Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MFSRH part 2 > HIV > Flashcards

HIV Flashcards

1
Q

factors influencing the efficacy of PEP?

A 
delayed initiation
transmission of resistant virus
variable genital tract drug penetration
poor / non-adherence
further high risk sexual exposures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

factors increasing the risk of HIV transmission

A

high viral load of source
breaches in mucosal barrier - ulcers / trauma
menstruation / other bleeding - theoretical
ejaculation
non-circumcision
discordant VL in genital tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

HIV prevelence in sex workers

  • western european
  • central european
  • eastern european
  • Male CSW
A
  • western european <1%
  • central european 1-2%
  • eastern european 2.5 - 8%
  • Male CSW 14%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

which medications are usually used for PEPSE

A

Truvada = tenofovir and emtricitabine OD
AND
Raltegravir BD 400mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Timeframe from exposure for starting PEPSE

A

72 hours

ideally within 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

At what risk of transmission is PEPSE indicated

A

> 1:1000 recommended

1:1000 - 1:10,000 consider

<1:10,000 not required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Is PEPSE required if the source is HIV +ve with an undetectable VL?

A

No - as long as on ART and taking reliably
<200 copies / ml
sustained for min 6m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

risk of HIV transmission per exposure for receptive anal intercourse on average
with ejaculation
without ejaculation

A

receptive anal 1:90
with ejaculation = 1:65
without ejaculation = 1:170

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

risk of HIV transmission per exposure for insertive anal intercourse on average
not circumcised
Circumcised

A

insertive anal intercourse on average 1:666
not circumcised 1:909
Circumcised 1:161

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risk of HIV transmission per exposure for receptive vaginal sex
and insertive vaginal sex

A

Receptive vaginal sex = 1:1,000

Insertive vaginal sex 1:1219

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If the source is known HIV +ve what is the risk of HIV transmission from:

  • human bite
  • semen splash to eye
  • oral sex - insertive or receptive
  • blood transfusion
  • needlestick injury
  • sharing injecting equipment
A
  • human bite <1;10,000
  • semen splash to eye <1;10,000
  • oral sex - insertive or receptive <1;10,000
  • blood transfusion 1:1
  • needlestick injury 1:333
  • sharing injecting equipment 1:149
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If HIV transmission risk falls into the ‘consider PEPSE’ category - what factors would suggest it should be offered?

A

Source or patient has a diagnosed STI
breaches in the mucosal barrier - ulcers, trauma etc
Primary HIV infection in the source
Victim of sexual assault / trauma
more than one high risk exposure within 72 hours
menstruation or other bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

calculation for estimating HIV risk of transmission

A

risk the source is HIV positive x risk per exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

management of a patient requiring PEPSE in ED

A

Sexual history
+
medical history

medication history incl OTC / alternative / recreational

smoking / alcohol

4th gen POCT

U+Es, LFTs

urine ACR

UPT if required + EC

1st dose hep B vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

management of a patient requiring PEPSE in GUM clinic

A 
Sexual history
medical history 
medication history incl OTC / alternative / recreational
smoking / alcohol
4th gen POCT
Send 4th gen serum sample
bloods for STS, Hep B, Hep C
STI screen
U+Es, LFTs
urine dip for proteinuria - if present send urine ACR
UPT if required + EC
hep B vaccine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What advice should you give a patient starting PEPSE?

A

rational for PEPSE
Drugs not licenced for PEPSE but commonly used
full course = 28 days
continue if baseline bloods return as +ve
usually minimal SE - sometimes GI upset or allergy
Baseline liver and renal function taken
Avoid further high risk sexual exposures - but if this occurs in the last 48 hours of course need to continue for another 48hr
safe sex, risk reduction advice
drug and alcohol advice
PEPSE not 100% effective
Return if develops rash or flu-like illness
take first dose immediately then remainder at same time daily
FU HIV test and PN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Initial FU after starting PEPSE

A 
review bloods at 48 hours
Check compliance and SE
any symptoms of STIs
2 weeks STI test
3m repeat bloods for STS and HIV
Plan for remaining Hep B vaccines - 3m and 12m
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of <16yo requiring PEPSE

A

assess as per adult guidelines
if >13 and >35kg can use adult dose
and refer to HIV transition team or paeds HIV team for follow up

If <13yr or <35kg refer to CHIVA guideline and refer to paeds HIV team - medication and dose will be weight and age dependent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Management of a pregnant woman requiring PEPSE

A

Pregnancy does not alter the decision to start PEPSE

Calculate risk and offer if >1:10,000 and within 72 hours

POCT + 4th gen serum test
SHS incl HBV, HCV, STS

serum U+Es, LTFS
Urine dip
explain PEPSE medications unlicensed in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

recommendations for missed doses of PEPSE

A

always reinforce importance of adherence

<24 hours since last dose - take missed dose immediately and next at usual time

12-48 hours since last dose - continue PEPSE

> 48 hours since last dose - stop PEPSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Management of a further high risk sexual exposure in the last 2 days of a patient taking PEPSE

A

Continue PEPSE for 48 hours after the last high risk sexual exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When should patients taking PEPSE be advised to return for an urgent review

A

if they develop a rash
or flu-like illness

may represent HIV seroconversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Management of a patient who has a +ve baseline HIV test after PEPSE has already been started

A

continue PEPSE

review by HIV specialist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Alternative for raltegravir in PEPSE for patients who cannot take it

A

Dolutegravir (integrase inhibitor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
If a HIV +ve patient has a CD4 count <200/mm3 what should they recieve in addition to ARVs?
CD4 count < 200/mm3 should receive prophylaxis against Pneumocystis jiroveci pneumonia = co-trimoxazole
26
Why is abacavir not recomended for PEPSE?
Hypersensitivity reaction in 8% of pateints | NRTI
27
What class of drug is Abacavir?
NRTI = Nucloside reverse transcriptase inhibitor
28
``` what is in truvada and what class of drug is it? ```
Tenofovir and Emtricitabine | Class = NRTI = Nucloside reverse transcriptase inhibitor
29
``` SE of Nevirapine and what class of drug is it? ```
Hepatotoxicity in 10% some require transplant, can cause death NNRTI = Non-Nucloside reverse transcriptase inhibitor
30
``` SE of Efavirenz and what class of drug is it ```
CNS side effects drowsiness, dizziness, headache, insomnia, strange dreams, reduced concentration, seizures NNRTI = Non - Nucloside reverse transcriptase inhibitor
31
``` What is in kaletra and what class of drug is it? ```
Lopinavir and Ritonavir Protease inhibitor = PI
32
SE of kaletra (Lopinavir and Ritonavir)
Nausea and vomiting diarrhoea hyperlimidaemia therefore co-administered with antiemetic and anti-diarrhoeal in PEPSE - no longer first line for PEPSE
33
``` SE of Maraviroc and what class of ARV is it? ```
few SE well tolerated CCR% receptor antagonist
34
Signs of PCP infection
CXR: bilateral interstitial pulmonary infiltrates (can present with other x-ray findings e.g. lobar consolidation or may be normal) Exercise-induced desaturation. Sputum often fails to show PCP Bronchoalveolar lavage (BAL) often needed to demonstrate PCP (silver stain shows characteristic cysts)
35
Symptoms of PCP
dyspnoea dry cough fever very few chest signs HIV +ve patient - CD4 <200
36
Treatment of PCP
co-trimoxazole IV pentamidine if severe steroids if hypoxic ( reduce risk of respiratory failure and death)
37
What additional baseline | investigations do pregnant women who are newly diagnosed with HIV require (BHIVA)
No additional baseline investigations | Those routinely offered
38
If a HIV positive pregnant woman is not on ART when should it be commenced?
- As soon as able in 2nd T where baseline VL ≤30,000 copies/mL - Start of 2nd T or ASAP thereafter if baseline VL 30,000–100,000 copies/mL - Within 1st T if VL >100,000 copies/mL and/or CD4 count < 200 cells/mm All women should have commenced ART by week 24 A woman who presents after 28 weeks should start ART without delay
39
If ART commenced in pregnancy what should be started?
Start Tenofovir DF or Abacavir with Emtricitabine or Lamivudine Third agent - efavirenz or atazanavir
40
Management of an untreated HIV +ve woman presenting in labour at term
STAT dose - Nevirapine 200 mg Commence oral zidovudine 300 mg and lamivudine 150 mg BD And raltegravir 400 mg BD And IV zidovudine for the duration of labour
41
Management of a women presenting in labour or with spontaneous rupture of the membranes (SROM) without a documented HIV test result?
Advised to have an urgent HIV test. 4th gen POCT and send serum sample Act immediately on a postitive result - initiate interventions to reduce vertical transmission
42
recommended investigations on diagnosis of new HBV infection in a pregnant F with HIV co-infection?
Confirm viraemia Quantitative HBV DNA, ‘e’ antigen status AND hepatitis A, C and D tests Test to assess hepatic inflammation/fibrosis and liver function
43
Which ARVs are recommended for treatment of pregnant women with HIV and HBV co-infection?
Tenofovir DF and emtricitabine or lamivudine should form the backbone
44
What is the recommendation regarding delivery route for a pregnant woman with HIV and HBV co-infection
Vaginal delivery can be recommended IF the HIV VL is fully suppressed on ART, Irrespective of HBV viral load
45
Management of an infant born to a woman with HBV
Neonatal immunisation +/- hepatitis B immunoglobulin commenced within 24 hours of delivery
46
BHIVA recommendations on invasive pre-natal diagnostic tests for women who are HIV +ve
Deferred until HIV viral load suppressed to <50 HIV RNA copies/mL
47
Can ECV be offered to HIV +ve pregnant women
Yes - if on ART and plasma viral load <50 HIV RNA | copies/mL.
48
HIV +ve pregnant women can be offered a vaginal delivery if the VL is less than......
plasma viral load of <50 copies/mL at 36 weeks | planned vaginal delivery should be supported
49
Recommended delivery method for HIV +ve pregnant women with a plasma viral load of 50-399 copies/ml at 36 weeks?
``` Consider pre-labour CS Take into account the actual viral load VL trajectory Duration on treatment Adherence issues Obstetric factors Patient preference and views ```
50
Recommended delivery method for HIV +ve pregnant women with a plasma viral load of ≥400 copies/ml at 36 weeks?
VL ≥400 HIV copies/mL at 36 weeks, | pre-labour CS recommended
51
For a HIV +ve patient with SROM in what timeframe should delivery be aimed for?
In all cases of term pre-labour SROM in HIV +ve women | Aim for delivery within 24 hours
52
When is Intrapartum intravenous zidovudine infusion recommended?
- women with a HIV VL >1000 copies/mL who present in labour or with SROM or are admitted for Pre-labour CS - untreated women presenting in labour /with SROM and current VL is not known - Consider in women on ART with a plasma HIV VL between 50 and 1000 copies/mL.
53
BHIVA advice re PEP for infants of HIV +ve mothers
2/52 zidovudine monotherapy if infant = V Low risk - mother on ART > 10 weeks AND - 2 documented HIV VL <50 during pregnancy at least 4 wk apart AND - Maternal VL <50 HIV at /after 36/40 Extend to 4 weeks zidovudine monotherapy: • If the criteria above not all fulfilled but maternal HVL <50 HIV or infant born <34 weeks but most recent maternal VL <50 H If infant at HIGH RISK - Use combination PEP = zidovudine, lamivudine and nevirapine - maternal VL is >50 on day of birth, uncertain or unknown VL
54
when should neonatal PEP should be commenced?
As soon as possible after birth | At least within 4 hours
55
Maximum duration of infant PEP advised by BHIVA
4 weeks
56
Factors which reduce vertical transmission of HIV
Reduce risk from 25-30% to 1-2% - maternal antiretroviral therapy - mode of delivery (caesarean section) - neonatal antiretroviral therapy - infant feeding (bottle feeding)
57
Toxoplasmosis accounts for what % of cerebral lesions in patients with HIV
50%
58
Symptoms of toxoplasmosis in patients with HIV
constitutional symptoms headache confusion drowsiness
59
CT findings of toxoplasmosis in HIV +ve patient
CT: single or multiple ring enhancing lesions#mass effect may be seen
60
management of toxoplasmosis
management: sulfadiazine and pyrimethamine
61
What stains with India ink
Cryptococcus neoformans
62
Most common cause of diarrhoea in HIV +ve patients
Cryptosporidium = most common cause of diarrhoea in patients with HIV infection. Mycobacterium avium intracellulare and giardiasis are known causes of diarrhoea in HIV patients but are not as common
63
in what % of patients is HIV seroconversion symptomatic
in 60-80%
64
typical presentation of HIV seroconversion illness
Occurs 3-12 weeks after infection ``` sore throat lymphadenopathy malaise, myalgia, arthralgia diarrhoea maculopapular rash mouth ulcers rarely meningoencephalitis ```

MFSRH part 2 (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions