HIV Flashcards
How does PCP present?
Exertional dyspnoea progressing over several weeks, malaise and dry cough
AIDS defining
CXR normal in 39% but perihilar haze and interstitial infiltrates
Which services should offer opt out testing?
Antenatal, SH, TOP, substance misuse, hep b/c services, tb and lymphoma
What do 4th gen tests test for?
Antibodies and p24 antigen
P24 antigen is a viral capsid protein detectable in blood earlier than antibodies in primary hiv infection
Window period 45 days (but most detectable prior)
Confirmatory testing indicated if positive
Which MSM should have 3/12 hiv tests?
Chems
>10 partners in year
Multiple/anon partners since last test
Condomless AI with unknown or zero discordant not suppressed
Also consider prep
What do PHE define as high prevalence?
2-5/1000 adults living with diagnosed HIV
> 5/1000 is extremely high
In high or extremely high prevalence area hiv test should be offered to anyone undergoing venepuncture
When should you test in best interests?
If pt cannot consent and would change management now eg indicator condition and unwell
Is CAP an indicator condition for HIV?
Yes
And indicator condition is any medical condition associated with an undiagnosed seroprevalence of 1 or more per 1000
At what level of undiagnosed hiv prevalence does screening become cost effective?
0.1%
Allows earlier rx,
Reduces onward transmission
When do BHIVA say start ART in pregnancy if not already on?
Beginning second trim with:
TDF + emtricitabine or lamivudine
Or abacavir + emtricitabine or lamivudine
Weigh up medication in first trimester vs achieving suppressed viral load by latest 36/40
Higher load will take longer to suppress so if VL >30,000 start at start 2nd trim ; if less just as soon as able 2nd trim
Which ART are not recommended started in pregnancy?
Efavirenz-good evidence but not in guidelines art naive (note also linked with depression)
TAF
Elvitegravir
Cobicistat
Can you treat hepatitis C in pregnancy?
No.
Do not use directly acting antivirals in pregnancy lack safety data
Ribavirin is a teratogen
Defer treatment until postnatal
Can recommend vaginal delivery regardless hepatitis c viral load
What are criteria to support BF?
Good adherence ART
Undetectable viral load
Monthly mother and child VL measurement during and for 2/12 after BF
Advise
Shortest time possible
Exclusive feeding only not mixed for first 6/12
Stop if mastitis or gi sx baby
U=U does not apply
If BF with known viral load-social services
How do you manage pre labour SROM viral load <50?
Immediate IOL aim delivery within 24hrs
If VL <50 vertical transmission risk is <0.5% regardless mode delivery
What infant pep is indicated if suppressed by 36 weeks but don’t have 2 VL <50 4 weeks apart?
Four weeks zidovudine within 4 hours
Combination pep if not superseded by 36 weeks
2 weeks zidovudaine only if suppressed by 36 weeks and 2 <50 viral loads.
When do you test routinely infant for HIV post natal ? (Not BF and not high risk)
Birth
(Not while on pep)
6 weeks
12 weeks
18-24 mths (ideally antibody only as just checking mat antibodies cleared)
Does Hep b viral load affect mode of delivery if hiv suppressed?
No can have vaginal delivery plus vacinnation within 24hrs
If maternal hbv >10 to power of 6, or e antigen positive or anti-hbe negative or unknown give HBIG too
If need an amino and VL not suppressed?
Do amnio but ensure on raltegravir regime and cover procedure with stat nevirapine 2-4hrs prior
Do people on ART need extra antenatal scans?
No
Of note dolutegavir associated with neural tube defects (past 6 weeks do not switch as neural tube closed)
When should people with HIV in pregnancy be assessed re mental health?
Booking
4/52 PN
3/12 PM
Minimum
Prevalence PND HIV high income is 30-53%
How do you treat new diagnosis in labour?
Double dose TDF 490mg stat
Nevirapine 200mg stat
Start bd
Lamivudine
Zidovudine
Raltegravir
IV zidovudine for duration labour
Can you give people with CD4 <200 live vaccines?
No
If > 200 consider VL (suppression will increase safety) and risk natural infection vs vaccination if been exposed…likely vaccination less risky
Live include VZV, MMR, yellow fever
You can give not live vaccines if <200 however may have reduced effect so consider delay if beneficial risk v benefit
Réceptive AI risk?
1:90
1:65 ejaculation
1: 170 no ejaculation
Risk insertive anal (not suppressed)
1:666
Not circumcised 1:161
Circumcised 1:909
Réceptive vaginal
1:1000
Insertive vaginal
1: 1219
Semen to eye
Giving and receiving oral sex
Human bite
< 1:10,000
Needle stick
1:333
Injecting sharing is 1:149
Why is it important to consider concurrent sti risk with hiv transmission?
Syphilis HSV increase risk x 10-50 male to female x 50-300 female to male
Break in mucosal barrier, increased lymphocytes
Gc/C4 increase risk 2-5 fold…increased virus in genital fluids
How effectively do condoms reduce hiv risk?
80-95%
Topical microbicides effective?
Yes-ring and gel in rct
