Hiv Flashcards
(44 cards)
Where is universal HIV screening recommended
GUM Antenatal services Termination of pregnancy services Health are services for patients with TB, lymphoma, hep B and C Drug dependency programmes
What is included in the pre test discussions
To establish informed consent for HIV testing and includes the following elements
- a risk assessment
- a discussion of the benefits of testing
- an explanation of the window period
- details of how to result will be given and preparation for +ve result where applicable
Benefits of knowing HIV status
Medical advances in particular the development of HAART have significantly improved the length and quality of life of most people living with HAART
For pregnant women or those attempting to conceive awareness of HIV status can reduced the transmission from mother to baby to virtually zero
Supports Behaviour change to reduce transmission
Prevents if allows for appropriate and effective tx of opportunistic infections related to HIV
Perceived weaknesses to knowing HIV status
Ruin relationships
Won’t have another relationship
Difficulty accessing life insurance
Window period to seroconversion testing
Now detection is of HIV Ag and antibody the test can detect from 4-6 weeks of infection
Giving HIV results
Ensure you have the notes and result
Ensure you have the right patient
Offer STI BBV
If neg do you think they should have a retest
Follow up appointment to discuss arrangements
What is included in the follow up appointment
Ongoing support and counselling safer sec and partner notification
Disclosure who and how to tell, support networks - family friends
Counselling for partners and family
Ongoing referral psychology, welfare rights, social services
What is PEPSE
Post exposure prophylaxis following sexual exposure
Combination of HAART
PEPSE is thought to work by inhibiting viral replication following exposure this preventing the virus from entering the blood
Who should be offered PEPSE
it is recommended to those who have sex with a HIV positive known status and a high viral load Receptive anal sex Insertive anal sex Receptive vaginal sex Sharing needle equipment
Those with unknown status and a huh prevalence group or area
- recommended for receptive anal sex only
What is the recommended PEPSE regimen
Truvada (emtricitabine and tenofovir)
Raltegravir
28 days
Common SE of PEPSE
Side effects are the main reasons or patients not completing the 4 week course
Much less common on the new regime
GI upset
Factors that affect the efficacy of PEPSE
Delay in administration Drug resistance Adherence Completion The patient may already be positive
Risks of PEPSE
HAART is not licensed for this indication
There is a known potential for SE and toxicity
Women should be counselled to avoid getting pregnant with taking PEP
PEP should be given only when the patient t fully understands the risks and still wishes to have it
Where can PEPSE be accessed
Most GUM clinics
Most A and E departments
Management of a patient requiring PEPSE
Take a complete sexual history and medical history
Start PEP immediately just be within 72 hours of exposure
Test for HIV and screen for STIS
Offer emergency contraception if indicated
Start hep B vaccine If indicated
Encourage HIV testing on contact if known
Take baseline FBC, U &E LFT
book follow up
Advise to protect partners until a neg result is known
What is does HIV cause.
AIDS
Acquired immunodeficiency syndrome
What does Hiv infection mechanism of action
Infection is characterised by the progressive loss of the CD4+helper subset if T lymphocytes
Loss of these cells leads to severe immunosuppression and constitutional disease
What is AIDS characterised by
Presence of opportunistic infections, neoplasms, and neurological complications that rarely occur in people with an intact immune system
What is the viral load during the primary infection
RNA levels (HIV viral load) are >10^7 copies per ml of blood
What Happens at 3 to 6 months
A set point is reached viral RNA levels are maintained at a steady state of 10^3-10^5 copies per ml
What does viral load setpoints correlate with
Subsequent progression of disease
What is the life expectancy of a person with AIDS in the absence of treatment
About 10 years but it can be a short as 3 or as long as 15
What is the typical course of HIV infection
Acute infection seroconversion to asymptomatic to HIV related illnesses to AIDS defining illness to death
What does the viral load indicate
The magnitude of HIV replication and subsequently associated rate of CD4 T cells destruction
