HIV Flashcards
(41 cards)
How is HIV transmitted?
• Sex (anal > vaginal > oral), blood, needles, breastfeeding
How does an acute HIV infection present? How long does it last?
Mono / Influenza-like illness that last weeks to months:
Fever > Fatigue > Malaise > Arthralgia > H/A > ↓Appetite > Rash > Night Sweats, Myalgias, N/V/D, pharyngitis, oral ulcers, stiff neck, weight loss
How does chronic symptomatic HIV infection present?
• Fever, fatigue, general weakness, weight loss, LAD
• Anemia
• Some vision loss
• Encephalopathy
• Dyspnea / dry cough
• Candidiasis / Dysphagia
• Diarrhea
• Increased infections?: Kaposi, Herpes Zoster, HSV
How does AIDS present?
• Fever, fatigue, general weakness, Wasting Syndrome of HIV, LAD
• CMV retinitis
• Encephalopathy / HIV dementia / toxoplasmosis of the brain / progressive multifocal leukoencephalopathy
• Candidiasis (mouth, esophagus, trachea, lungs)
• Recurrent pneumonia / coccidiodomycosis / cryptococcosis / TB / pneumocystis jiroveci pneumonia
• Cryptosporidiosis / isosporiasis / chronic intestinal
• Kaposi sarcoma / lymphoma / invasive cervical cancer
• Salmonella septicemia, mycobacterium
What are risk factors for contracting HIV?
• Males 15-19
• Sexual Hx: MSM, Sex Workers
• SoHx: IVDU
What specific test is ordered to test of HIV? When are HIV antibodies detected?
• ELISA
• HIV antigens or antibodies are detected in all by 6 wks – 3 mo
What needs to be discussed during pretest HIV counselling?
Consent
Confidentiality
Counselling
Correct Test Results (Test is for antibodies, Produce detectable antibodies within 3 months, Neg could mean too soon = false negative)
Connect to prevention / care / treatment
What post HIV test counselling must be done?
Assess the patient’s understanding of HIV
Treatment
Reporting
What post positive HIV basic investigations are needed?
• CBC, Cr, eGFR, Pho, ACR, ALT, AST, T-bilirubin, INR, lipids, FPG / A1c
• Baseline ECG
What post positive HIV-specific investigations are needed?
• HIV resistance testing, HIV viral load, CD4
• HLA-B*5701
What co-morbid infections must be tested for after a positive HIV test?
• HAV
• HBV
• HCV
• Syphilis
• G/C consider cervical + anal swabs
• Toxoplasmosis IgG
• TB skin test + CXR
What specific features of history must be taken after an HIV positive test?
• HIV Exposure (date, place, route)
• Symptoms
• PMHx: Varicella, HZV, TB exposure
• Sexual Hx: STI
• GYNE: Abnormal PAP (include ana cytology)
• Meds: Prior antiretroviral regimens
• Immunization status
• Mental health / Behaviour
What labs must be taken after initiating antiretroviral medication?
• q 1 mo CD4 and pVL until pVL < 40 copies per / ml
What labs must be taken every 3 months an HIV positive test? When can you switch to every 6 months?
• HIV viral load, CD4
• CBC, Cr, eGFR, Pho, ACR, ALT, AST, T-bilirubin, INR, lipids, FPG / A1C
• Once pVL <40 x 2yr + CD4 is consistently >/350 switch to q 6 months
How often do you screen for CVD in HIV?
Every year
When do you screen for osteoporesis in HIV?
• BMD in postmenopausal females AND males >/50 yo
When do you perform anal cytology in HIV
• NOT STANDARD OF CARE
When do you screen for hypogonadism, what do you test, and when do you consider treatment?
• In symptomatic men (libido, ED, BMD, hot flashes, wt, muscle strength, fatigue, MDD, sleep disturbance)
• Serum testosterone
• Consider treating if testosterone < 10 mmol/L
When do you start PAP and how often do you screen for cervical cancer?
• Start at age 21 OR 3yrs after 1st sexual contact whichever comes first
• Repeat q6mo
• If normal then q1yr
• If CD4 < 200 do more frequently
When do you give HBV vaccine in HIV?
• If susceptible OR with +anti-HBc w/ neg HBsAg & anti-HBs
When do you give Tetanus / Diptheria vaccine in HIV?
• Q 10 yrs
When you give the pneumococcal vaccine in HIV?
• No previous immunization: Pneu-13 THEN Pneu-23 8 w later
• Previous Pneu-23: >/1 yr later, Pneu-13
• Repeat Pneu-23 5 yrs after initial Pneu-23
When you give the HPV vaccine in HIV?
• 3 dose series between ages 9 – 26 regardless of CD4
When you give the MMR and Varicella vaccine in HIV?
• Consider if non-immune and CD4 >/200
