Basic Care and management of HIV

Question 1

Worldwide, how many people have HIV?

Answer 1

37 million in 2014 with about 1.2 million AIDs related death

1 in 5 are unaware that they are affected

Question 2

How many folks in DC have HIV/AIDs?

Answer 2

1 in 20 residents has HIV, 1 in 50 has AIDs.

1 in 7 gay/bisexual men has HIV
1 in 3 black gay/bisexual men has HIV

Question 3

How do you get HIV?

Answer 3

Blood or plasma or certain body fluids like semen, breast milk and CSF

Question 4

Discuss risks of transmission of HIV

Answer 4

Depends on the mode:

• Anal intercourse - 0.8 - 3%
• Vaginal - 0.05 - 0.15%
• Needlestick - 0.3%
• Maternal fetal - 20-30%

I’m not sure where she is getting this from since HIV has varying infectivity depending on the time after exposure, but hey, she presented it.

Question 5

So during the phase of high infectivity, what HIV symptoms will we see?

Answer 5

Constitutional symptoms, fever, malaise, etc.

Half of patients will have lymphadenopathy all over the place (weird for fever and flu like symptoms, where it should really just be in their throat, not their groin, axilla, etc), thrombocytopenia, leukopenia and a third with ulcers, elevated liver enzymes.

Question 6

So who do we screen for HIV?

Answer 6

• Unexplained nephropathy
• Young person with shingles
• A bunch of STIs with syphillis and Hepatitis
• Pneumonia not responding to treatment
• TB, blood transfusion prior to 1985
• psoriasis
• Recurrent infections

Question 7

When do HIV antibodies appear?

Answer 7

20-30 days post infection. But there is antigen there!

You can use a Western blot during the PHI, but it can still come up negative for HIV antigen

Question 8

How does an ELISA work?

Answer 8

PArtially purified, inactivated HIV antigens are pre-coated onto an ELISA plate.

Patient serum added which will have antibodies against HIV. Anti-human immunoglobulin with an enzyme on it is added to the solution. It willbind to the human antibody that is bound to the HIV antigen.

Chromogen or whatever substrate is then added, and when cleaved by the enzyme attached to the anti-human immunoglobulin, colors will appear in solution

Question 9

What will we find specifically on Western Blot?

Answer 9

gp160 (envelope precursor)
gp120 (outer envelope glycoprotein)
gp41 (transmembrane glycoprotein)

p65 (reverse transcriptase)
p51 (reverse transcriptase)
p31 (endonuclease)

p55 (core precursor)
p40 (core)
p24 (core capsid)
p18 (core matrix)

Question 10

That is a lot of western blot…what do we focus on?

Answer 10

p24 antigen can be detected in serum as early as day 1 of symptomatic PHI. Levels decrease after week 2, but then we can see antibodies and immune complexes beginning to form

HIV RNA PCR is obviously more sensitive than p24 for HIV infection, and are extremely high during primary infection, but this is very expensive.

Question 11

When you think mono…

Answer 11

…think HIV

Question 12

You stick yourself with an HIV needle. What do you do?

Answer 12

• Wash the area
• Tell supervisor
• Occupational health if business hours, otherwise ED

Remember rule of 3’s for post-percutaneous exposure

• HIV - 0.3% - Going to start ART inside of 2 hours
• HCV - 3% - Nothing to do really
• HBV - 30% if you are not immunized - If no vaccination, give HBIG and Hep B vaccine series