HIV Flashcards
What is HIV
Blood-borne virus
Human immunodeficiency virus
Life-long
Effective treatment but no cure
How is HIV treated?
HAART
Highly active anti-retroviral therapy
Uses at least 3 anti-HIV drugs from at least 2 different drug categories
How is HIV monitored?
Plasma HIV viral load
CD4 cell count
Why is it important for a person with HIV to take there full medications regularly?
The ability of HIV to mutate & reproduce itself in the presence of ARV drugs – HIV drug resistance. Anything that lowers ARV drug concn allows the virus to replicate with low drug levels can lead to drug resistance.
What are the risk factors for HIV?
Sharing needles STIs Sexual intercourse with an affected individual (esp receptive anal sex) Sex without a condom Multiple sexual partners Risk taking behaviour High viral load in a known HIV positive
Who should be offered a HIV screen?
All pts diagnosed with an STI
All sexual partners of a HIV +ve pt
All patients presenting where HIV is a differential
All male-male sex
All female contacts of those who have male-male sex
IVDUs
All M&F who have sex abroad in a country with a high prevalence
Blood donors
Dialysis pts
Organ donors & recipients
How often can people be tested for HIV?
-ve test with possible exposure has occurred within the window period should be retested
Male-male intercourse annually/frequently with ongoing high-risk exposure
IVDUs annually/frequently
Antenatal care: Refuse reoffer at 36week
What clinical oral syndromes would give a differential of HIV?
Candida/thrush Kaposi's sarcoma Gingivitis Aphthous ulcers Oral hairy leukoplakia
What clinical dermatology syndromes would give a differential of HIV?
Acne/Psoriasis diagnosed at an old age Impetigo Itchy folliculitis Fungal infections Seborrhoea dermatitis
What infections would give a differential of HIV?
Recurring HSV Recurrent HZV/chicken pox Crusted scabies Severe viral warts Molluscum contagiosum on the face & large
What clinical respiratory syndromes would give a differential of HIV?
Atypical pneumonia
TB
Recurrent bacterial pneumonia
What clinical GI syndromes would give a differential of HIV?
Oesophageal candida
Chronic diarrhoea
What clinical haematological syndromes would give a differential of HIV?
Lymphoma
Lymphopenia
Thrombocytopenia
What methods can be used to test for HIV?
- Blood assay: First line, tests for Abx (4-8weeks) & p24 antigen (2-4weeks)
- Rapid point of care test: Fingerpick, 30secs-20mins, not as specific/sensitive as blood test, all +ve results confirmed by serology
How is a diagnosis of HIV confirmed?
Confirmatory assays & 2nd sample testing
What are the patient barriers to testing for HIV?
Ignorance Denial Stigma Fear Access Needle phobia Confidentiality
What are the HCP barriers to testing for HIV?
Stigma Fear of causing offence Compartmentalisation 'Not my job' Historically a protected skill
How is HIV transmission prevented?
Condoms Abstinence Needle exchange programs Circumcision Anti-retroviral therapy PREP
What is PREP?
Pre-exposure prophylaxis
2drugs combined
Taken before sex
Highly effective (86%)
What is PEP?
Post-exposure prophylaxis
PEPSE following sexual exposure
Taken within 72hours (unprotected sex or condom failure)
Why is there a 72hour window for PEP?
HIV may take 48-72hours to become established in the body after exposure therefore works best the earlier it is given
What is the main role of anti-retrovirals?
Anti-retrovirals prevent virus multiplying & entering host cells
How is mother-child transmission of HIV prevented?
HAART to mother to suppress viral load
Avoid breastfeeding
Consider mode of delivery
Neonate post-exposure prophylaxis for 4weeks
What is HAART made up of?
-2 nucleoside reverse transcriptase inhibitors
EITHER:
- Non-nucleoside reverse transcriptase inhibitor
- Boosted protease inhibitor
- Integrase inhibitor
