HIV Flashcards
What type of virus is HIV?
Enveloped, diploid, single-stranded, positive-sense RNA viruses with a DNA intermediate (which is an integrated viral genome (a provirus) that persists within the host-cell DNA)
How does HIV produce cellular immune deficiency?
- Characterized by the depletion of helper T lymphocytes (CD4+ cells)
- The loss of CD4+ cells results in the development of opportunistic infections and neoplastic processes
By the #s - global estimates for adults and children, 2008 vs. 2016
- People living with HIV – 33.4 million vs 36.7 million
- New HIV infections 2.7 million vs 1.8 million
- Deaths due to AIDS 2.0 million vs 1.0 million
Which age bracket contains the largest % of HIV cases?
20-29 y/o make up 37% of HIV cases
Which modes of transmission have the highest % likelihood?
- Mother-infant 15-35% (*~2%)
- Transfusion 80%
Who should get tested for HIV?
- All patients aged 13-64 in all health-care settings*
- HIV screening should be voluntary
- Opt-out screening: patients are notified that testing will be performed unless they decline
- Separate written consent for HIV testing not recommended; general informed consent is sufficient
- Prevention counseling should not be required
- High-risk patients should be screened at least annually
Who is at highest risk for HIV?
- Unprotected sexual intercourse, especially receptive anal intercourse (8-fold higher risk of transmission)
- A large number of sexual partners
- **Prior or current sexually transmitted diseases (STDs):
- Sharing of intravenous drug paraphernalia
- Receipt of blood products (before 1985 in the United States)
- Mucosal contact with infected blood or needle-stick injuries
- Maternal HIV infection (for newborns, infants, and children)
- Gay and bisexual men (including transgender), particularly young African American, are most affected
Which STDs increase risk for HIV?
Gonorrhea and chlamydia infections increase the HIV transmission risk 3-fold, syphilis raises the transmission risk 7-fold, and herpes genitalis raises the transmission risk up to 25-fold during an outbreak
List the ways to reduce HIV risk
- Consistent, correct condom use
- Screening and tx of STIs in individuals at risk for HIV
- Addiction tx for IV drug users and/or participation in needle exchange programs
- In those with high ongoing risk for infection daily pre-exposure prophylaxis with tenofovir-emtricitabine (Truvada)
- If mucosal or parenteral exposure to HIV within the prior 72 hours, post exposure prophylaxis with ART
Which patients should have HIV screening at least annually?
- Injection-drug users (IDUs)
- Sex partners of IDUs
- Persons who exchange sex for money or drugs
- Sex partners of HIV infected
- Men who have sex with men (MSM)
- Heterosexuals who themselves or their sex partners have had >1 sex partner since last HIV test
- Before new sexual relationship
Diagnosis of HIV
-acute or early infection
Combination antigen/antibody immunoassay and HIV viral load (RT-PCR based)
Diagnosis of HIV
-immunoassay/VL results
(-) immunoassay and (-) VL signifies no HIV infection (if recent exposure repeat in 1-2 weeks)
(-) immunoassay and (+) VL suggests an early infection (VL <1000 copies/ml very rarely represents false positive test, repeat!)
(+) immunoassay and (+) VL, early or established infection
What is the next step in the event of (+) immunoassay?
(+) immunoassay needs a second, antibody-only immunoassay (preferably the HIV-1/HIV-2 differentiation immunoassay) if not already performed
What are the 3 phases of HIV/AIDS?
- Primary HIV infection
- Chronic asymptomatic phase
- Advanced AIDS
Etiology of primary HIV infection
- Symptomatic illness in 40-90%
- Illness is nonspecific and mononucleosis-like
- Appears 2-4 weeks after exposure
- Clinical illness lasts 1-4 weeks
List the acute retroviral syndrome symptoms
- Fever
- Lymphadenopathy
- Pharyngitis
- Rash
- Myalgias
- GI complaints
- Encephalopathy
*Ask your patient if at any point since their last HIV (-) test they’ve experienced these symptoms
