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DipGUM 🤦‍♀️ > HIV > Flashcards

HIV Flashcards

1
Q

When to do POCT

A

Rapid turnaround needed
Community site (high risk areas)
Urgent source case testing in exposure incident
Venepuncture refused

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2
Q

How long for 4th gen HIV test to be positive

A

45 days

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3
Q

How long for POCT to be positive?

A

90 days

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4
Q

Risk factors for HIV

A 
Sti
Partner HIV pos
MSM
Female contacts of MSM
Trans woman who has sex with men and no test in past year 
PWID
Partners who PWID
High prevalence country >1%
High risk sex - group, chemsex
Injections/ transfusions, transplants in high risk countries 
Sex workers or those who paid for sex 
Sexual assault by the above
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5
Q

Settings where HIV testing should be routine

A 
GUM
Antenatal
Drug dependency programmes
TOp
TB/ hep c/ b lymphoma services
Sx or signs of HIV indicator condition 
Accessing healthcare in high prevalence >2/1000 and extremely high >5/1000
Sex partners of those with HIV
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6
Q

Hiv testing in other settings - where?

A 
Dialysis
Organ and blood donation
Hosp admission and:
Sx or part of differential
High risk country or group
MSM and no test in past year
Trans woman and no test in past year
Sex with someone from high risk country 
High risk sex e.g chemsex
Sti
PWID
Partner HIV pos 
Prisons
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7
Q

AIDS defining thoracic conditions which need test

A

Candidiasis (bronchial/tracheal/pulmonary)
Herpes simplex bronchitis/ pneumonia
Mycobacterium avium complex, mycobacterium kansasii, other mycobacterium
Pneumocystis carinii pneumonia
Recurrent pneumonia (2 or more in 12 months)
TB (pulmonary or extra pulmonary )

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8
Q

AIDS defining gastro conditions needing HIV testing

A

Atypical disseminated leishmaniasis
Cryptosporidosis diarrhoea >1/12
Isosporiasis >1/12
Oesophageal candidiasis

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9
Q

Neuro aids deifning conditions need test

A 
Cervebral toxoplasmosis 
Cryptococcal meningitis
Primary cerebral lymphoma 
Progressive multi focal leukoencephalopathy 
Reactivation of American trypanosomiasis
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10
Q

Dermatology aids defining

A

Herpes simplex ulcer >1/12

Kaposis sarcoma

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11
Q

Oncology aids defining

A

Cattleman’s disease
Non Hodgkin’s lymphoma
Cervical ca

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12
Q

Ophthalmology aids deifning

A

CMV retinitis

Infective retinal diseases including HSV and toxoplasma

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13
Q

Aids defining infective causes

A

Cryptococcosis extrapulmonary
Histoplasmosis
Penicilliosis
Salmonella septicaemia recurrent

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14
Q

Medical conditions associated with an undiagnosed HIV prevalence >1/1000

A 
Anal cancer dysplasia
Candidemia 
Cervical dysplasia 
CAP
GBS
Hep a b or c
Herpes zoster
Malignant lymphoma 
Mononucleosis like illness
Ms like disease
Oral hairy leukoplakia
Peripheral neuropathy
Lung ca primary 
Seborrhic dermatitis
Severe psoriasis
Sti
Su cortical dementia
Chronic diarrhoea unexplain
Unexplained fever
Unexplained lymphadenopathy 
Unexplained oral Candida
Unexplained weight loss
Leukocytopenia thronbocytopenia > 4 weeks
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15
Q

What to discuss in giving HIV diagnosis

A 
Not aids
Good prognosis
Art option
U=u
Keep working, have kids, normal life expectancy 
Support network
Specialist hiv team
PN
Routes of tanmsision 
Condoms
Pep/ prep for partners
Prosecutions for reckless transmission
Reg stis 
Encourage disclosure to partner s
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16
Q

Annual hiv test for who?

A

Heterosexuals with new partner
PWID
Sex workers
MSM

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17
Q

3 monthly HIV test for

A

MSM - condomless anal sex with partner of unknown status over past 12/12
MSM and drug use during sex in past 6/12
Over 10 sexual partners in last 12/12
Multiple or anonymous partners since last test
Prep users
Follow up for sts or anogenital ct/GC

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18
Q

Antenatal hiv testing when?

A

Booking
If refuse reoffer
If refuse third offer at 36 weeks
Reoffer at 34-36 weeks for those with risk factors
POCT if present for first time in labour and send venous

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19
Q

Risk of vertical transmission of unknowingly positive HIV mother

A

20-35%

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20
Q

Factors increasing risk of vertical HIV transmission

A

Maternal viral load
Obs factors - mode, duration of ROM, del pre 32 weeks
Infant prematurity
Breast feeding

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21
Q

Ways to reduce maternal transmission of HIV

A

Don’t breastfeed
Art for mum and baby
No FBS or FSE
Mode of del

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22
Q

Primary infection with HIV time frame

A

1-4 weeks from acquisition until auffiencent antibodies to be detected on testing
Highly infectious time

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23
Q

Primary HIV 1 Sx

A

40-90% get them
Last 7-10 days
Fever, malaise, arthralgia, loss of aperitif, rash, myalgia, pharyngitis, oral ulcers, weight loss

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24
Q

Neuro Sx of primary hiv infection

A 
Headache 
Menigism
Cranial nerve palsies
Transient heniplegia or dysarthria 
High viral loads in CSF
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25
Years after HIV acquired and immune system weakened. First manifestations?
Frequent minor infections viral or recurrent vaginal or oral Candida Dry skin, seborrhoeic derm, thanks psoriasis Anaemia or thrombocytopenia Systemic fatigue weight loss nigjts sweats As becomes more profound - oral hairy leukoplakia or multidermatomal shingles
26
Impact of HIV on kidneys
Glomerulonephritis | HIV associated nepheopathy
27
CV impact of HIV
Increased atherosclerosis Dilated cardiomyopathy Pericarditis and pericardial effusions Pulmonary HTN
28
Hiv impact on liver
Faster progression of cirrhosis in Hep b and c | Higher rates of fatty liver
29
Bone impact of HIV
Osteopenia and osteoporosis High rates of vit D deficiency Osteonecrosis
30
Neuro impact of HIV
Peripheral neuropathy Bell’s palsy Cognitive impairment
31
Disease progression gene factors
Mutation in CCR5 - hiv uses it to gain entry to CD4 cells | HLA -B27 and 57 - resistance to disease progression
32
HIV 2
West Africa Less transmissible Less pathogenic Natural hx similar but lower viral loads and slower progression
33
Baseline ix when hiv pos
``` HIV serology 1vs2 CD4 count and CD4 % HIV viral load Resistance testing at baseline - HLA-B27 and 57 test (for hypersensitivity reaction) Renal, liver, bone profile Hba1c Urine dip Urine PCR FBC Hep B and C Vaccinate against Hep B A, varicella and measles if not already Sti screen inc sts Women - annual smear. Rubella if no prev vaccine Over 40’s - qrisk2 Over 50 - FRAX ```
34
When to measure CD4 count
>500 annually 350-500 6/12 <350 - 3/12 Annual hiv viral load, FBC, renal, liver bone profiles lipids ans sti screen
35
What to check pre starting art
CD4 in past 3/12 Viral load and full bloods inc urine PCR if urine pos for protein in past 6/12 Review resistance testing Check tropism test for CCR5 antagonist are considered
36
Post art starting when follow up bloods?
``` 4 week, 3/12 and 6/12 Renal and liver Urine dip HIV viral load If CD4 < 350 when starting art - 3/12ly ```
37
How to assess birological response to art?
HIV viral load should fall by 10fold within 4 weeks If not do further load after 4 weeks If not undetectable by 6/12 or rises- virological failure? Incomplete virological response? Rebound or blip?
38
Once established on art when check bloods?
``` Every 6/12 viral load If CD4 < 200 3/12 If CD4< 350 annually If >350 on 2 occasions over at least 1 year - stop monitoring Annual blood screens ```
39
Once established on ART when to routine screening tests
Smear yearly Sti screen yearly and every visit for MSM at risk Qrisk2 annually for those over 40 Frax 3 yearly for those over 50
40
How many months post HIV acquisition can define primary infection
6/12
41
Times when expedited initiation of ART recommended
Neuro involvement Aids deifning illness CD4 <350 PRimary HIVinfevtuon diagnosed within 12 weeks of a prev neg test
42
Art | Two NRTI backbones recommended
Nneucleotide reverse transcriptase inhibitors Tenofovir and Emtricitabine (truvada) Alternative abacavir and lamivudine (kivexa)
43
Name the classes of the 6 preferred 3rd agents for ART
Non neucloside reverse transcriptase inhibitors (nnrtis) : rilpivirine Integrase inhibitors: raltegravir, dolutegravir, elvitegravir Protease inhibitors: atazanavir/ritonavir or darunavir/ ritonavir
44
Strep pneumoniae
``` Gram positive Pneumonia and otitis media and sinusitis Invasive when in CSF or blood Carried in 10-15% of most peoples noses Carriage rates double in HIV Causes consolidation Can spread to brain meningitis ```
45
Risk factors for invasive pneumococcal disease
``` Extremes of age No spleen Diabetics Alcoholics Chronic renal pulmonary or liver or cv disease Immunodefin ie cancer or HIV ```
46
CXR findings of strep pneumoniae pneumonia
Lobar consolidation | Differential is PCP, TB and fungal infections
47
Bacterial causes of penimonia in HIV 1
``` Staph aureus E. coli H. Influenza Klebsiella Pseudomonas aeruginosa ```
48
Pneumococcal prevention in HIV
Give to HIV positive regardless of CD4 or art use Co trimoxazole for all with CD4 less than 200 against PCP. Also reduces risk of pneumonia and invasive baceterial disease Influenza A vaccination Smoking cessation
49
TB findings on CXR
Primary TB - pulmonary lesion (usually hilar lymphadenopathy also) Cavitation and patchy consolidation Particularly in upper lobes Can get pleural effusions
50
With HIV primary TB can progress to?
Progressive primary TB | Post primary TB (=reactivation)
51
Sites of extrapulmonary TB
``` Brain Lymph nodes Pericardium Renal and Gu tract Joints GI tract ```
52
When to start ART when TB presenting condition
CD4 < 100 ASAP 100-350 - ASAP but can wait until 2/12 post TB Rx >350 mins physician decision
53
Hiv diagnosed in pregnancy. What aiming to get undecteavle by? Gestation
36 weeks
54
Diagnosed with hiv in pregnancy - what to give baby?
4 weeks of AZT (zidovudine) mono therapy | No breastfeeding
55
If mum viral load >1000 what to do for delivery?
C/s Stat nevirapine, raltegravir and IV AZT in labour Baby triple therapy for 4 weeks
56
Hiv mode of delivery depending on viral load
If <50 nvd If 50-400 consider c/s If >400 - section
57
What to give if VL over 1000 in labour or if not known of consider if VL 50-1000
Zidovudine IV
58
Neonatal pep when to start?
Within 4hours max
59
If mother in ART for >10 weeks and VL <50 on/after 36 weeks -
2 weeks zidovudine
60
If mother on ART less than 10 weeks and BL less than 50 now but was previously higher what give?
4 weeks zidovudine
61
If maternal VL >50 on dah of delivery
``` 4 weeks of combo prep AZT 3TC, NVP Zidovudine Lamivudine Nevirapine ```
62
When to test neonate for HIV?
Non breastfeeding - 48 hours, 6 weeks, 12 weeks, 18-24 months BF- 48 hours, 2weeks, monthly whilst breastfeeding and 4 and 8 weeks post stopping
63
When to give neonate cotrimoxazole prophylaxis?
1month old if HIV PCR positive at any stage or confirmed HIV pos. only stop if exclude HIV

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