HIV

Question 1

What type of virus is HIV?

Answer 1

lentivirus (characterized by a long latent period)

Question 2

Type ___ is predominant in Africa and Type ___ is dominant in America. Type ____ is slightly more virulent

Answer 2

II, I, I

Question 3

What are the modes of transmission for HIV?

Answer 3

Primary: sex, drug use, vertical transmission from mother to child or breast feeding
Other: needle stick in health care setting, rare – artificial insemination and organ transplantation

Question 4

What fluids can transmit HIV?

Answer 4

Blood, semen, vaginal fluids, breast milk, fluids contaminated with blood

Question 5

Exposure to HIV is followed by ______, where symptoms may be non-specific. This usually happens 2-6 weeks after exposure

Answer 5

acute infection

Question 6

On average, there is a “window” of ___ days before antibody tests come back positive for HIV, but it can take as long as ____ months

Answer 6

25, 3

Question 7

Symptoms of acute infection include:

Answer 7

Flu-like symptoms: fever (present in 80-90%), Rash, fatigue, pharyngitis, generalized lymphadenopathy, myalgia/arthralgia, mucocutaneous ulceration, headache

Question 8

During acute infection there is a dramatic drop in _____, meaning the viral load is very high

Answer 8

CD4 T cells

Question 9

After acute infection has subsided, CD4 counts (increase/decrease)

Answer 9

increase slightly, body enters a long latent period

Question 10

During the latent period, what happens to CD4 count?

Answer 10

It declines gradually

Question 11

A diagnosis of AIDS can be confirmed when CD4 count drops below ______

Answer 11

200 cells/μL,

Question 12

How long is the latent period for HIV?

Answer 12

May be as brief as a few months to median of 11 years before development of AIDS

Question 13

What type of specimen is used to test for the presence of HIV?

Answer 13

Blood, buccal, or urine

Question 14

What is the downside of antibody screening tests for HIV?

Answer 14

may have false negatives if test performed during window before antibodies develop

Question 15

What is the downside to ELISA testing for HIV? What is used to alleviate this concern?

Answer 15

ELISA may have false positives with infection (TB, rheumatoid arthritis, autoimmune), recent vaccination, pregnancy, liver disease

Western Blot confirmatory test

Question 16

ELISA tests are highly _____ and Western Blot tests are highly _____

Answer 16

sensitive(99.6%), specific (99%)

Question 17

What are the pros and cons of P24 antigen testing?

Answer 17

Can detect antigen (p24 protein) in as little as 2 weeks (sometimes used in conjunction with antibody test in early testing situations, such as occupational exposure and sexual assault cases)

Lacks both sensitivity/specificity, so limited use

Question 18

What is PCR NAAT (RNA or Nucleic Acid Amplification Test) generally used for? Does it detect infection early?

Answer 18

Testing in newborns and high risk individuals
Also used to monitor response to treatment

Yes, it can detect infection in as little as 11 days, but isn’t widely used or available in the community

Question 19

Who should get tested for HIV?

Answer 19

CDC recommends HIV screening for patients aged 13–64 years in all health-care settings
Anyone who is high risk
HIV testing is now considered much more “routine”

Question 20

For a patient who is positive for HIV, what should your initial HISTORY include?

Answer 20

Detailed medical history, including sexual and substance abuse history; vaccination history; previous STDs; travel history; and assessment for specific HIV-related symptoms or diagnoses

Question 21

What kind of testing should you initially perform on someone who has been diagnosed with HIV?

Answer 21

testing for gonorrhea and chlamydia
complete blood and platelet counts, blood chemistry profile, and lipid profile;
toxoplasma antibody test
testing for antibodies to hepatitis C virus
history of Hep A or Hep B, vaccination if applicable
syphilis serology
CD4 T-lymphocyte analysis and determination of HIV plasma viral load
HIV genotypic resistance testing
tuberculin skin test
urinalysis
chest radiograph

Question 22

In addition to initial testing and establishment of routine medical care, what are some important things to consider for a new HIV patient?

Answer 22

Counseling, social services, partner notification (voluntary or confidentially through health department), prophylaxis for certain opportunistic infections, immediate administration of antiviral therapy

Question 23

What are some considerations you should take for a patient who is pregnant?

Answer 23

Screening for HIV, and if positive, antiviral therapy as soon as known to be infected to decrease risk of perinatal transmission
counseling re: avoidance of breast feeding
Definitive testing in infants under 18 months is usually done by nucleic acid testing (as mother’s antibodies will be transferred)
Should also consider testing other children if their status is not known

Question 24

Is antiviral therapy effective in reducing transmission from mother to baby?

Answer 24

Yes, very effective. Chance of transmission drops for 15-25% to <2% if initiated early

Question 25

What are people with HIV/AIDS most at risk for?

Answer 25

opportunistic infections

Question 26

What are the pros and cons of Orasure HIV 1 and Oraquick Advance HIV 1/2 rapid testing

Answer 26

They can be administered by a non-clinician in a community setting

They are not the most accurate type of testing and always require confirmation testing

Question 27

What is important to remember about virtually all types of HIV testing?

Answer 27

They require a confirmatory test, typically a Western Blot to rule out false positives

Question 28

What are the stages of HIV?

Answer 28

Exposure, acute infection, latent period (asymptomatic infection), symptomatic infection, AIDS

Question 29

Why is early detection important?

Answer 29

Because patients who start HAART (Highly active antiretroviral therapy ) as soon as HIV is detected are more likely to experience slowed progression of disease

Question 30

Is HIV a reportable disease?

Answer 30

Yes

Question 31

What combination of (two) tests represents the most realistic means of improving screening in the general community? (Hint: developed by Lab Corps)

Answer 31

The antibody/antigen combination test

Detects antibody to HIV-1 and/or HIV-2 and antigen (specifically p24 antigen) to increase the likelihood of detecting infection
Less likely to miss infection in window period although still has a 1 week window between exposure and development of P24 antigen

Question 32

What is Truvada?

Answer 32

Post-exposure prophylaxis for sex or injection drug partners who may have been exposed to HIV + person’s blood or genital secretions in past 72 hours

Also used as a pre-exposure prophylaxis to prevent transmission to people who’s partners are HIV positive