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BMSc > Blood borne viruses > Flashcards

Blood borne viruses Flashcards

1
Q

how are BBVs spread

A

by blood/bodily fluids including semen, vaginal secretions and breast milk

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2
Q

name the three main BBVs

A

hep B and C

HIV

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3
Q

give examples of professions in which there is contact with bodily fluids and as such risk of BBV transmission

A 
health care
emergency services
lab work
mortuary
prisons
hairdresser/beautician
plumbing
tattoing/piercing
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4
Q

describe the common course of Hep B infection

A

acute infection for 1-3 months

then 1/20 of those people will be affected by a chronic infection defined as >6 months duration

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5
Q

what are the complications of hep b

A

cirrhosis

liver cancer

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6
Q

how is hep b treated

A 
antiviral (tenofovir or entecavir)
or immunomodulator (interferon alpha)
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7
Q

what is the most common reason for hepatitis C infection

A

drug use

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8
Q

how long does the acute infection last for

A

up to 6 months

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9
Q

what proportion of people infected with hep c remain chronically infected

A

75 percent

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10
Q

how many genotypes of hep c are there and which are the most curable with antiviral medication

A

genotypes 1,2,3

genotypes 1 - 50 percent will be cured with medication

genotypes 2,3- 80 percent are cured with medications

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11
Q

what are the long term complications of hep c

A

cirrhosis and liver cancer

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12
Q

What proportion of people infected with HIV are unaware

A

1 in 4

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13
Q

what is the commonest route of infection in the uk of HIV

A

sexual intercours

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14
Q

what affects the chances of infection transmission

A

viral load is proportional to chance of infection

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15
Q

how is HIV treated

A

HAART

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16
Q

what is the typical course of HIV infection

A

seroconvesion illness two to six weeks following infection (avg 15 days) - flu like illness
asymptomatic for up to 10 years
Symptomatic is characterised by opportunistic infections and certain cancers = AIDS

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17
Q

describe the current nice guidelines for referring/treating infertile couples

A

Offer couple further clinical assessment afte 1 yr of not conceiving
Offer earlier if:
female older than 36
known pathology e.g. vasectomy, tubal blockage
apparently no chance of pregnancy with expectant management

offer IVF treatment after 2 yrs for unexplained infertility

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18
Q

Under which aspect of the nice guidelines of treatment of BBV patients fit under`

A

‘apparently no chance of pregnancy with expectant managment’ –>as such can be offered treatment straight away

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19
Q

What investigations are typically done prior to IVF

A 
day 21 progesterone
rubella immunity 
chalmydia
gonorhea
TV/BV/candida/syphillus
FSH/LH/E2
Testosterone, SHBG, FAI
prolactin
HSG/hycosy/laparoscopy and HTB to check tubal patency
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20
Q

what abnormality is more common in HIV pts

A

hydrosalpinx (4o percent of HIV positive patients)

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21
Q

what abnormalities in sperm are seen in HIV pts

A

lower sperm motility
semen parameters not significantly different where detectable/undetectable viral load
significant correlation between CD4 count and sperm count and progressive motility
no correlation between CD4 count and sperm morphology

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22
Q

what affect does haart have on sperm parameters

A

lowers sperm count, lower motility and higher percentage abnormal forms

23
Q

how is the risks of BBV transmission minimised in the ACU

A

hep B immunisation to staff
USS probe decontaminated
theatre
gametes/embryos handles and stored separately to non BBV

24
Q

give the advantages of IUI in these patients

A

less invasive than ivf

cheaper

25
Q

what are the disadvantages of IUI

A

need good sperm parameters
low success rate
cycle will be cancelled if more than three follicles more than 14mm (risk of multiple pregnancy)

26
Q

what is the success rate of IUI

A

13 percent per transfer per treatment cycle

27
Q

how is sperm prep done for BBV patients

A

Integral part of IUI +/- superovulation / IVF / ICSI

  1. Density gradient preparation by centrifugation through viscous media (usually 40% / 80%)
    Puresperm used clinically (Colloidal silica suspension in isotonic salt solution)
  2. Pellet washed
  3. Followed by swim-up
  4. Test for VL
28
Q

what is the difference between HIV virus RNA present in semen vs blood

A

generally levels are lower in semen (10 times lower)

29
Q

what is done to the sperm to reduce risk of transmission of HIV

A

sperm washing

30
Q

what percentage of men with undetectable viral load using HAART had virus detected in their semen pre and/or post sperm wash

A

9.7 percent

31
Q

what is the best indicator for reducing (if not elimating0 risk of transmission of HOV

A

reducing or elimating viral load

32
Q

when is sperm washing primarily used

A

IUI

33
Q

what services are offered in ninewells

A

sperm washing + IUI
IVF/ICSI

don’t do : TUPSI,
PrEP

34
Q

how often is peginterferon alpha taken for hep b

A

weekly injection for 12 months

35
Q

what further steps must be taken in case of patients with hep b

A

immunise seronegative partner

consider deferring ART to see if acute infection clears

36
Q

what blood result indicated current hep b infection (acute or chonic)

A

HBsAg

Anti-HBc positive

37
Q

what blood results indicate a previous infection but the person is now immune

A

Anti HBc and Anti HBs positive

38
Q

what blood results indicate a vaccinated person

A

antiHBs positive

39
Q

how are patients with hep c treated

A

refer to hepatologist
pegylated inferferon and ribavirin
will take 24/48 weeks to erradicate depending on serotype

no current immunisation but sexual transmission risk is low

40
Q

how long should a pregnancy be avoided after hep c treatment

A

6 mths

41
Q

what are the treatment options of a HIV positive male

A 
if no HAART/detectable VL:
sperm washing then IU/IVF/ICSI
HIV test for female 4/52 post treatment
DI
adoption

if HAART/undetectable VL for more than 6mths:
options as above
TUPSI - monthly HIV test for female partner
consider PrEP

42
Q

what is the risk of HIV transmission be receptive vaginal intercourse per exposure

A

0.1 percent

recepive anal intercourse is 10x higher
and insertive vaginal or anal intercourse is much lower

43
Q

So what would be the avg HIV transmission risk over a course of TUPSI

A

3 percent (taking into account 5 exposures per cycle and average of 6 cycles to conceive)

44
Q

what is the dangers of having seroconversion illness in pregnancy

A

high risk of in utero transmission to fetus

45
Q

what is PreP

A

post exposure prophylaxis

46
Q

when should prep be started

A

within 72 hours of risk

47
Q

how long is a course of prep

A

28 days

48
Q

what are the negatives of Prep and why is it not widely used

A

may create viral resistance
toxicity
cost

49
Q

when may prep be useful

A

in reducing HIV transmission in high risk people:
MSM, sero discordant couples, high risk women/men
however still only used experimentally or in the special circumstance of conception

50
Q

how is a HIV positive female treated

A

if not on treatment: self insemination

if HAART:
self insemination
can consider TUPSI if VL undetectable for more than 6 months and normal fertility screen - monthly test for male partener
if no conception at 6/12 refer to ACU for IVF/ICSI

51
Q

what is the problem with HIV positive male and female and why can they not have UPSI?

A

theoretical risk of HIV superinfection however not reported in cohort studies

52
Q

is TUPSI acceptable in HIV positive male and female

A

yes

53
Q

when can TUPSI not be used in cases where the male and female is HIV +

A

if either partner has a detectable drug resistant virus

if female- recommend self insemination
if male- offer sperm washing

BMSc (17 decks)

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