HIV

Question 1

What percentage of new HIV infections are female?

Answer 1

20-25%

Question 2

Prevalence of HIV in
- Australia
- MSM in Australia

Answer 2

0.14%
7-8%

Question 3

What is the rate of vertical HIV transmission?

Answer 3

12-40%

Question 4

HIV Diagnosis

Answer 4

screening: ELISA - tests both IgG and antigen (becomes positive in ~2 weeks)
If positive:
HIV plasma viral load (false positives 4-26%)
Western blot

Question 5

HIV surface protein

Answer 5

GP-120
GP-41

Question 6

HIV target cell

Answer 6

CD4+ T lymphocytes *** most important
Monocytes and macrophages
Dendritic cells
Astrocytes
Thymic progenitor cells
CD34+ progenitor cells

Question 7

HIV attachment

Answer 7

CD4 and either CXCR4 or CCR5

Question 8

Factors that determine disease progression

Answer 8

viral load + CD4+ count
certain HLA types

Question 9

When to start ART

Answer 9

at diagnosis

Question 10

What ART to start

Answer 10

1. Reverse transcriptase inhibitors - nucleoside/nucleotide analogues
2. Integrase inhibitors

eg.
1. Bictegravir / tenofovir alafenamide / emtricitabine
2. dolutegravir / abacavir / lamivudine

Question 11

Nucleoside analogues
Nucleotide analogues

Answer 11

Lamivudine, Emtricitabine, Abacavir
Tenofovir (disoproxil fumarate or alafenamide)

Question 12

Integrase inhibitors

Answer 12

dolutegravir, raltegravir, bictegravir

Question 13

Considerations prior to commencing therapy

Answer 13

treatment naive
?viral resistance
comorbidities - CVD, metabolic syndrome
Pharmacogenetic screening (HLA B5701 - abacavir hypersensitivity reaction)

Question 14

Goal of therapy

Answer 14

virological suppression - HIV below limit of assay detection
** occasionally “blips” occur and are not necessarily an indication to change

Question 15

Treatment failure is define by

Answer 15

persistent elevated RNA viral load >200 copies / mL after 24 weeks on ARVs

Question 16

When to test for new drug resistance?

Answer 16

while patient is taking a failing regimen or within 4 weeks of ceasing

Question 17

Drug toxicity - Tenofovir

Answer 17

renal toxicity
- including RTA type 4 (fanconis)
- eGFR decline
decreased bone mineral density

Question 18

Drug toxicity - Abacavir

Answer 18

allergic reactions including hypersensitivity with HLA B5701
Increased risk of CVD

Question 19

Drug toxicity - Dolutegravir + Bictegravir

Answer 19

insomnia, GI upset, weight gain
** SAFE IN PREGNANCY ***

Question 20

Lipodystrophy

Answer 20

change associated with older antiretroviral therapy
- fat wasting in peripheries and sunken cheeks
- increased fat in abdomen, breast enlargement, buffalo hump

Question 21

Carbotegravir

Answer 21

Injectable integrase inhibitor
1-2 monthly

Question 22

Infections occuring at CD4 count
- 200-500
- 50-200
- <50

Answer 22

• herpes zoster, pneumococcal pneumonia, oral candidiasis, tuberculosis
• PJP, CNS toxoplasmosis, cryptococcosis, Kaposi’s sarcoma, NHL, CNS lymphoma
• disseminated MAC, CMV retinitis, cryptosporidiosis

Question 23

Primary prophylaxis

Answer 23

CD4 < 200 start bactrim 1 tablet daily to protect against PJP and CNS toxoplasmosis
CD4 <50 start azithromycin 1g weekly for MAC prophylaxis

Question 24

IRIS

Answer 24

paradoxical and pathological worsening of symptoms / imaging after commencing ART to pre-existing opportunistic infections
typically against TB, cryptococcal meningitis, PCP, PML

Question 25

What group has improved outcomes with delaying commencement of ART?

Answer 25

Where CNS infections present to prevent IRIS

Question 26

Kaposi sarcoma
- what virus is it associated with?

Answer 26

HHV-8

Question 27

Treatment for toxoplasma encephalitis

Answer 27

pyrimethamine + sulfadiazone + leucovorin
- steroids if mass effect
- anticonvulsants if there is a history of seizure