INFECTIOUS DISEASES: HIV

Question 1

Baseline investigations for patients newly diagnosed with HIV

Answer 1

Confirmatory HIV test

CD4 count

HIV viral load

HIV resistance profile

HLA B5701 status

Serology for syphilis, hep B (sAg, cAb,sAb), hep c,hep A

Toxoplasma IgG, measles IgG, varicella IgG, rubella IgG

FBC, U&Es, LFTs, bone profile, lipid profile

Schistosoma serology (if spent >1mnth in sub-Saharan Africa)

Wome should have annual cervical cytology

Question 2

Where is support provided for patient with HIV?

Answer 2

HIV clinical nurse, community support groups, psych support if needed

Question 3

What is post-exposure prophylaxis in HIV

Answer 3

Depends on the type of incidents- low risk may not need PEP

Combination of oral anti-reterovirals as soon as possible for 4 weeks

Serological testing at 12 weeks following completion of PEP

Reduces risk of transmission by 80%

Question 4

What is the HIV seroconversion reaction?

Answer 4

Symptomatic in 60-80% of patients

3-12 weeks after infection

The HIV has entered the body is now rapidly multiplying

Question 5

Features of seroconversion reaction?

Answer 5

Sore throat, lymphadenopathy, malaise, mylagia, arthralgia, diarrhoea, maculopapular rash, mouth ulcers

Question 6

Diagnosis of HIV?

Answer 6

Combination tests of HIV antibodies and P24 antigen

If positive, repeat to confirm the diagnosis

Viral load may also be measured- HIV RNA level

Testing for HIV in asymptomatic patients should be done at 4 weeks after possible exposure, if negative, offer a repeat test at 12 weeks

Question 7

What is anti-retroviral therapy?

Answer 7

Involves a combination of at least 3 drugs, usually 2 nucleoside reverse transcriptase inhibitors (NRTI) and either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitors (NNRTI)

Question 8

As well as their normal ART treatment what else should patients with HIV and a low CD4+ count be on?

Answer 8

CD4< 200–> co-trimoxazole 480mg PO OD as primary prophylaxis against PCP

CD4<50 –> Azithromycin 1250mg PO once weekly protect against MAI, also be assessed by opthalmology with dilated fundoscopy to look for intra-ocular infections

Question 9

Nucleoside analogue reverse transcriptase inhibtors side effects?

Answer 9

Periperheral neuropathy

Tenofovir: renal impairment and osteroporosis

Zidovudine: anaemia, myopathy, black nails

Didanosine: pancreatitis

Question 10

non- Nucleoside analogue reverse transcriptase inhibtors side effects

Answer 10

P450 enzyme interactions

rashes

Question 11

Protease inhibtors side effects

Answer 11

Diabetes, hyperlipdaemia, buffalo hump, central obsesity, p450 enzyme inhibition

Question 12

What is Septic Arthritis ?

Answer 12

Infection of the joint and synovial fluid