HIV Overview Flashcards
(18 cards)
Natural history of HIV infection
over time CD4 count drops and HIV RNA rises
increased risk of developing infections and malignancies
increased risk of cardiovascular disease
severity of infections increases as CD4 count drops
most AIDS diagnoses occur at CD4 count <200
Timeline of natural history of HIV infection
acute infection (seroconversion)
asymptomatic
HIV related illnesses
AIDS defining illnesses
death
Describe primary HIV
30-60% of patients have seroconversion illness
acute onset 2-4 weeks post-exposure
usually self-limiting in 1-2 weeks
non-specific viral symptoms
Symptoms of primary HIV - seroconversion
flu-like illness
fever
malaise/lethargy
pharyngitis
lymphadenopathy
viral type rash - non-specific, generalised macules
occasional AIDS-defining illness due to profound drop in CD4 eg. candidiasis, herpes zoster, PCP
Indicators of HIV
following suggest HIV unless proven otherwise:
- kaposi sarcoma
- oral hairy leukoplakia
- oropharyngeal candidiasis (without proven cause)
- CMV ulcers
other indicators:
- recurrent LRTIs
- TB
- unexplained weight loss +/- diarrhoea
- persistent extra-inguinal lymphadenopathy
Common AIDS presentations
PCP
TB
non-hodgkin’s lymphoma
cryptococcal meningitis
cerebral abscess (often causes by toxoplasma)
mycobacterium avium complex
CMV retinitis
PCP symptoms
insidious onset SOB
dry cough
pyrexia
malaise
desaturate on mild exercise
Who should be tested for HIV?
routinely recommended for following individuals:
- MSM
- female contacts of MSM
- black africans
- people reporting current or prior injecting drug use
- sex workers
- prisoners
- trans women
- people from country with high diagnosed seroprevalence (>1%)
- people reporting sexual contact with anyone from country of high seroprevalence
- individuals known to have/have had a mother living with HIV and do not have documented HIV negative status
HIV pre test discussion topics
risk and lifestyle
benefits of knowing HIV status and treatment possibilities
what tests are available and what is recommended
window period for testing
seroconversion
difference between HIV and AIDS
confidentiality
What is seroconversion?
the point where antibodies to a specific virus or other antigen become detectable in the blood serum, indicating the body’s immune system has responded to the presence of that antigen
What is immune reconstitution inflammatory syndrome (IRIS)?
a condition where the immune system, after recovering from a period of suppression, reacts strongly against pathogens, leading to a paradoxical worsening of a pre-existing or previously latent infection, or the unmasking of a new one. This usually occurs in HIV-positive patients after starting antiretroviral therapy
TB
CMV
cryptococcal meningitis
genital herpes
shingles
When to start HIV treatment?
primary HIV infection
symptomatic HIV infection
asymptomatic HIV infection
treatment as prevention
test and treat
pregnancy
How are HIV patients who are not on treatment monitored?
CD4 and viral load every 3-6 months
How are HIV patients who are on treatment monitored?
viral load and routine bloods 6 monthly
2 CD4 counts >350 1 year apart - don’t need another
Risk factors for HIV
MSM
high prevalence countries
IV drug users
?sex workers
Factors to consider in HIV and pregnancy
all pregnant women should be recommended HIV testing early in pregnancy
viral load tested at least every 3 months and at 36 weeks in women with established therapy
delivery can be vaginal if undetectable at 36 weeks
PEP can be given to baby dependent on risk
breastfeeding not recommended in UK but can be done if undetectable if mum and baby monitored closely
Describe post-exposure prophylaxis
PEPSE (post-exposure prophylaxis following sexual exposure) recommended if risk >1/1000
start within 72 hours, sooner the better
tenofovir disoproxil and emtricitabine 245/200mg OD and raltegravir 1200mg OD for 28 days
follow up bloods at 12 weeks for HIV testing
do not forget hepatitis B vaccination
Describe PrEP
pre-exposure prophylaxis
for high risk patients who fit eligibility criteria
regular STI monitoring
tenofovir disoproxil and emtricitabine 245/200mg
- daily (women or choice)
- event-based
