HIV Flashcards
What receptor does HIV use to enter immune cells?
CD4
T-helper cells
What is the course of HIV?
Infection Seroconversion Asymptomatic HIV-related illness AIDS Death
Which group has the highest prevalence of HIV?
MSM
What are the risk factors for HIV? (5)
MSM Unprotected sex High-Prevalence areas eg. sub-Saharan Africa IVDU CSW
When does seroconversion occur?
About 2-6 weeks post-exposure
What are the features of seroconversion?
Similar to glandular fever eg. sore throat, LNs, fever, malaise
Maculopapular rash
Mouth/penile ulcers
What often co-exists with Primary HIV?
Early syphilis
What are 3 AIDS-related malignancies?
Kaposis sarcoma
Non-Hodgkin Lymphoma
Invasive cervical cancer
What are some non-AIDS-related malignancies?
Hodgkins Lymphoma Anal cancer Hepatocellular carcinoma ENT cancers Lung cancer
Which cancer requires everyone to be HIV tested?
Non-Hodgkin Lymphoma
What are the two tests for HIV?
HIV antibodies
p-24
When are HIV antibodies detectable?
4-8 weeks
When are p-24 antigens detectable?
2-4 weeks
What is the recommended test for HIV?
Combination of both HIV antibodies and p-24
When will the majority of individuals with HIV be detectable?
4 weeks post-exposure
Negative result is highly likely to exclude HIV
When should a repeat test at 8 weeks be done?
If there is a high-risk infection event
What is a rapid POC test?
Quick test, takes 30sec to 20mins
All positive tests confirmed with additional tests
Who gets tested?
Everyone during STI screen
Pregnancy booking visits
What is pre-exopsure prophylaxis (PREP)?
Truvada (2 drugs)
Prevents 86% infections
Can be taken daily or before sex
What is post-exposure prophylaxis (PEPSE)?
Prevents the virus multiplying and entering host cells
Taken within 72hrs of exposure - earlier the better
Who gets PEPSE?
Anyone who has had unprotected sex with a high-risk individual in the last 72hrs
Needle stick injuries
How is mother-child transmission of HIV prevented?
Suppress viral load with HAART
Can have vaginal birth in viral load is suppressed
Neonatal PEP for 4 weeks
Avoid breast feeding unless mother wants
What are some other factors that may reduce the risk of exposure?
Condoms
Needles exchange
What does HAART stand for?
Highly Active Anti-Retroviral Therapy
What is HAART?
3 anti-HIV drugs from 2 different classes
3 drugs in 1 pill
What is the typical drugs combination for HAART?
2x nucleotide/side reverse transcriptase inhibitors +
One of non-nucleotide reverse transcriptase inhibitor OR boosted protease inhibitor
When is HAART offered?
CD4 <350
Pregnancy, regardless of CD count
When should HAART be considered?
CD4 350-500 with other feature:
- Hep B/C infection
- Low %age CD4 cells vs CD8 cells
- High risk of CVD
When is viral load said to be undetectable?
VL <50
What are the side effects of HAART?
Hypersensitivity
Anaemia
Liver/kidney toxicity
Pancreatitis
What is important about Ritonavir and Cobicistate?
CYP3A4 inhibitor -> interacts with statins and steroids
Can cause iatrogenic Cushing’s
What is important about Rilpvirine and Atazanavir?
PPIs are contraindicated
Why must viral load be continually monitored?
HIV can mutate and develop resistance to ARVs
What are the future targets for HIV therapy by 2020?
90% know their status
90% on sustainable ART
90% on treatment have durable suppression
