HIV

Question 1

What is a late HIV diagnosis associated with?

Answer 1

• Increased risk of opportunistic infections
• Increased morbidity and mortality
• Impaired response to HAART (highly active antiretroviral therapy)
• Increased healthcare costs

Question 2

How do we define a late HIV diagnosis?

Answer 2

CD4 count <350cells/mm3 within 3 months of diagnosis

Question 3

What is NICE’s recommendation about HIV testing?

Answer 3

In areas of HIV prevalence (2 per 1000 population or more) HIV testing should be offered to;

1. all new GP patients who have not been previously tested
2. All patients with a risk factor for HIV
3. All acute presentations to hospital

Question 4

Who can consent someone for HIV testing?

Answer 4

Any doctor, nurse, midwife or trained healthcare worker

Question 5

What sort of consent must be acquired from a patient who would benefit from an HIV test?

Answer 5

Informed verbal consent, either telling the patient they should have a test due to the high prevalence area they live in or due to the symptoms they are presenting with

Question 6

What would you do if a patient got a; positive HIV result?

Answer 6

Repeat the test

Question 7

What would you do if a patient got a; negative HIV test?

Answer 7

No further action, unless window period (4 weeks) is suspected

Question 8

What sort of pathogen is Pneumocystis jirovecii?

Answer 8

A yeast-like fungus

Question 9

Pneumocystis jirovecii (PCP) is one of the most common opportunistic infections in HIV, which HIV patients are particularly more at risk?

Answer 9

• Those with a CD4 count <200cells/mm3

Question 10

What are the signs and symptoms of a pneumocystis jirovecii infection?

Answer 10

• Exertional dyspnoea (progressive over several weeks)
• Malaise
• Dry cough
• Oxygenation drops between rest and exercise

Question 11

What investigations (samples and imaging) can be used to confirm a PCP infection?

Answer 11

• Sputum PCP PCR
• Broncho-alveolar lavage (BAL) PCP PCR
• Serum β-d-Glucan (fungal cell wall antigen, highly sensitive test, negative result would help exclude PCP)
• CXR: bilateral diffuse pulmonary infiltrates
• CT thorax: diffuse ground-glass opacities

Question 12

If someone tests positive for HIV who else should also be offered testing?

Answer 12

All known sexual contacts for the individual - current and previous partners
If they are a woman - any children should also be tested

Question 13

What is the transmission rate of HIV from mother to baby without any antiretroviral medication?

Answer 13

15-45%

Question 14

What medication can be given to a baby born to an HIV infected mother to reduce the chance of HIV acquisition?

Answer 14

Zidovudine

Question 15

Can a mother with HIV breastfeed?

Answer 15

There is a theoretical risk of HIV transmission via breastfeeding so the current advice is to bottle-feed

Question 16

Who needs to be notified about any campylobacter infection?

Answer 16

Public health

Question 17

When should a notifiable disease be reported to public health officials?

Answer 17

When there is any suspicion of a notifiable disease

This means we do not wait for any laboratory test confirmation

Question 18

How soon after exposure does post-exposure prophylaxis need to be given to be effective?

Answer 18

Within 72 hours