HIV

Question 1

which area of the world is most greatly affected by HIV?

Answer 1

sub-Saharan africa

Question 2

A pregnant women is HIV positive, what treatment does she get?

Answer 2

antiretroviral prophylaxis

has seen almost a complete decrease in xfer from mom to baby

Question 3

What age group is most at risk for HIV?

Answer 3

15-24 y/o

Question 4

Describe the UN aids new plan

Answer 4

Goal set for 2020

90-90-90 percent plan
90 of ppl know there dx
90 of ppl have access to tx
90 of ppl are virologically suppressed

If it is in place by 2020, estimates put eradication of aids by 2030

Question 5

What is the total number of affected ppl in Canada and the prevalence rate?

Answer 5

75500

approx. 0.3 percent

Question 6

what group of people account for 50 percent of new transmissions?

Answer 6

those who are unaware of their status

Question 7

in order of ranking, what people groups attribute to new transmissions?

Answer 7

MSM (men who have sex with men) at 54

Heterosexual activities at 32

IV drug users at 10

Question 8

what is the trend in rates among young gay men

Answer 8

increasing

Question 9

Which city is leading the new diagnosis rate and why?

Answer 9

Vancouver because of high amounts of IDU (iv drug users)

Question 10

In which provinces do MSM constitute half of new infections?

Answer 10

BC, Ontario, Quebec, and atlantic provinces

Question 11

In which provinces does heterosexual activity account for half of transmission?

Answer 11

Alberta and Manitoba

Question 12

In which province does IDU account for 70 percent of new infections?

Answer 12

Saskatchewan

Question 13

Who was patient 0?

Answer 13

thirty six y/o, white, heterosexual male presented to a Toronto hospital in 1959

Had PCP, got really sick and died.

Because it was so mysterious, they froze a tissue sample. Once testing was available, they tested it and it was positive.

Question 14

what is the trend of new diagnosis among whites and Asians?

Answer 14

decreasing in whites

increasing in asians

Question 15

What population groups are most at risk in Canada?

Answer 15

MSM
IDU
Women
Aboriginal
Youth
Mentally ill
Older adults

Question 16

What is the highest risk sexual activity in HIV transmission?

Answer 16

Anal intercourse

Question 17

Describe the trend of HIV status and infection rate in the MSM group

Answer 17

Rate of HIV was declining for several years, but now has increased

In Vancouver, 18 percent of gay men are infected and 14 percent of those are unaware

Question 18

Describe the trend of HIV in women

Answer 18

Are increasingly represented in the stats with increasing rates.

Primarily from unprotected sex (often coerced sex)

Question 19

Why are women at such a high risk for HIV?

Answer 19

male to female transmission is 2 to 2.5 times more effective.

Question 20

Why are younger women especially vulnerable to HIV?

Answer 20

Immature genital mucosa (19-20 y/o)

Decreased mucous production (dec lubrication)

Undiagnosed/untreated STIs and inflamm disorders of the genital tract

Question 21

What are some psychosocial factors that contribute to women being vulnerable to HIV?

Answer 21

first sexual encounters are often with older men

first encounters may be non consensual

Social determinants; poverty, inequality, power imbalances, fear, violence

Question 22

Describe the trends of HIV in aboriginal women

Answer 22

Increased rates (3.5x)

pregnancy transmission is 10x higher

higher IDU

Question 23

what percent of people with HIV have a mental health condition?

Answer 23

80

Question 24

Explain why older adults are at risk for HIV?

Answer 24

lower index of suspicion for HIV infection

Question 25

What is a predictor of HIV risk in older adults?

Answer 25

Viagra

Question 26

Explain why the risk of reception so much higher

Answer 26

because the rectum does not naturally lubricate and it is lined with CD4 receptors.

Question 27

About how long does it take for the T cells to become depleted to the point where you are immunocompromised in the chronic stage?

Answer 27

8-15 years

Question 28

What percent of CD4 cells are lost in the early stage of acute infection?

Answer 28

80

Question 29

Explain how HIV leads to chronic diarrhea and malabsorption

Answer 29

it increases gut permeability increasing microbial translocation and immune activity

Question 30

What biomarkers are associated with HIV?

Answer 30

inflammatory markers such as D-dimer and IL-6

Question 31

Describe the four stages of infection for HIV

Answer 31

Primary Acute: symptoms of seroconversion illness 2-4 weeks after infection (flu-like) Chronic Asymptomatic: generalized lymphadenopathy, thrombocytopenia Chronic Symptomatic: wt loss, fatigue, diarrhea, candidiasis, herpes simplex and zoster AIDS: AIDS defining ilnesses

Question 32

Explain the difference between non-nominal and nominal HIV testing?

Answer 32

nominal testing uses their real name Non-nominal uses a pseudonym or initials Either way, there is follow up by public health. Helps preserve confidentiality

Question 33

Is HIV a reportable condition and what does this mean?

Answer 33

yes it is means positive test results must be reported to the local medical health officer for follow-up by the local public health nurse or HCP Testing HCP is responsible to ensure that partner notification is initiated

Question 34

What five topics should be covered in pretest counselling?

Answer 34

1) emphasize confidentiality and understanding of non-nominal testing 2) review transmission risks and prevention strategies 3) describe partner notification process 4) explore psychological preparedness, coping, and support mechanisms 5) emphasize need to return for result

Question 35

What is ELISA?

Answer 35

it is the initial screening test looking for HIV antibodies. Has a high sensitivity and low specifity first test is a third gen EIA and then goes to fourth if positive to confim. if pos, get a western blot

Question 36

What is a Western Blot test?

Answer 36

antibody test to confirm reactivity; high sensitivity and specifity of 99.9 if it is non reactive can have NAAT that looks for RNA and if it is positive, they are in acute infection phase

Question 37

What is a pooled NAAT?

Answer 37

it is a test that can be done with increased accuracy over 4th gen Elisa. Targets clinics with a large MSM population do it pooled because it is expensive. if positive, test each individually after.

Question 38

Explain the important points to cover in the post test counselling for NEGATIVE results.

Answer 38

INTERPRET: means either no infection or too early to test. Risks within the past 3-6 months dictate need for retesting 3 months after the last possible exposure REINFORCE: reduction of risk