2: HIV Flashcards
describe worldwide HIV epidemic in terms of numbers and access to treatment
- total number w/ HIV/AIDS increased worldwide
- less than 1/3 of people who need antiretroviral drugs have access to them
what method of contracting HIV has the highest transmission rate? the rest of the ways to contract HIV have what type of transmission rates?
transfusion of contaminated blood - 90%
rest of the methods are all
CDC testing guidelines
- “opt out testing”
- don’t need specific informed consent
- persons at high risk should be screen at least annually
- prevention counseling not required, but strongly recommended for high risk persons
why are E Europe and Central Asia numbers still rising?
heroin/IV drug use
historical indications for HIV testing (long list)
- sexually active gay men
- persons w/ multiple partners
- current or past injection-drug users
- recipients of blood products b/w 1978 and 1985
- persons w/ current or past STIs
- commercial sex workers and their contacts
- persons sexually assaulted
- persons w/ occupational exposures
- pregnant women/women of childbearing age
- children born to HIV-infected moms
- sexual partners of those at risk of infection
- persons who consider themselves at risk/request testing
first good protease inhibitor
Indenovir
clinical indications for testing (long list)
- TB
- syphilis
- recurrent shingles
- unexplained chronic constitutional sx
- unexplained generalized adenopathy
- unexplained chronic diarrhea or wastin g
- unexplained encephalopathy
- unexplained thrombocytopenia
- thrush or chronic/recurrent vaginal candidiasis
- HIV-associated opportunistic diseases
- suspected primary HIV syndrome
significance of the release of HAART (the protease inhibitors) in 1996
60-80% reduction in deaths from AIDS in US
four H’s are risk groups:
heroin addicts
homosexuals
hemophiliac
Haitians
common signs/sx of primary HIV infection:
- those presenting in 50-90% of patients (6)
- those presenting in 25-50% of patients (3)
- those presenting in
50-90%
- fever
- fatigue
- rash
- myalgia/arthralgia
- pharyngitis
- night sweats
25-50%
- N/V/D
- low wbc/plts
- weight loss
how long is the eclipse period of HIV infection?
10-12d (from time of initial infection to viral detection)
when does one start making Ab’s to HIV?
after about 3w (period of seroconversion - from initial infection to first creation of Ab’s)
testing for HIV: how are viruses detected (what component do they test for)?
HIV RNA in plasma
other options in the primary HIV ddx
- EBV mono
- CMV
- HSV
- flu
- rubella
- viral hepatitis
- toxoplasmosis
- syphilis
- disseminated GC
- rickettsial disease
- lyme disease
- streptococcal infection
- early TSS
clinical clues for primary HIV infection (7)
- mucocutaneous ulcerations
- rash
- abrupt onset: “10 sx/signs in 24h”
- GI sx
- antedecent high risk exposure
- prolonged sx
-cough/URI: diagnosis less likely
what test is used to detect HIV Abs?
ELISA (highly sensitive)
- if result is (-), HIV AB reported as (-)
- if result is (+), ELISA repeated
- if repeat (+), Western blot (more specific) for confirmation
what happens when western blot results are indeterminate?
means 1 of 3 characteristic bands present - recommend supplemental testing
what can an indeterminate western blot indicate?
presence of recent HIV-1 infection or HIV-2 infection, which is endemic in West Africa
can you use a low CD4+ count to diagnose HIV?
no - not diagnostic and cannot be used instead of HIV Ab testing
are there any rapid tests for HIV?
yes - blood and oral swabs can give results in 20 min
what should you determine in a newly diagnosed HIV history? (8)
- HIV risk behaviors (sexual and drug use)
- knowledge of HIV infection
- emotional response to diagnosis
- family and social situation
- employment and insurance status
- travel history
- exposure to TB, syphilis, other STIs, and viral hep (A,B,C)
- status of immunizations
labs to run on a newly diagnosed HIV patient (12)
- CBC and differential counts
- BUN/creatinine, liver fxn tests, fasting glucose/lipid profile
- CD4 count and HIV viral load
- HIV genotype test
- syphilis testing (RPR or VDRL)
- anti-HAV, HBsAg, HBcAb (HBsAB if prior immunization), anti-HCV
- toxoplasmosis (IgG) serology
- PPD
- chlamydia and GC assays in persons at risk
- consider anal pap smear in persons at risk
- G6PD quantitative testing (if needing pneumocystic prophylaxis)
what is the main surrogate marker for monitoring HIV disease progression?
CD4 count
normal range of CD4
350-1100/mm3
