HIV Flashcards
Which populations are at the highest risk of HIV?
- Sub saharan Africa, especially southern africa
- men who have male sexual partners
- Children of people living with HIV
- People who inject drugs
- People who have transactional sex
Explain HIV testing
- 4th generation testing, tests the p24 antigen/HIV antibody
- There is a window period of 45 days so if you are testing someone, test them right away but also 45 days after exposure
- Confirmatory test (different assay)
- Can do POC testing
What are the symptoms of seroconversion?
•Systemic: - fever - rash •Pharyngitis •Mouth sores and thrush •Oesophageal sores • Myalgia •Enlargement of the spleen and liver •Lymphadenopathy •Skin rash •nausea and vomiting •Central: - malaise - headache - neuropathy
What are the differentials in someone with symptoms of seroconversion?
- Infectious mononucleosis
- Secondary syphilis
- Drug rash
- Other viral infections e.g. CMV, influenza
In which respiratory conditions are AIDS-defining?
- Tuberculosis
* Pneumocystis
Which neurological conditions are AIDS-defining?
- Cerebral toxoplasmosis
- Primary cerebral lymphoma
- Crytpococcal meningitis
- Progressive multifocal leucoencephalopathy
What are the dermatological AIDS-defining conditions?
Karposi’s sarcoma
What are the gastroenterological AIDS- defining conditions?
Persistent cryptosporidosis
What viral load is undetectable?
Below 200 copies per ml
How is the CD4 count calculated?
From total lymphocyte count
Describe the natural history of HIV infection
- HIV RNA copies rapidly increase in first weeks (acute HIV)
- Falls down sharply
- Enters clinical latency for many years
- Steadily increases then sharply increases
- CD 4 count is slowly decreasing throughout after an initial sharp dip
What is the aim of HIV treatment?
Viral load suppression and CD4 recovery
What is the treatment of HIV
- HAART - highly active antiretroviral treatment
* normally triple therapy with 2 nucleoside reverse transcriptase inhibitors and 1 drug from another class
What are the classes of antiretrovirals?
- Nucleoside reverse transcriptase inhibitors
- non-nucleoside reverse transcriptase inhibitors
- Integrase inhibitors
- Protease inhibitors
- Other egg, CCR5 entry inhibitor
What are the challenges with ART?
- Good adherence is essential
- Psychological impact
- Short term side effects
- Longer term toxicities
- Drug-drug interactions
What is the short term toxicities of antiretrovirals?
- Rash
- Hypersensitivity
- CNS side effects
- GI side effects
- Renal
- Hepatic
What are the longer term toxicities of antiretrovirals?
- Body shape changes: lipoatrophy/lipodystrophy/weight gain
- Renal (tenofovir disoproxil)
- Hepatic
- Lipid
- Bone
What enzyme are antiretrovirals often mediated by?
CYP450
Name 3 drug classes that have interactions with antiretrovirals
- Proton pump inhibitors
- Statins
- Antipsychotics
Describe partner notification when there is a new HIV case
- All previous partners
- Shared needles
- Children where relevant until the last negative test
- Should be carried out by the HIV team
What is the HIV prevention?
- Condoms
- Treatment as prevention (TasP)- undetectable viral load
- Pre-exposure prophylaxis (PrEP)
- Prevention of mother to child transmission (PMTCT)
- Harm reduction measures e.g. needle exchange
What is PEP?
- Post Exposure Prophylaxis
- Take within 72 hours
- Available from sexual health/A&E
- Based on exposure type and risk of contact
- normally 2 NTIs and Integrase inhibitors
What is PrEP?
- Available from sexual health
- For people at higher risk of HIV through sexual transmission
- Cheap
- In the long term are complications for renal/bone
How is mother to child transmission prevented?
- universal antenatal HIV screening is offered
- Antiretrovirals for mother during pregnancy
- If not undetectable then minimise the risk at delivery e.g. caesarian
- PEP for the baby
- Avoid breast feeding
