HIV

Question 1

What type of virus is HIV?

Answer 1

RNA retrovirus

Question 2

1. Which type of HIV is most common?
2. Which HIV type is most common in Africa?

Answer 2

1. HIV 1
2. HIV 2

Question 3

How does HIV cause illness

Answer 3

Destroys CD4 T helper cells

Question 4

What happens within first few weeks of HIV infection

Answer 4

Seroconversion - flu like illness that resolves. Patient asymptomatic until disease progression occurs

Question 5

How is HIV transmitted

Answer 5

Unprotected anal/vaginal/oral sex
Vertical transmission (mother to child via pregnancy, birth and breastfeeding)
Mucus membrane or blood exposure to infected blood/body fluids eg needles, fluid in eyes

Question 6

What is AIDS and what does it cause?

Answer 6

Occurs in end state HIV where CD4 count drops to a level that opportunistic infections are more likely to occur

Eg kaposki sarcoma
PCP
Cytomegalovirus infection
Oesophageal/bronchial candidiasis
Lymphoma
TB

Question 7

How to screen for HIV

Answer 7

Screen early, better outcomes

Identify patients with risk factors
4th generation home kit
OR…
Lab test for HIV antibodies and p24 antigen

Point of care tests for HIV antibodies

Question 8

Monitoring of HIV is done how?

Answer 8

1. CD4 cell count monitoring
   500-1200 per mm3 = normal
   < 200 per mm3 = high risk of AIDS
2. Viral load monitoring (HIV RNA per ml)
   <20 = undetectable viral load

Question 9

Manegement of HIV

Answer 9

Treatment at GUM/HIV/infectious disease centres…
- antiretroviral therapy with tenfovir + emtricitabine and add a third agent

• PCP prophylaxis if viral load <200 with co-trimoxazole
• monitor cardiovascular risk factors and treat, eg blood lipids and give statins if high
• yearly cervical smear to check for HPV/cervical cancer
• yearly influenza vaccine, pneumococcal, HPV, hep A and B.
• Post exposure prophylaxis (ART therapy combination of emtricitabine/tenofovir and raltegivir for 28 days) given after exposure to reduce transmission risk.

Question 10

What is tenfovir and emtricitabine examples of

Answer 10

Nucleoside reverse transcriptase inhibitors (NRTIs), a type of anti retroviral therapy

Question 11

What should be avoided in HIV

Answer 11

Live vaccines eg.BCG and typhoid

Question 12

Advice about reproductive health to people with HIV

Answer 12

Use condoms regardless of whether there is an undetectable viral load

Question 13

How to prevent HIV transmission in babies during birth

Answer 13

Mother’s Viral load < 50 - normal vaginal delivery

Viral load > 50 - consider pre labour c-section, give baby zidovudine for 2-4 weeks

Viral load > 400 - do c -section

Vral load unknown/ > 1000 - IV zidovudine infusion

High risk babies given zidovudine, lamivudine Anne nevirapine for 4 weeks

Avoid breastfeeding