HIV 101 Flashcards
What is the life expectancy of a patient with HIV?
since the advent of HAART, people living with HIV have an expected lifespan similar to those who are HIV negative
-it is no longer a death sentence
-this is contingent on a number of factors including timely diagnosis, CD4 count at time of tx initiation, access to treatment
Which patients do not share the improved HIV life expectancy outlook?
individuals who are not white
individuals with history of injection drug use
individuals who began ART at low CD4 counts
What are some terms to avoid in the context of HIV? What are some better terms to use?
HIV +/infected person
-use: person living with HIV
HIV virus
-use: HIV
become infected with HIV or catch/caught AIDS
-use: acquire/acquired HIV
HIV/AIDS
-use: either HIV or AIDS, not both
compliant
-use: adherent
“dirty” or “clean” injection equipment
-use: shared needles, injecting equipment/paraphernalia
IVDU or drug abuser/addict
-use: PWID
HAART
-use: ART/cART
What are the UNAIDS targets?
95% of people living with HIV to know their status
95% of people diagnosed on antiretroviral treatment
95% of people receiving antiretrovirals to be suppressed by 2025
this approach aims to “end HIV/AIDS” as public health threat
What is the most common risk for HIV transmission in SK?
PWID
-heterosexual sex as a risk for transmission is almost equal
Why is routine HIV testing important?
~20% of people with HIV are unaware they have HIV
stigma and discrimination will lessen with routine testing
routine testing gives pts earlier opportunities for support, services, and care
earlier tx = improved outcomes
testing and awareness help prevent transmission
knowing you are HIV + is just as important as knowing you are HIV -
What are the SK recommendations for HIV testing?
opportunities for testing include but are not limited to:
-pts aged 13-70 receiving primary or emerg care who do not know their HIV status
-multiple partners and no HIV test in last 12 mo
-anyone who requests it
-all pregnant women
-anyone with an STI or Hep B/C
-current or history of illicit drug use
-from endemic countries
-all TB patients
-signs/sx consistent with HIV
What is required prior to testing for HIV?
verbal, informed consent
-document consent
What is the information patients require prior to giving consent to test for HIV?
clinical and prevention benefits of testing
right to refuse
HIV reportable to MHO
follow-up services will be offered
if +, identify others who have been exposed
person testing+ must inform sexual/drug partners
Who should be tested for HIV?
test everyone
What are the HIV testing options in SK?
standard screen
point of care
dried blood spot
self testing kits
Describe the standard screen.
uses the 4th generation Ab + Ag
nearly 100% sensitive and specific for chronic HIV
results take a few days to 2 weeks
window period cut to 15-20 days
positive confirmed with Geenius 12
True or false: there is a way to separate out HIV1 and HIV2 with the Roche duo test
false
Describe point of care.
rapid antibody screen for HIV 1+2
results in minutes
negative = no HIV
positive = need for confirmatory testing (4th gen + Geenius)
Describe the dried blood spot.
currently utilized in select projects and communities in SK as part of research studies
approved by the SHA recently available in rural areas
blood is collected using a finger prick and placed on a sheet of paper that is sent away for testing
What are advantages of the dried blood spot?
better confidentiality
multiplex testing
no immediate results (preferred by some)
What does HIV target?
CD4 T lymphocytes (T cells), cells that help coordinate an immune response by stimulating other immune cells such as macrophages, B cells, and CD8 T lymphocytes
What is AIDS?
end or advanced stage of HIV infection
defined as a CD4 count < 200 or presence of 1 or more AIDS-defining illnesses or OI’s (Pneumocystis pneumonia, Mycobacterium Avium Complex, Cytomegalovirus, etc)
What are the types of HIV?
HIV is a retrovirus that occurs as 2 types: HIV-1 and HIV-2
-HIV-1 is the most common (95%) and occurs all over the world
-HIV-2 is mainly present in West Africa
-rates of transmission and best tx may differ
How is HIV transmitted?
HIV is spread by contact with HIV-infected body fluids
-blood
-semen
-vaginal fluid
-rectal fluid
-breastmilk
What must occur for HIV transmission to occur?
fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream
-mucous membranes are found inside the rectum, vagina, penis, and mouth
When is vertical transmission of HIV at highest risk?
seroconversion occurs during pregnancy due to higher VL
pregnant woman is HIV+ but not diagnosed
pregnant woman is HIV+ and not on ART
What is the risk of vertical transmission for women taking ART?
women taking ART that maintain a suppressed viral load from conception have < 1% risk of vertical transmission
What is the recommendation for HIV and breastfeeding in resource-rich settings?
not to breastfeed as HIV can pass through milk even if the mom is suppressed
What is the risk of passing HIV sexually in those on ART?
effectively zero in those taking ART and maintaining an undetectable viral load
What are the symptoms of HIV?
flu-like symptoms within 2-4 weeks after infection
-fever, sore throat, enlarged lymph nodes, night sweats, chills, fatigue, muscle aches, rash
many have no symptoms at all
What is CD4 count?
marker of immune system health
-highlights urgency to start ARVs and if OI proph is necessary
-indicates disease progression
-if improving, marks therapeutic response
What is considered a normal CD4 count?
800-1200
-different “normal” values seen in the literature
Describe opportunistic infection risk by CD4 count.
any CD4 count: tuberculosis
< 250: Coccidiomycosis
< 200: Pneumocystis
< 150: Histoplasmosis and Cryptococcus
< 100: Toxoplasmosis
< 50: MAC, CMV, PML
What is viral load?
the amount of virus present in the blood
-measured in copies/ml
the most important lab we’re interested in
How many HIV copies is considered suppressed?
less than 50 copies
-a result that is “undetected” means zero copies were found
How long does it take for viral suppression with consistent antiretroviral therapy?
typically most patients are suppressed in 1-2 months with consistent antiretroviral therapy
-this can vary based on viral load
