HIV

Question 1

What are the initial investigations after a person has been diagnosed with HIV?

Answer 1

Viral load
CD4 T cell count
HIV genotype

Question 2

When should treatment be started after the diagnosis of HIV?

Answer 2

Straight away

Question 3

What is the composition of combined therapies for HIV?

Answer 3

Have at least 2 classes, and 3 drugs

All in 1 tablet

Question 4

What are the classes of antiretroviral drugs?

Answer 4

Nucleoside reverse transcriptate inhibitors (NRTIs)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Protease inhibitors (PIs)
Integrase inhibitors (INSTIs)
Fusion inhibitors (FIs)
Chemokine receptor antagonists (CCR5 antagonists)

Question 5

What parameters are monitored in a person with HIV?

Answer 5

Viral load
- Decreases in weeks-months after treatment commenced
Other STIs

Question 6

What is the most common reason that viral load does not decreases after treatment is started?

Answer 6

Patient not taking medications

Question 7

What is the biggest risk factor for contracting HIV in Australia?

Answer 7

MSM

Question 8

What is the biggest risk factor for contracting HIV in sub-Saharan Africa?

Answer 8

Sex

Question 9

What is the biggest risk factor for contracting HIV in East and South-East Asia?

Answer 9

IVDU

Question 10

What is the risk of contracting HIV from a needle-stick injury, if the patient has HIV?

Answer 10

1 in 300

Question 11

What is the risk of contracting hepatitis C from a needle-stick injury, if the patient has hepatitis C?

Answer 11

1 in 30

Question 12

What is the risk of contracting hepatitis B from a needle-stick injury, if the patient has hepatitis B?

Answer 12

If vaccinated, vanishingly small

If unvaccinated, 1 in 3

Question 13

Why does treatment equal cure in hepatitis C?

Answer 13

No reservoir

Question 14

What is the reservoir for HIV?

Answer 14

CD4 cells

Question 15

What is the reservoir for hepatitis B?

Answer 15

DNA of hepatocytes

Question 16

Is there treatment for hepatitis B? Is there a cure?

Answer 16

Treatment, yes

No cure

Question 17

Who gets pre-exposure prophylaxis (PrEP)?

Answer 17

Partner has HIV
Person/partner has significant risk
Within 72 hours of risky sex

Question 18

Along with HIV, what else do you test for?

Answer 18

Hepatitis B
Hepatitis C
Combined PCR on urine
- Chlamydia
- Gonorrhoea
Syphilis

Question 19

What are the symptoms of initial infection with HIV?

Answer 19

Often asymptomatic
Flu-like illness
- Fever
- Lymphadenopathy
- Rash (uncommon)

Question 20

What does HIV serology involve?

Answer 20

Dual testing for Ag and Ab

Question 21

When does HIV antigen become positive in a serology test?

Answer 21

Within 10-14 days

Question 22

If the combined HIV serology is negative, when is the patient out of the woods?

Answer 22

Test remains -ve after 6 weeks

Question 23

In what cases is PCR testing for HIV used?

Answer 23

When concerned about vertical transfer

Question 24

Is specific consent required for HIV testing?

Answer 24

Yes

Question 25

Why is it important to test for chlamydia?

Answer 25

Largely asymptomatic

Question 26

Which populations are at higher risk of contracting gonorrhoea and syphilis?

Answer 26

MSM | Indigenous Australians

Question 27

From where are swabs taken for gonorrhoea testing?

Answer 27

Throat | Anal

Question 28

What are classical infections of AIDS?

Answer 28

``` Cerebral toxoplasmosis CMV retinitis Crytococcal meningitis Pneumocystis pneumonia Mycobacterium avium complex (MAC) infection ```

Question 29

What are some atypical, or severe skin or oral infections that suggest impaired cell-mediated immunity, especially if risk factors are present?

Answer 29

``` Shingles in young person Warts - Intra-oral - Widespread facial - Severe anogenital Severe/widespread herpes simplex Facial molluscum contagiosum Oral candidiasis Oral hairy luekoplakia Necrotising gingivitis TB ```

Question 30

What are some cancers that are more common in HIV?

Answer 30

Lymphomas Kaposi's sarcoma Anal cancer

Question 31

What are the key messages to convey to a patient at diagnosis with HIV?

Answer 31

Readily treatable Shouldn't interfere greatly with life plans - will need regular medical checks Use condoms Treatment prevents transmission

Question 32

What are the key questions to ask a patient at diagnosis with HIV?

Answer 32

Have donated blood/semen in last year? Any sexual partners from last year contactable? Could you call them and recommend a test? Who can you talk to for support?

Question 33

What is seroconversion?

Answer 33

HIV Ab test converts from -ve to +ve 3-5 weeks after transmission

Question 34

What is seroconversion illness?

Answer 34

Febrile illness around time of seroconversion | Sometimes severe enough to present to hospital

Question 35

What is seroconversion illness often assumed to be?

Answer 35

Flu | Glandular fever

Question 36

What are the possible symptoms of seroconversion illness?

Answer 36

``` Fever Sore throat Rash Diarrhoea Weight loss ```

Question 37

What are the parameters for CD4 cells?

Answer 37

More than 500 = normal 500-200 = mild immunosuppression Less than 200 = risk of AIDS

Question 38

What are the principles of antiretroviral therapy (ART)?

Answer 38

Suppress viral replication to - Prevent viral infection of CD4 cells - Allow reconstitution of cell-mediated immunity - Stop reverse transcriptase making random drug-resistant mutations

Question 39

Can patients go on drug holidays on ART?

Answer 39

No, unless essential | Continuous viral suppression better than intermittent therapy, even at high CD4 counts

Question 40

What is immune reconstitution inflammatory syndrome?

Answer 40

When cell-mediated immunity improves, some weeks after starting ART, asymptomatic infections may suddenly present with inflammation Symptoms occurring some weeks after starting ART, in someone with initially low CD4 count, consider possibility of T cell-mediated immune flare in existing infection