hiv

Question 1

when to routine assess for HIV 2

high risk?

over 70?

pregnancy

Answer 1

Q 5 years for 18-70, or when pt request for it

yearly for high risk

once for over 70 if HIV status unknown

pregnancy, once with each pregnancy

Question 2

if exposure to sexual assault, when to test for HIV?
(window period)

newest test can be as soon as?

Answer 2

initial testing for previous exposure, not for the assault itself, then 3 months post to assess for contraction of HIV

16-18 days, so earliest is 4 weeks

Question 3

point of care testing good?

Answer 3

if positive, still has to to the serology testing

no sufficient to rule out active/acute HIV infection

not recommended for recent exposure

Rapid, point of care testing now available (+ve tests must be confirmed using standard methods)

Question 4

when to refer?

report?

Answer 4

NP need to refer when Positive, we can order drugs, but we can continue

HIV is reportable

Question 5

acute HIV infection what happens in body

how to confirm and when

Answer 5

viral replication and CD4 decline

confirmed by high HIV RNA and no HIV antibody
Seroconversion:
Positive HIV antibody test within 4 weeks of acute infection

by 4-6 weeks earliest
usually 3 -6 months

Question 6

HIV Atb tests: 3

which is screening?

Answer 6

ELISA & Western Blot (WB)
Quantitative plasma HIV RNA (HIV Viral load) – if acute HIV suspected

ELISA is the usual screening (all +ve confirmed with WB)
If –ve, WB not required (sensitivity 99.7%; specificity 98.5%)

Question 7

window period?

Answer 7

If “window period” in setting of acute infection: may be sero-negative!

Question 8

Aids, define, cd4 count, fraction?

Answer 8

AIDS
Defined by CD4 count <200
CD4 Fraction of <14% of total lymphocytes
One of AIDS related OI such as:
PC pneumonia
Cryptococcal meningitis
Recurrent bacterial pneumonia
Candida esophagitis
CNS toxoplasmosis
Tuberculosis
Lymphoma

Question 9

when to start HAART

Answer 9

Any time
Especially if (even if CD4 >500):
Hep  B; C
CD4 decline >100 over 1 year
Discordant couple
VL>100 000
Nephropathy
Risk for CAD

Question 10

mmr in hiv pts?

Answer 10

MMR
Indicated if born after 1957and no vaccination; vaccinated 1963-1967
Contraindicated in patients with CD4<200
Consult with IDS

Question 11

oi prophalaxis

Answer 11

PCP / Toxo – CD4 count <200: TMP-SMX 1 DS tab, PO, q 24h (can dc after 3 mos or more of CD4 count >200 and response to HAART - collaboration with IDS / MD)
S. Pneumoniae – CD4 count >200: Pneumococcal vaccine
MAC – CD4 <50: Azythromicin 1200 mg, PO, once/week or Clarithromycin 500 mg, PO, q 12h (may dc if CD4 count>100 and HIV RNA suppressed for 3-6 mos or longer while on HAART – collaboration with IDS / MD)

Question 12

HIV specific skin infections

Answer 12

HIV specific – Kaposi sarcoma

Question 13

ulcerative lesions think?

when with this infection, can have what other infection?

Answer 13

HSV - usually ulcer, but no blister

Periungual infection is another characteristic manifestation of HSV-2 infection in the HIV-infected patient
all paronychial lesions should be cultured for HSV.

Question 14

The most common form of yeast infection in HIV-infected persons is

Answer 14

thrush.