12 - HIV/AIDs

Question 1

What age range has the highest number of HIV diagnoses in Wisconsin? What gender and race is it more common in?

Answer 1

20-24, followed by 25-29

More common in men than women.

2/3 of the people diagnosed as POC.

Question 2

What puts someone at a higher risk for getting HIV?

Answer 2

Men who have sex with men (MSM)

Question 3

How common is pediatric HIV perinatal exposure?

Answer 3

Very uncommon.

No reported cases in 2015 or 2016.

Question 4

What are the guidelines for HIV screening?

Answer 4

1. Screen any patient aged 13-64 once - can be done at any healthcare setting
2. Screen any pregnant patient at initial visit and also in the 3rd trimester if there’s any known risk
3. Test annually if pt is an IV drug user, a commercial sex worker, or has has more than 1 sexual partner since their last HIV test

Question 5

Why is HIV testing so important?

Answer 5

People who don’t know they have HIV contribute disproportionately to new infections.

Testing people can reduce transmission by about 1/3

Question 6

Other than transmission reduction, why else is testing someone for HIV important?

Answer 6

Diagnosis allows pts to get antiretroviral therapy treatment which decreases mortality.

32% of new cases also diagnosed with AIDs within 1 year.

And most people with HIV have had multiple healthcare encounters prior to being diagnosed (missed opportunity).

Question 7

Describe the symptoms associated with acute retroviral syndrome? When does it occur?

Answer 7

2-3 wks after infection.

Primary response to infection (symptoms seen in 80%):

• Fever (80%)
• Arthralgia/myalgia (54%)
• Anorexia/weight loss (54%)
• Rash (51%)
• Lymphadenopathy
• Fatigue/malaise (68%)
• Pharyngitis/oral ulcers (44%)

Question 8

What illness can acute retroviral syndrome from HIV be mistaken for?

Answer 8

Mononucleosis

1% of pts tested for infectious mononucleosis were positive for an acute HIV infection

Question 9

What are the three different tests that can be done to test for HIV? What is the time period that each can detect an infection?

Answer 9

1. Antibody test (Elisa confirmed with Western blot): negative until 4-6 wks after infection.
2. Antigen test: tests for HIV viral load: detects infection after 7-14 days
3. Combination HIV Ab/Antigen test: standard in most places: can detect infection 10-14 days after infection

Question 10

What is batched testing? What is the benefit of it?

Answer 10

Pooled HIV RNA testing that uses samples of 20-90 pts combined.

For positive pools, test run on progressively smaller pools.

This increases the yield of HIV testing by up to 10% compared to antibody testing alone.

Question 11

What are the basic concepts for HIV treatment?

Answer 11

1. Start on any pt able to take it
2. Resistance testing prior to treatment
3. Follow T-cell counts every month
4. Treatment interruption not recommended

Question 12

What are the three goals of HIV treatment?

Answer 12

Undetectable viral load (<20 copies/microL)

Increase in CD4 T-cells

Eliminate HIV-related symptoms

Question 13

What are the components of retroviral treatment?

Answer 13

At least 3 medications and 2 classes of drugs.

The drug cocktail should include a nucleoside reverse transcriptase inhibitor (NRTI) and an integrase inhibitor

Other things that can be the third drug are Non-nucleoside reverse transcriptase inhibitors and protease inhibitors.

Question 14

How effective is antiretroviral therapy (ART) at preventing perinatal transmission?

Answer 14

Full treatment: less than 1% transmission

AZT (Zidovudine) only: 8% transmission

Untreated: 25% transmission

Question 15

What does the HIV viral load correlate with?

Answer 15

The likelihood of transmission

Question 16

What did the U=U campaign help teach people about HIV?

Answer 16

A person living with HIV who has an undetectable viral load does not transmit the virus to their partners.

Ie undetectable = untransmissible

Question 17

What is the likelihood of transmission of HIV from 1 exposure (ie a needle stick)? How does this compare to the likelihood of transmission of Hep B and Hep C?

Answer 17

Rule of 3’s:

Hepatitis B: 30%
Hepatitis C: 3%
HIV: 0.3%

Question 18

What is the definition of a healthcare exposure to HIV?

Answer 18

Percutaneous injury (needle stick, cut) OR contact with mucus membrane.

Blood, tissue, or potentially infectious fluids that “you have to work hard to find” (CSF, semen, vaginal secretions, synovial, pleural, pericardial, peritoneal, or amniotic).

Question 19

What factors increase transmission in a healthcare setting?

Answer 19

Deep injury
Visible blood on device
Intravascular device

Question 20

What are NOT considered infectious for HIV unless visibly bloody?

Answer 20

Feces, vomit, urine, tears, sweat, sputum, saliva, and nasal secretions.

Question 21

What are the guidelines for post-exposure prophylaxis (PEP)?

Answer 21

Initiate 2-3 drug therapy ASAP following exposure (<72 hrs)

After this was initiated, there were no healthcare related transmissions since 2001.

Can be used for sexual exposure to HIV (non-occupational; nPEP).

Question 22

What is the hypothesis behind pre-exposure prophylaxis (PreEP)?

Answer 22

An HIV infected individual uses an antiretroviral med ahead of HIV exposure.

By having the antiretroviral in blood/tissues, PrEP may make it so that HIV is unable to establish infection.

Analogous to prophylaxis for malaria in travelers.

Question 23

What are the steps involved in perscribing PrEP?

Answer 23

Before: assess sexual risk, screen for HIV and STIs

Initiation: reinforce adherence and discuss additional risk reduction methods

Every 3 mo: HIV and STI testing and assess med adherence

Every 6 mo: monitor kidney function and assess sexual risk.

Question 24

What is the largest issue with prescribing people with PrEP?

Answer 24

Adherence, which is more pronounced among young people.

Question 25

How does PEP differ from PrEP?

Answer 25

PrEP is only 2 drugs, while PEP is 3 drugs.