HIV Testing and Clinical Management

Question 1

What occurs when HIV is diagnosed late?

Answer 1

Death more likely

Transmission to others

Question 2

Most common people with HIV?

Answer 2

White homosexual men 35-49 years old

Question 3

Clinical indicator diseases for adult HIV infection?

Answer 3

Kaposi's sarcoma = severe or recalcitrant seborrhoeic dermatitis, recurrent herpes zoster, oral candidosis, ral hairy leukoplakia
Head and neck cancer
Hodgkin's lymphoma
Castleman's disease
Lymphadenopathy of unknown cause
Chronic parotitis
Lymphoepithelial parotid cysts

Question 4

Signs of HIV primary infection?

Answer 4

Fever
Adenopathy
Malaise
Rash
Arthralgia
Myalgia

Question 5

Signs of advanced HIV (CD4<200)?

Answer 5

Oral candidiasis
Hairy leukopiakia
Herpes simplex
Non-hodgkin's lymphoma
Primary CNS lymphoma

Question 6

What is candida?

Answer 6

Fungal infec - white marks (oral thrush)

Usually in healthy adults

Question 7

Risk factors of candida?

Answer 7

antibiotics, immunocompromised

Question 8

What is shingles?

Answer 8

Reactivation of varicella zoster virus
Dermatomal distribution
Painful blistering rash, malaise

Question 9

Risk factors of shingles?

Answer 9

Age

Immunocompromised

Question 10

How to recommend a HIV test to a pt?

Answer 10

Verbal and documented consent - send clotted blood to lab

If pt says no - explore why

Question 11

How to test for HIV?

Answer 11

4th generation test:
- Antibody/antigen
- Window period 1 month
- Cheap
- Confirmatory test >99.9% PPV
THEN:
Call specialist for advice
Result: given face to face in a confidential environment
Contact tracing done by specialist services

PR antibody and antigen only tests, point of care tests

Question 12

What is Kaposi’s sarcoma?

Answer 12

Human herpesvirus-8
Usually linked with HIV
Black/brown marks
Spindle cells on biopsy
Refer to oncology

Question 13

What is oral hairy leukoplakia?

Answer 13

Epstein-Barr virus
White patches that cannot be scraped off - white striations on side of tongue
Linked with HIV, smoking and immunosuppression

Question 14

What presents with herpes simplex virus (HSV)?

Answer 14

Coldsores

Question 15

How does HIV impact HSV?

Answer 15

More severe coldsores
More frequent
Outbreaks last longer
May have genital herpes

Question 16

How to treat HIV?

Answer 16

Highly antiviral retroviral therapy (HAART) - Act on different points of HIV replication cycle = suppresses virus
Consists of 3 antiretroviral drugs

Question 17

Replication cycle of HIV? How the medications work?

Answer 17

CD4 = lymphocyte that HIV can bind to via a co-receptor
Drugs can inhibit this process by binding to the co-receptor to stop HIV entering the cell
HIV RNA gets into cell and uses reverse transcriptase to turn itself into the DNA = NRTI and NNRTI work against reverse transcriptase

Question 18

Why does HIV become resistant to drugs?

Answer 18

1 mutation in every 2 new viruses produced
1 -10 billion new virus particles each day
1-5 billion mutations per day

Question 19

Why are therapeutic drug levels essential to keep HIV suppressed?

Answer 19

1. Non-adherence : missing one or two doses can cause resistance
2. Drug-Drug interactions : Many drugs interact with antiretrovirals, and therefore cause subtherapeutic levels