HIV Flashcards
Is HIV reportable?
Yes
Approximately how many Americans are infected with HIV? About how many new diagnoses of HIV are there annually?
- About 1.2 million
- About 40,000 new diagnoses
What percentage of those infected with HIV are unaware they’re infected?
16%
What group has the highest risk of infection with HIV?
Hispanic males who have sex with men
Why does the CDC recommend universal screening for HIV?
25% of infected individuals report no high risk behaviors
What are the CDC screening guidelines for HIV?
Routinely screen all patients ages 13 - 64
Screen all:
- Pregnant women (in the 1st trimester)
- Patients treated for TB
- Patients diagnosed with:
- Syphilis
- Gonorrhea
- Chlamydia
- Patients with high risk behaviors
- Patients of STD/STI clinics:
- At EACH visit
- Even if they are low risk
What test/s should be ordered for HIV initial and confirmation testing?
1: ELISA/EIA (HIV 1/2 antigen/antibody immunoassay) and if +, order #2
Order #3 if:
- #2 is:
- Negative or
- Indeterminate
- Acute infection is suspected
- HIV exposure is suspected/confirmed
NOTE: #3 is expensive and usually not used for initial screening but for confirmation of other above tests or in special situations
Describe the initial presentation of HIV, including duration and signs and symptoms.
Initial phase </= 14 days
Nonspecific symptoms:
- Fever (96%)
- Pharyngitis (70%)
- Nonpruritic macular rash (70%)
- Lymphadenopathy (74%)
- Malaise
- Headache
What details about early HIV infection are important for Primary Care Providers to keep in mind?
Early HIV infection involves acute retroviral syndrome:
- Self-limiting, viral-type syndrome occurring 2-4 weeks post-infection
- HIGHLY INFECTIOUS!
- HIV tests will be NEGATIVE during this phase
Why should PCP’s explore HIV patients’ histories when planning their treatment?
- 30% have history of Hepatitis C
- 8% have history of Hepatitis B
- Liver disease progresses faster and affects choice of antiviral therapy
- HIV = significant risk factor for reactivation of latent TB
- Many have history of other STIs
Which immunizations should HIV patients be given? Partners, close contacts?
- Pneumococcal
- Tetanus
- Hepatitis A/B
- Flu: annually
NEVER give:
- Live vaccines
- Attenuated vaccines
Consider immunizations for patients’ close contacts (except oral polio and small pox)
Which labs should PCPs order for HIV patients, when and why?
CD4:
- Baseline
- Repeat once at least, usually q3-4 months
- to determine need for prophylaxis for opportunistic infections
Viral load:
- Baseline
- Q3-4 months
- Goal if on ART therapy: undetectable viral load within 16-24 weeks of initiation of therapy
Screen for Hepatitis A, B, C:
- many have history of these infections
Glucose and lipid panel:
- if on ART therapy
Screen for other STDs/STIs:
- many have history of these infections
Name common HIV-related opportunistic infections.
- Pneumocycstitis jiroveci (formerly carinii)
- Toxoplasmosis
- Legionella
- Salmonella
- Mycobacterium avid complex (MAC)
- others
When should prophylactic treatment of opportunistic infections be started for HIV patients? Which antibiotics should be considered?
When CD4 < 200
- Bactrim/TMP-SMX 1 tab of double-strength daily
- Azithromycin/Clarithromycin
List common assessment findings of patients with established HIV.
- Anemia
- Leukopenia
- Thrombocytopenia
- Involuntary weight loss
- Persistent diarrhea
- Severe chronic fatigue
- Dementia
- Peripheral neuropathy
- Herpes zoster*
- Opportunistic infections
*NOTE: These patients may received Shingrix for herpes zoster
