HIV - Testing & Clinical Management

Question 1

What is prevalence of HIV in Yorkshire

Answer 1

• Sheffield - 1.1 in 1000

* Leeds - 2 in 1000

Question 2

What is the aids defining CD4 count

Answer 2

CD4 < 200

Question 3

What is Candidiasis?

Answer 3

• Fungal infection
• Unusual in healthy adults
• 84-100% of PLWH affected
• Risk factors: antibiotics, immunocompromised

Question 4

What is shingles

Answer 4

A painful blistering rash, malaise

• Reactivation of Varicella Zoster Virus
• Dermatomal distribution

RF: age, immunocompromised

Question 5

How do we test for HIV in the lab?

Answer 5

• 4th generation test:

Uses both HIV antibody to bind antigen and HIV antigens to bind to antibodies in the serum

• Positive test if both antibody and antigen bound to.
• 1 month period for exposure - 99.9% +ve
• Cheap 5 pounds

Question 6

If test comes back +ve, what things can be done to help pt.

Answer 6

• Call specialist for advice
• Result given face to face in a confidential environment
• Contact done by specialist tracing

Question 7

What is Kaposi’s sarcoma

Answer 7

• Caused by human herpesvirus-8. Usually linked with HIV

* Spindle cells on biopsy

Question 8

What is Hairy leukoplakia

Answer 8

• Caused by Epstein-Barr virus
• White patches CANT be scraped off
• Linked with HIV, smoking and immunosuppression

Question 9

What is HAART (treatment for HIV)

Answer 9

• Highly Active Anti-Retroviral Therapy

Consists of 3 or more antiretroviral drugs - HIV mutates all the time so act on different points of mutation cycle.

Question 10

Name 2 Fusion Inhibitor drugs

Answer 10

• Enfuvirtide

* Maraviroc

Question 11

NRTI drugs (4)

Answer 11

• Zidovudine
• Stavudine
• Abacavir
• Didanosine

Question 12

NNRTIs (3)

Answer 12

• Nevirapine
• Delaviridine
• Etravirine

Question 13

Integrase Inhibitor drug (1)

Answer 13

• Raltegravir

Question 14

Protease Inhibitor drugs (4)

Answer 14

• Ritonavir
• Indinavir
• Lopinavir
• Tipranavir

Question 15

Why HIV becomes resistant to drugs

Answer 15

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

Question 16

Why is it so important not to miss a dose of HIV drug

Answer 16

1.) NON-ADHERENCE

• Drug level can drop low enough for HIV to replicate rapidly enough for resistance

Question 17

What is another way of HIV developing resistance

Answer 17

2.) Drug-Drug interactions: Many drugs interact with antiretrovirals and therefore cause subtherapeutic level