HIV

Question 1

What do these statements mean?

Area of high HIV prevalence

Area of extremely high HIV prevalence

Answer 1

Area of high HIV prevalence- 0.2 - 0.5% prevalence

Area of extremely high HIV prevalence - >0.5% prevalence

Question 2

Which groups should be offered HIV testing?

Answer 2

Young people and adults are offered an HIV test when admitted to hospital or
attending an emergency department in areas of extremely high HIV prevalence, or when having a blood test when admitted to hospital or attending an emergency department in areas of high HIV prevalence.

Young people and adults in areas of high or extremely high HIV prevalence are offered an HIV test by their GP practice when registering or when having a blood test if they have not had an HIV test in the past 12 months.

Young people and adults newly diagnosed with an HIV indicator condition are offered an HIV test.

Young people and adults in at-risk groups who test negative for HIV are advised that the test should be repeated at least annually

People who may have been exposed to HIV by a person newly diagnosed with HIV are offered an HIV test

Question 3

Patient with HIV requires liver transplant for other reasons.

When can transplant be performed?

Answer 3

Recommend transplant if HIV viral load is <200

Avoid ARVs such as ritonavir, as likely to interact with calcineurin inhibitors

Switch tenofovir disoproxil to alafenamide, as less likely to cause renal impairment

Question 4

Patient with HIV requires liver transplant for other reasons.

Donor Toxoplasma IgG positive

Do we need to do anything for the recipient?

Answer 4

Recipient should receive toxoplasma prophylaxis lifelong - Co-trimoxazole

This also covers PCP

Question 5

Patient with HIV requires liver transplant for other reasons.

How long do they require PCP prophylaxis for?

Answer 5

Lifelong PCP prophylaxis - Co-trimoxazole

This also covers Toxoplasma

Question 6

HIV resistance report

Resistant to zidovudine and stavudine

What other drugs should we be concerned about?

Answer 6

Zidovudine/ stavudine resistance can be due to a thymidine kinase mutation, and may also confer resistance to

Type-1 TAM pattern:
Abacavir
Tenofovir

TAM - thymidine analogue mutation

Question 7

What is the most common HIV Protease Inhibitor mutation that confers resistance?

Answer 7

L10F/I/V/R/Y

Provides resistance to Atazanavir/ Darunavir/ Lopinavir

HIV-1 develops resistance to PIs as a result of protease mutations that reduce PI binding affinity and compensate for the reduced fitness associated with PI binding-site mutations.

The genetic barrier to PI resistance is high because most binding-site mutations appear to require one or more additional mutations to compensate for their reduced fitness. PI-resistance mutations appear to develop only in viruses exposed to a narrow window of suboptimal drug concentrations that both exert selective pressure on the virus and allow virus replication

Question 8

What is the most common HIV NNRTI mutation that confers resistance?

Answer 8

K103N

Resistance to Efavirenz/ Nevirapine

Question 9

What is the most common HIV NRTI mutation that confers resistance?

Answer 9

M184V/I

Resistance to lamivudine/emtrictabine/ abacavir

HBV DNA polymerase mutations with similar names:
L180M
M204I
M204V

Question 10

HIV PEP

Source has undetectable viral load

What requirements does this need to meet?

Answer 10

<200 copies/ml in past 6 months

good adherence to ART