HIV

Question 1

Baseline investigations for new diagnosed HIv patient?

Answer 1

• Confirmatory HIV test
• CD4 count
• HIV viral load
• HIV resistance profile
• HLA B5701 status
• Serology for syphilis, hepatitis B, hepatitis C and hepatitis A
• Toxoplasma, Measles, Varicella and Rubella - all IgG
• FBC, U&Es, LFTs, bone profile, lipid profile
• Schistosoma serology (if spent more than 1 months in sub-saharan Africa
• Women - annual cervical cytology

Question 2

Where should all newly diagnosed HIV patients be referred to?

Answer 2

HIV clinical nurse specialist team
For contact tracing

Question 3

Additional testing for TB

Answer 3

• TB and Mycobacterium Avium infection culture (MAI)
• Fungal culture and PCR, fungal stains
• Cryptococcal antigen (CRAG commonly in CSF if serum CRAG positive)
• Toxoplasma PCR
• Viral PCR - eg EBV, CMV, HSV, VZV, JC virus (human polyomavirus)

Question 4

Tissue samples in HIV testing

Answer 4

• Histology/cytology in formalin
• AND microbiology in saline

Question 5

Support for patients with HIV

Answer 5

• HIV clinical nurse specialist - advice, education, medical and social support to patients, families and partners
• Also have links to community support groups if needed
• Can be reffered to psychology team for assessment if having psychological difficulties with diagnosis

Question 6

Antiretroviral drugs for HIV

Answer 6

• Cannot be issued by GPs
• Important doses are correct and not missed - can lead to drug resistance
• Drug interactions are common - check using HIVdruginteractions.org

Question 7

Managing HIV patients with low CD4 count

Answer 7

• Suceptible to opportunistic infections
• If less than 200 prescribe co-trimoxazole as prolphylaxis against PCP
• If CD4 less than 50 give Azithromycin too to protect against MAI, also need to be assessed by ophthalmology with dilated fundoscopy to look for evidence of intra-ocular infections

Question 8

Vaccinations for HIV patients

Answer 8

• All should be vaccinated against hep B and pneumococcas
• All need annual influenza

Question 9

Post-exposure prophylaxis for HIV

Answer 9

• If concern of member of staff being exposed to HIV via needlestick injury or bodily fluid exposure can contact infection consultant for advice - for infection ward only
• If not on infection ward, ask occupational health during working hours or genitourinary medicine doctor on call out of hours
• GUM team also manage PEP in community inc potential sexual exposure to HIV