HIV Flashcards
Which groups are most at risk from HIV infection?
MSM still highest and then black african men then black african women
What aspects of HIV infection are measurable?
The p24 antigen is measurable and can be detected before the HIV Ab is produced and detectable
We can also measure viral load and CD4 count
What types of sexual intercourse are highest risk for contracting HIV?
Receptive anal intercourse > receptive vaginal intercourse > Insertive anal intercouse > Insertive vaginal intercourse
**traumatic sexual behaviour such as fisting also make transmission more likely
If you have a concurrent STI then transmission is also more likely (Gonorrhoea, BV, Chlamydia)
What way other than sexual is HIV transmitted?
Horizontally (low risk during birth - blood mixing, slightly lower during C-section, most likely during breastfeeding)
IVDU transmission - RARE, HepC risk much higher
OCCUPATIONAL - as health care worker. Consult occupational health immediately and get PEP
Should a mother with HIV be advised to breast feed her baby?
If her viral load is very low and her HIV is well controlled with HAART then she can be encouraged to breast feed as the risk of transmission is very low
Advise her of risks though
Describe the first phase of the HIV infection
The PRIMARY PHASE - AKA SEROCONVERSION
When diagnosis is made within 6/12 of infection
Often have flu-like symptoms of viral infection
At this time the person has a very high viral load and their CD4 count is low - they are VERY INFECTIOUS
What stage of HIV comes after the seroconversion?
THE ASYMPTOMATIC STAGE
HIV virus is silent and CD4 count is nearly back to normal.
Can last 5-10 years but possibly longer
- Can still be detected if person is tested
What stage of HIV comes after the asymptomatic stage?
SYMPTOMATIC STAGE …
Non-specific - lymphadenopathy, fever, myalgia, diarrhoea
Skin lesions - folliculitis, herpes zoster, dermatitis
Oral lesions - candida and hairy leukoplakia
Recurrent material infection - impetigo and pneumonia
Abnormal blood results - lymphopenia and thrombocytopenia
What stage of HIV comes after the symptomatic stage?
ADVANCED HIV
CD4 count has become very low and the patient is very susceptible to infection
If diagnosis is made at this stage prognosis is poor
Different viral loads indicate different infections
What is the basis of treatment for HIV? What is the aim?
Highly active anti retroviral therapy - HAART
- Usually this is a combination of three different types of retroviral
- The aim is an undetectable viral load
Broader aims are 90/90/90
- 90% of people with HIV know they have it
- 90% of these on HAART
- 90% of these with undetectable viral load
What drug interactions might there be with anti retrovirals?
Statins Steroids Anti-anxiety/sedatives Anti-coagulants Chemotherapy drugs Anti-TB drugs Some recreational drugs Mutli-vitamins or antacids
What sort of clinical diseases might someone with HIV present with/who should be tested?
TB Kaposi's sarcoma (purple lesions on skin) Candida Non-hodgkin's lymphoma Cytomegalovirus retinitis
How long does it take for HIV infection to show up on screening?
4 weeks usually (this is detection of the HIV Ab)
The p24 antigen can sometimes be detected after just 2 weeks - if positive at 2 weeks invite them for another test 2 weeks later
What types of testing are there and which ones are most accurate?
Point of care testing - can be done by self at home
If test is positive it is known as REACTIVE - there is a high rate of false positives so they person should have a VENOUS SAMPLE sent off to the lab for analysis (much more accurate)
What information should be given to a patient with a diagnosis of HIV?
If they have a detectable viral load they must not have unprotected sex (against the law)
Should use condoms at all times
If their viral load is undetectable they are very unlikely to pass it on - they can try for a baby etc.
