HIV Flashcards
HIV definition
a virus that leads to AIDS, where progressive immune system failure allows for life-threatening opportunistic infections and cancers
HIV transmission
- vertical - mother-to-baby
- horizontal - unprotected sex, bodily fluids (IVDU, blood transfusion)
CD4 count under 200
3 P:
- pneumocystis pneumonia
- progressive multifocal leukoencephalopathy
- histo(P)lasmosis
CD4 count under 100
4 C:
- oral candidiasis
- cerebral toxoplasmosis
- cryptococcal meningitis
- cryptosporidiosis
CD4 count under 50
- CNS lymphoma
- cytomegalovirus
HIV window period and seroconversion
- seroconversion - point at which antibodies are developed against HIV
- symptomatic - glandular fever type illness - maculopapular rash, sore throat, diarrhoea, myalgia, fever, lymph nodes
- window period - where HIV becomes reliably detectable
HIV testing
- combined test - IgM and IgG antibodies and p24 antigen, take bloods
- antibodies usually appear at 4-6 weeks but can take up to 12 so second test
- point of care test - swabs or finger prick - also do PCR as increased false positive
- CD4 count for disease progression
Benefits of HIV testing
- start antiretroviral medication
- reduce transmission
- treat opportunistic infections
- peace of mind
- lifestyle, HIV support groups
PrEP
- recommended for MSM or people who have condomless sex with HIV positive partners (unless undetectable)
- do not give if HIV positive!
- combination of Tenofovir DF and Emtricitabine
- either daily or event based dosing
PrEP regimen - daily
DAILY DOSING
- anal sex: 2 pills 2 to 24 hours before sex and then a pill at 24 hours and 48 hours
- then one pill per day
- vaginal sex - have to take for 7 days
PrEP regimen - event-based
EVENT BASED
- cannot take with HIV
- two tablets between 2 and 24 hours before sex
- single pill 24 hours after the first dose
- next pill 24 hours after the second dose
- having sex multiple times over more than 24 hours - take pills until 48h passes
- having sex less than a week after previous sex - single initial dose
PrEP side effects
- nausea and vomiting
- headache
- GI disturbance
- usually settle within 2 weeks
- minor: reduces creatinine clearance and bone density
PrEP monitoring
- check Hep B status
- HIV test every 3 months
- STI screen every 3 months
- urine dip every 3 months
- U&Es annually
PEPSE
- combination of highly active antiretroviral drugs
- Truvada once daily and either Kaletra or Raltegravir twice daily
- give within 24-72 hours, 28 day prescription
- S/E - N&V, rash, gastro upset
- give loperamide, metaclopramide
- repeat HIV test in 12 weeks
