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SEXUAL HEALTH AND HIV > HIV TESTING > Flashcards

HIV TESTING Flashcards

1
Q

What proportion of people with HIV in the UK remain undiagnosed?

A

About a quarter

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2
Q

What proportion of people with HIV are diagnosed very late, when there CD4 count is below 200 cells/microlitre?

A

30% (as of 2012)

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3
Q

What groups of patient are more likely to be diagnosed later on in the disease progression?

A

Older age groups

Heterosexual men

Black and ethnic minority groups

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4
Q

When were new guidelines on HIV testing brought out in the UK?

A

UK National Guidelines for HIV Testing 2008

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5
Q

Which groups did 2011 NICE guidelines regarding HIV testing target?

A

Black African communities

Men who have sex with men

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6
Q

Is HIV testing done on an opt-in or opt-out basis?

A

Opt-out

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7
Q

What are the specific settings where HIV testing should be routine?

A

GUM/Sexual Health Clinics

Antenatal services

Termination of pregnancy services

Drug dependency programmes

Healthcare services for those diagnosed with an AIDS defining condition (esp TB, hep B, hep C and lymphoma)

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8
Q

What is the prevalence of HIV in women undergoing termination?

A

Up to 1%

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9
Q

At what prevalence does it become cost effective to test all patients for HIV?

A

In any area where prevalence is equal to or more than 2 in 1000 among 15 to 59 year olds

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10
Q

At what prevalence does it become cost effective to test patients with a certain symptom or condition for HIV?

A

With any symptom or condition where the prevalence of HIV is equal or more than 1 in 1000

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11
Q

What proportion of people with TB have HIV?

A

Over 5%

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12
Q

Which groups of symptom-less people should routinely be offered HIV test?

A

Patients diagnosed with STI

Sexual partners of individuals known to be HIV positive

Men who have had sexual contact with men

Female sexual contacts of men who have sex with men

Individuals who have ever injected drugs

Men and women from countries where prevalence of HIV is more than 1%

Men and women who have had sexual contact abroad or in the UK with individuals from countries where prevalence of HIV is more than 1%

Blood donors

Organ transplant donors

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13
Q

What are the respiratory AIDS defining conditions?

A

Tuberculosis

Pneumocystis

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14
Q

What are the other respiratory conditions that are not necessarily AIDS defining but that are associated enough with HIV that sufferers should be tested?

A

Bacterial pneumonia

Aspergillosis

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15
Q

What are the neurological AIDS defining conditions?

A

Cerebral toxoplasmosis
Primary cerebral lymphoma
Cryptococcal meningitis
Progressive multifocal leucoencephalopathy

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16
Q

What are the other neurological conditions that are not necessarily AIDS defining but that are associated enough with HIV that sufferers should be tested?

A 
Aseptic meningitis/encephalitis
Space occupying lesion of unknown cause
Guillain-Barre syndrome
Transverse myelitis
Peripheral neuropathy
Dementia
Leucoencephalopathy
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17
Q

What are the dermatological AIDS defining conditions?

A

Kaposi sarcoma

18
Q

What are the other dermatological conditions that are not necessarily AIDS defining but that are associated enough with HIV that sufferers should be tested?

A

Severe or recalcitrant seborrhoeic dermatitis

Severe or recalcitrant psoriasis, multidermatomal or recurrent herpes zoster

19
Q

What are the gastrointestinal AIDS defining conditions?

A

Persistent cryptosporidiosis

20
Q

What are the other oral and gastrointestinal conditions that are not necessarily AIDS defining but that are associated enough with HIV that sufferers should be tested?

A 
Oral candidiasis
Oral hairy cell leucoplakia
Chronic diarrhoea of unknown cause
Weight loss of unknown cause
Salmonella, shigella or campylobacter
Hepatitis B infection
Hepatitis C infecion
21
Q

What are the oncological AIDS defining conditions?

A

Non-Hodgkin’s lymphoma

Cervical cancer

22
Q

What are the other oncological conditions that are not necessarily AIDS defining but that are associated enough with HIV that sufferers should be tested?

A

Anal cancer or anal intraepithelial dysplasia

Lung cancer

Seminoma

Head and neck cancer - associated with HPV

Hodgkin’s lymphoma

Castleman’s disease (giant lymph nodes - lymphoproliferative disorder)

23
Q

What are the gynaecological AIDS defining conditions?

A

Cervical cancer - associated with HPV

24
Q

What are the other gynaecological conditions that are not necessarily AIDS defining but that are associated enough with HIV that sufferers should be tested?

A

Vaginal intraepithelial neoplasia

Cervical intraepithelial neoplasia Grade 2 or above

25
Q

What are the haematological AIDS defining conditions?

A

Non-Hodgkin’s lymphomas

26
Q

What are the other haematological conditions that are not necessarily AIDS defining but that are associated enough with HIV that sufferers should be tested?

A

Any explained blood dyscrasia including:

Neutropenia

Thromboytopenia

Lymphopenia

27
Q

What are the ophthalmological AIDS defining conditions?

A

Cytomegalovirus retinitis

28
Q

What are the other ophthalmological conditions that are not necessarily AIDS defining but that are associated enough with HIV that sufferers should be tested?

A

Infective retinal disease including herpes viruses and toxoplasma

Any unexplained retinopathy

29
Q

What are the ENT conditions that are not necessarily AIDS defining but that are associated enough with HIV that sufferers should be tested?

A

Lymphadenopathy of unknown cause

Chronic parotitis

Lymphoepithelial parotid cysts

30
Q

What are the non specific conditions which are associated enough with HIV that sufferers should be tested?

A

Pyrexia of unknown cause

Any lymphadenopathy of unknown cause

Mononucleosis-like syndrome (primary HIV infection)

Any sexually transmitted infection

31
Q

What are different things we can look for when diagnosing HIV?

A

Antibodies

Antigen - p24

Viral load

32
Q

What are the different types of test?

A

Lab-based blood tests

Rapid point of care tests

33
Q

What is the recommended first-line screening test for HIV infection?

A

Laboratory assay that tests for HIV antibody and p24 antigen simultaneously - 4th generation

34
Q

What do third generation HIV tests look for?

A

They detect IgM, IgG and IgA antibodies against HIV.

35
Q

What is the window period for third generation HIV tests?

A

3 months. Basically the point where the person will start making antibodies which is on average 25 days, but 97% of people will have made antibodies by 3 months so we say the window period is 3 months.

36
Q

What do fourth generation HIV tests look for?

A

HIV antibodies and p24 antigens

37
Q

What is the window period for fourth generation HIV tests?

A

2 to 4 weeks. This is dependent on the point where p24 antigen starts being made in large enough amounts to be detected.

38
Q

What are the advantages of using a rapid point of care test over a lab test?

A

Fast - result in 30 minutes

Simple equipment

Easy to perform and interpret

Include a control

39
Q

What are the disadvantages of using a rapid point of care test versus a lab test?

A

Expensive

Reduced sensitivity in early infection

Prone to operator errors

May give false positive result

Positive results require lab tests anyway

40
Q

Does having a routine HIV test in itself affect future life insurance?

A

No, not since 1994

SEXUAL HEALTH AND HIV (13 decks)

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