia

Answer 10

Epstein Barr virus
White patches which can’t be scraped off
Linked with HIV, smoking and immunosuppression

Question 11

Herpes Simplex Virus (HSV)

Answer 11

Coldsores
HSV1/HSV2

In HIV…
More severe
More frequent
Outbreaks last longer
May also have genital herpes

Question 12

HAART - highly active anti-retroviral therapy

Answer 12

Accts on different points in HIV replication cycle

Question 13

Mechanism of HAART reagents

Answer 13

Blocks CCR5 co-receptor to prevent binding of HIV

NRTIs and NNRTIs work against reverse transcriptase

Integrate inhibitors inhibit integrase enzymes

Question 14

why has HIV become resistant to drugs

Mechanism of mutation

Answer 14

1 mutation in every 2 new viruses produced
Wild type virus –> virus with single drug resistance –> mono therapy selects for resistant strain –> triple therapy

mutant has a survival advantage and becomes the dominant strain

Question 15

Therapeutic drug level

1. non-adherence
2. drug-drug interactions result in…

Answer 15

ESSENTIAL to keep HIV suppressed
missing 1 or 2 doses can cause resistance
many drugs interact with antiretrovirals –> sub therapeutic levels