HIV & MSM Flashcards
(38 cards)
In the UK, how many people with HIV are undiagnosed?
17%
When is the most likely time to transmit HIV?
During seroconversion
Can HIV be spread by blood transfusion?
No
Since 1985 all blood is screened for HIV
What are the 90% targets?
90% diagnosed
90% on HAART
90% undetectable viral load
Prevalence of HIV in Southampton
What does that mean
2/1000
Anyone registering with a GP or attending A&E should be tested
Management strategies in HIV
- Timely diagnosis
- Monitor and treat and treat with ARV to maintain CD4+ counts above a critical level so avoid opportunistic infections and HIV related malignancies
- Prophylaxis to prevent opportunistic infections in patients at risk (CD4<200)
- Prevent/treat long term complications of ART
- Reduce transmission rates (public health)
Who is at risk of a late diagnosis?
What counts as a late diagnosis?
<350 CD4+ when diagnosed
• Women (consider themselves as low risk)
• Aged >50 (women only screened in pregnancy? consider low risk)
• Heterosexual (consider low risk)
• Black ethnicity (don’t engage with GPs)
• Outside London (less targeted testing in local authorities)
Who should start antiretroviral therapy?
- All patients with chronic infection irrespective on CD4 count
- Within 2 weeks of initiation of antibiotics in a patient presenting with an AIDs defining illness or CD4<200
- Immediately in primary infection (damage is done early on)
Pros of early ART?
Reduces AIDs defining illness but also reduces dementia, hypertension, bone disease as it prevents HIV’s pro-inflammatory effect
What is ART?
Suppress virus to allow immune reconstitution
Maintain suppression to prevent acquisition of drug resistance
2 NRTIs + NNRTI or PI or integrase inhibitor
Name an entry inihibitor ART
Enfurvitide
Name 3 NRTIs ART
Zidovudine
Tenofovir
Abacavir
Name 2 NNRTIs ART
Nevirapine
Efavirenz
Name 3 protease inhibitors ART
Darunavir
Neifinavir
Tripanavir
Name in integrase inhibitor
Raltegravir
6 parts of the HIV replication cycle
Attachment Reverse transcriptase Integration Expression Assembly Budding/maturation
Prevention of HIV transmission
Condoms
Abstinence
Sero-sorting (BAD! New STIs due to unprotected sex and risk of seroconversion with UAI)
Circumcision (for heterosexual epidemic) Treatment as prevention Prevention of vertical transmission PEPSE PrEP
Course of action for a HIV+ MSM with HIV- partner
Disclosure
HAART treatment index partner as prevention until viral load is undetectable
Condom use
How to prevent vertical transmission
Disclosure
HAART mother until viral load is undetectable
Can have vaginal delivery!
Do not breastfeed
What is PEP
Post exposure prophylaxis
Case by case decision, within 72hrs of recent possible exposure
When is PEP definitely advised?
- Receptive anal sex w/ HIV+ (even if undetectable viral load) or if unknown HIV status but MSM or African migrant
- Insertive anal/vaginal sex with HIV+ unless undetectable viral load
- Sharing injecting equipment with HIV+ unless undetectable viral load
When is PEP considered
Insertive anal/vaginal sex with unknown HIV status if from high risk group
Fellatio with ejaculation if HIV+
Splash of semen into eye if HIV+
Sharing injecting equipment with unknown HIV status if high risk group
What factors increase the risk of HIV transmission?
- Deep wounds
- Visible blood on device
- Injury with needle that’s been in artery or vein
- Terminal HIV illness/high viral load
- Large volume of blood transferred
Do needle-stick injuries from discarded needles in public places require PEP?
No
HIV much less viable when outside of the body
IVDU are not high prevalence group
