HIV

Question 1

What populations are at the highest risk of contracting HIV?

Answer 1

• sub-saharan Africa (esp. southern)
• MSM
• children of people living with HIV
• people who inject drugs
• people who have transactional sex
• people from marginalised populations

Question 2

Describe the testing for HIV

Answer 2

• 4th generation testing (ELISA)
• p24 antigen/HIV antibody
• 45 day window period
• different assay used for confirmatory testing

Question 3

Describe the main symptoms of seroconversion HIV

Answer 3

• fever
• malaise
• lymphadenopathy
• rash
  (Many more systemic symptoms)

Question 4

What are the differential diagnoses of primary HIV

Answer 4

• infectious mononucleosis (EBV)
• secondary syphilis
• drug rash
• other viral infections (eg. CMV, influenza)

Question 5

What are the blood markers of HIV?

Answer 5

• HIV viral load: can be up to >10 million, aim is to remain below 200 (undetectable)
• CD4: calculated from total lymphocyte count (HIV-negative = 400-1600 per m3)
• risk of opportunistic infection increases sharply below 200/m3

Question 6

What is the treatment for HIV?

Answer 6

• HAART (highly active antiretroviral treatment): 2 nucleoside reverse transcriptase inhibitors + 1 drug from another class

Question 7

What are the different classes of anti-retrovirals?

Answer 7

• nucleoside reverse transcriptase inhibitors
• non-nucleoside reverse transcriptase inhibitors
• integrase inhibitors
• protease inhibitors
• other eg. CCR5 inhibitor

Question 8

What are the challenges of anti-retroviral treatment?

Answer 8

• good adherence essential (to promote optimum outcomes and prevent mutation of the virus = resistance)
• psychological impact
• short term side effects
• long term toxicities
• drug interactions

Question 9

What are the short term toxicities associated with anti-retroviral therapy?

Answer 9

• rash
• hypersensitivity
• CNS side effects (sleep disturbance, vivid dreams, mood changes)
• GI side effects
• renal
• hepatic

Question 10

What is the long term toxicities associated with anti-retroviral therapy?

Answer 10

• body shape changes (lipoatrophy/lipodystrophy, weight gain)
• renal
• hepatic
• lipid
• bone

Question 11

Describe the drug interactions associated with anti-retroviral therapy

Answer 11

• class-specific
• mediated by CYP450 - induction/inhibition
• careful if patient takes = PPIs, statins, anti-psychotics (long-QT syndrome)

Question 12

Who needs to be notified about a positive HIV test?

Answer 12

• previous partners
• people who have shared needles with
• children until last negative test

Question 13

Describe the options for HIV prevention

Answer 13

• condoms
• treatment as prevention = TasP
• pre-exposure prophylaxis = PrEP (long-term: caution renal/bone)
• post-exposure prophylaxis = PEP (taken within 72hrs)
• prevention of mother to child transmission = PMTCT (during pregnancy, PEP for baby, avoid breast feeding)
• harm reduction measures eg. Needle exchange