gyn care in HIV patient

Question 1

diagnosis of HIV

Answer 1

• ELISA (screening)
• Western blot (confirmatory)
• would get CD4 count, viral load (HIV RNA PCR), HBsAg, Hep C Ab, CBC and LFTs

Question 2

additional testing

Answer 2

at first appt/diagnosis: HCV, GCT, RPR, HSV Abs if unknown. Then annually GCT, RPR

Question 3

strategies to decrease transmission

Answer 3

• always use condoms
• use water based lubricants. not spermicides containing nonoxyl (breaks down condoms)
• partner pre-exposure prophylaxis (tenovifir + emtricitabine)
• post-exposure prophylaxis if non-frequent non-occupational contact
• decreasing risk of trasmission: oral, vaginal penetrative, anal. “insertive” less risk than penetrative.

Question 4

contraception options

Answer 4

• no contraindications
• watch hormonal options with interactions with liver enzymes
• dmpa no interactions

Question 5

what are goals if considering pregnancy?

Answer 5

• pre-pregnancy counseling
• viral load undetectable
• don’t be on efavirenz (risk of CNS defects)

Question 6

is HRT okay?

Answer 6

• yes. don’t be on fosamprenavir (decreases antiretroviral levels)

Question 7

who should be on antiretroviral treatment?

Answer 7

everyone!

Question 8

pap smear start?

Answer 8

1 year of sexual debut or HIV diagnosis. No later than 21.

Question 9

how to screen/schedule?

Answer 9

< 30: cytology only. if yearly negative x 3, then can go to q 3 years
> 30: can do cotesting. if negative then q3years
HPV managed as normally
LSIL and up = colposcopy