BBV

Question 1

What are the different types of HIV?

Answer 1

HIV1 and HIV2

Question 2

What proportion of people are unaware they have HIV?

Answer 2

1/4

Question 3

What proportion of patients infected with Hep B develop a chronic infection?

Answer 3

1/20

Question 4

What proportion of patients infected with Hep C develop a chronic infection?

Answer 4

75%

Question 5

What is the main route of transmission for Hep C?

Answer 5

IVDU

Question 6

When must the BBV screen be carried out?

Answer 6

Within 3 months before they plan to provide gametes for use in treatment

Question 7

What is detected in BBV serology?

Answer 7

Anti-HIV1&2; HBsAg, anti-HBc; anti-HCV-ab

Question 8

What % of HIV +ve women will have hydrosalpinx?

Answer 8

40%

Question 9

What type of infertility is HIV associated with in women?

Answer 9

Tubal factor

Question 10

How may being HIV +ve affect a man’s sperm?

Answer 10

Lower motility - likely proportional to CD4 count

Question 11

How may HAART affect a man’s sperm?

Answer 11

Lower count and motility, and greater % of abnormal forms

Question 12

What are the treatment options of Hep B?

Answer 12

12 months of weekly injection of immunomodulator peginterferon alpha-2a, or antiviral e.g. tenofovir or entecavir

Question 13

How many genotypes of Hep C are there?

Answer 13

3

Question 14

What is the % success of eradication therapy in genotype 1 of Hep C?

Answer 14

50%

Question 15

What is the % success of eradication therapy in genotype 2 of Hep C?

Answer 15

80%

Question 16

Which CURRENT NICE guidelines related to BBV +ve patients and fertility services?

Answer 16

1.2, 13.9

Question 17

How may Hep B patients conceive naturally?

Answer 17

Immunisation of seronegative partner

Question 18

How may Hep C patients conceive naturally?

Answer 18

Post-eradication therapy of seropositive partner

Question 19

What is TUPSI?

Answer 19

Used in HIV patients. Patients have Unprotected SI in calculated fertile window while seronegative partner is taking PrEP (usually, occasionally they may decide to do it without PrEP). TUPSI should only be done if VL undetectable for 6months or is taking HAART

Question 20

How often should HIV -ve patients doing TUPSI be tested for HIV?

Answer 20

Monthly

Question 21

How often should HIV +ve patients doing TUPSI have their VL tested?

Answer 21

Monthly

Question 22

What is an alternative option for HIV +ve when with detectable VL or not on HAART

Answer 22

Self-insemination

Question 23

What is the usual VL in semen compared to blood

Answer 23

USUALLY 10x less in semen

Question 24

What is the risk of HIV transmission in receptive vaginal intercourse at each exposure?

Answer 24

0.1%

Question 25

What is required before a BBV +ve couple can be referred to fertility services?

Answer 25

1) GU work-up; 2) HIV parameters; 3) STI screen; 4) Fertility work-up; 5) counselling

Question 26

How do we reduce risk of transmission of BBV’s in ART?

Answer 26

Sperm washing

Question 27

How do we reduce risk of transmission of BBV’s in natural conception?

Answer 27

HIV = PrEP
Hep B = immunisation
Hep C = eradication therapy in +ve patient

Question 28

How is risk to staff minimised?

Answer 28

Immunisation against Hep B

Question 29

How is risk to other patients minimised?

Answer 29

Probe wiping; BBV +ve = end of theatre list; separate cryopreservation containers

Question 30

What would be the immunological profile of a patient with acute Hep B?

Answer 30

HBsAg = +ve
Anti-HBc = +ve
Anti-HBs = -ve

Question 31

What would be the immunological profile of a patient with chronic Hep B?

Answer 31

HBsAg = +ve
Anti-HBc = +ve
Anti-HBs = -ve
OR
HBsAg = -ve
Anti-HBc = +ve
Anti-HBs = -ve

Question 32

What would be the immunological profile of a patient with resolving acute Hep B infection?

Answer 32

HBsAg = -ve
Anti-HBc = +ve
Anti-HBs = -ve