gyn care in HIV patient Flashcards
1
Q
diagnosis of HIV
A
- ELISA (screening)
- Western blot (confirmatory)
- would get CD4 count, viral load (HIV RNA PCR), HBsAg, Hep C Ab, CBC and LFTs
2
Q
additional testing
A
at first appt/diagnosis: HCV, GCT, RPR, HSV Abs if unknown. Then annually GCT, RPR
3
Q
strategies to decrease transmission
A
- always use condoms
- use water based lubricants. not spermicides containing nonoxyl (breaks down condoms)
- partner pre-exposure prophylaxis (tenovifir + emtricitabine)
- post-exposure prophylaxis if non-frequent non-occupational contact
- decreasing risk of trasmission: oral, vaginal penetrative, anal. “insertive” less risk than penetrative.
4
Q
contraception options
A
- no contraindications
- watch hormonal options with interactions with liver enzymes
- dmpa no interactions
5
Q
what are goals if considering pregnancy?
A
- pre-pregnancy counseling
- viral load undetectable
- don’t be on efavirenz (risk of CNS defects)
6
Q
is HRT okay?
A
- yes. don’t be on fosamprenavir (decreases antiretroviral levels)
7
Q
who should be on antiretroviral treatment?
A
everyone!
8
Q
pap smear start?
A
1 year of sexual debut or HIV diagnosis. No later than 21.
9
Q
how to screen/schedule?
A
< 30: cytology only. if yearly negative x 3, then can go to q 3 years
> 30: can do cotesting. if negative then q3years
HPV managed as normally
LSIL and up = colposcopy