Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Dip GUM > HIV > Flashcards

HIV Flashcards

1
Q

what is the sensitivity of HIV screening tests?

A

high sensitivity (>98%)

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

What do HIV screening tests usually detect?

A
  • antibodies to HIV-1 and HIV-2

4th gen - also detects - HIV-1 p24 antigen

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

Seological tests for HIV are usually based on what laboratory assay?

A

Serological tests - usually use
enzyme immuno assays (EIA)
4th generation (antibody and antigen) tests - more sensitive than antibody only tests

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

Why are 4th generation HIV tests recommended?

A

4th generation = antibody and antigen tests,
More sensitive than antibody only tests
Better in detecting or excluding HIV when a recent exposure has occurred (<4-6 weeks).

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

In what situation may there be a false negative HIV test?

A

A test can be falsely negative very early in the window period
e.g. If a high risk HIV exposure occurred in the previous 4-6 weeks s

A negative test with a 4th generation (antigen + antibody test) EIA at 4 weeks excludes HIV infection with a high degree of certainty.

(a few cases described of prolonged seroconversion, usually with simultaneous other viral illness)

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

What confirmation is required of a positive HIV screening test?

A

Confirmation by second and third serological test

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

what is an equivocal or indeterminate HIV test?

A

An equivocal / indeterminate tests = a positive screening test which is negative when tested by a second and third serological test.

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

Causes of an equivocal or indeterminate HIV test

A

Usually caused by a false positive reaction

Could be an early seroconversion when the screening test is more sensitive than the confirmatory tests.

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

Management of an equivocal or indeterminate HIV test

A

Repeat the sample 1 wk later
Will identify seroconversion if the confirmation test(s) become positive and/or p24Ag or HIV viral load is detectable

Patient can be reassured of false positive reaction if the repeat blood, drawn at least 1 week later, is negative

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

What test can be used for HIV incidence testing

A

Antibody avidity testing
Can predict whether the infection occurred in the preceding 4-5 months.
(sensitivity + specificity of 96% and 97%)

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

What principle foes HIV Antibody avidity testing utilise?

A

The test exploits the principle that the initial antibodies bind less strongly (low avidity) to antigen compared to antibodies produced later as part of the evolving immune response.
Can predict whether the infection occurred in the preceding 4-5 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When can HIV seroconversion be diagnosed?

A

Seroconversion can be diagnosed when the 4th generation screening test is positive but a confirmatory (3rd generation) test is negative.

A p24Ag or viral load test needs to be positive.
Evolving line blot assays with additional bands developing on follow-up sampling can also be used.

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

Sensitivity of HIV tests?

A

HIV tests - incredibly sensitive
>98%
due to the high levels of HIV antibodies produced by an infected person

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

Specificity of HIV tests?

A

specificity >98%

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

When might salivary HIV diagnostic tests be useful?

A

for children / severe needle phobia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the correct storage of HIV samples

A

No refrigeration of samples is necessary unless stored for more than 1-2 days.

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

What proportion of new HIV diagnoses are MSM?

A

UK in 2015

MSM = 46% of new HIV diagnoses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a late HIV diagnosis?

A

For public health monitoring - late HIV diagnosis = CD4 cell count <350 within 3m of HIV diagnosis

Very late HIV diagnosis = CD4 count <200.

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

What is the significance of a late HIV diagnosis?

A

People diagnosed late are at increased risk of developing an AIDS-defining illness
+ have 10x increased risk of death in the year following their diagnosis

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

HIV prevention strategies

A

Condom use
PEPSE
Serosorting/stategic positioning - mixed data
PREP
Male circumcision - data from Africa suggests MC protects heterosexual men from acquiring HIV
Reduce the number of partners

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

What is the approximate rate of STS and HIV co-infection

A

Syphilis-HIV coinfection remains high

Up to 40% of cases of syphilis being in HIV infected MSM

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

How may being HIV +ve affect the presentation of STS

A

some minor differences syphiis presentation in HIV +ve patients include:

  • primary syphilis- up to 70% present with >1 chancre + larger / deeper lesions
  • 25% present with concomitant lesions of primary and secondary stages at presentation
  • atypical and severe presentations of syphilis occur more frequently (still a v small minority)
  • Syphilis can cause transient increase in the viral load and decrease in the CD4 cell count - resolve after treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Differences in managing STS in HIV +ve patients

A
  • HIV patients are more likely to present with neurological syphilis in early syphilis
  • HIV infection associated with increased risk of neurological complications in the short and long term
  • consider treating all HIV patients with a neurosyphilis drug regimens given the high rates of positive CSF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Globally what proportion of people living with HIV are women?

A

Women >15 years = approximately 50% of global adults living with HIV
- The burden of disease in women is not evenly distributed worldwide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In the UK what proportion of people living with HIV are women?

A

In the UK in 2015 31% of patients accessing HIV care were women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the primary aim of ART?

A

To prevent mortality and morbidity associated with chronic HIV infection
Effective
Tolerable
Low drug toxicity
Improve physical + psychological well-being

Reduce onward transmission - sexual, MTCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What proportion of patients on ART achieve a suppressed HIV VL?

A

93% (2013 data)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Before prescribing ART what topics should be discussed with the patient to assess their readiness to take therapy?

A

Understanding of HIV therapy
Perceptions of personal need for ART
Concerns about ART / specific ARV drugs,
Concerns re social consequences (disclosure/ lifestyle interference)
Confidence re adherence
Psychological issues / concerns
Socio-economic factors (incl. poverty, housing, immigration status, domestic violence)
Pregnancy or parenting plans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Factors affecting adherence to ARVs

A

adverse effects
Social beliefs
Cultural beliefs.
Depression sig. associated with low adherence [1
Anxiety
Problematic drug or alcohol use
Socio-economic status - poverty, non-employment, unsettled immigration status, lack of supportive network

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

when should ARVs be started for a patient presenting with an AIDS defining illness?

A

Individuals presenting with an AIDS-defining infection
Or a serious bacterial infection and a CD4 count <200

Start ART within 2 weeks of initiation of specific antimicrobial chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

when should ARVs be started for a HIV diagnosis

A

At time of diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What was the ACTG 5164 study

and what did it show?

A

ACTG 5164 study
demonstrated fewer AIDS progressions/deaths
And improved cost-effectiveness

when ART was commenced within 14 days treatment for acute infection (e.g. PCP)
Rather than ART initiation at the completion of antibiotic treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

definition of Primary HIV infection (PHI)

A

Primary HIV infection (PHI) = HIV infection within a maximum of 6 months from the estimated time of HIV transmission.

Diagnosed based on laboratory test results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Which studies showed clinical benefit to starting immediate ART over deferral

A

START, TEMPRANO and HPTN 052 trials

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What factors would encourage prioritisation of early ART initiation

A

primary HIV infection
low initial CD4 T cell counts <350
high plasma viral loads (>100,000 copies HIV RNA)
short test intervals - diagnosis within 12 weeks of a previous negative test
Neurological involvement
Any AIDS-defining illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What was the SMART study

and what did it show?

A

The SMART study compared 2 ART strategies in HIV-infected adults with CD4 counts > 350

1st group = viral suppression strategy = continuous ART to maximally suppress HIV replication.

2nd group = CD4 count-guided ART interruption strategy (drug conservation) = involved stopping ART when CD4 counts >350 and re-initiating ART when CD4 <250

treatment interruption = increased all-cause mortality
seen regardless of the lowest point of CD4 cell count.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Potential downsides to starting ART in primary HIV infection

A

Ambivalence to ART at a time of emotional challenges - an risk poor adherence and the development of drug resistance
Patient may be in a vulnerable psychological state and ll-prepared to commit to starting long-term treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Potential benefits to starting ART in primary HIV infection

A

Better probability of immunological recovery to normal levels
Patient may be comforted to know they are taking immediate control of their infection
Reduced risk of onward transmission at a time of v high VL
Reduction in morbidity
Clinical benefit from starting ART irrespective of CD4 count (START, TEMPRANO and HPTN052 trials)
Limitation of viral reservoir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Advice for reduction in transmission of HIV

A

Initiation of ARVs will reduce the risk of onward sexual transmission - discuss as a part of safer sex messages
Undetectable VL for 6m + means it isn’t possible transmit HIV (U=U)
Condoms
Water based lubricant
Avoid sharing needles and injecting equipment
Pre-exposure prophylaxis (PrEP)
Post-exposure prophylaxis (PEPSE)
Antenatal screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How soon after initiating ART does the VL become undetectable?

A

Taking ART does not result in immediate viral suppression.

Most achieve viral suppression by 3–6 months

Integrase inhibitors are characterised by more rapid viral suppression - most undetectable by 1–3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the PARTNER study

and what did it show?

A

PARTNER study demonstrated a protective effect of viral suppression in serodifferent couples
HIV-positive person on suppressive ART - VL <200

condomless sex acts - 16,800 in MSM and 28,000 in heterosexual couples

no cases of HIV transmission
86 would have been expected based on previous incidence studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Advice for sero-discordant heterosexual people wishing to conceive

A

If fully suppressed on ART with undetectable VL for 6m+
U=U
Sex without condom around time of ovulation = timed UPSI = very little to no risk

PrEP does not add any benefit but may carry SE - not advised in current guidelines

Sperm washing not recommended in the context of viral suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What ART is recommended to start for new diagnoses of HIV

A

therapy-naïve patients with HIV
recommend starting ART with 2 nucleoside reverse transcriptase inhibitors (NRTIs) as the backbone

plus 1 of: ritonavir-boosted protease inhibitor (PI/r), non- nucleoside reverse transcriptase inhibitor (NNRTI) or integrase inhibitor (INI)

e.g. Truvada (Tenofovir-DF and emtricitabine) and Raltegravir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What drugs are in Truvada

A

Tenofovir-DF and emtricitabine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What drugs are in Kivexa

A

Abacavir and lamivudine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What test is required prior to starting a patient on Abacavir

A

HLA-B * 57:01

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the HLA-B * 57:01 test done for?

A

To determine if a patient is likely to have a hypersensitivity reaction to Abacavir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are critical outcomes to consider when choosing which ART to start?

A 
Viral suppression at week 48/96, 
proportion with virological failure, 
proportion developing resistance, 
proportion discontinuing for adverse events, 
proportion with grade 3/4 adverse events
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

In which patients must Abacavir not be used

A

HLA-B * 57:01 positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the main risk associated with abacavir

A

abacavir and cardiovascular disease

Abacavir is not to be used in individuals at high risk of CVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the main risk associated with tenofovir-DF

A

Renal toxicity

tenofovir-DF is not used in people with stage 3–5 CKD or at high risk of progression of CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Why is tenofovir-AF different to tenofovir-DF

A

Tenofovir alefenamide = new formulation of tenofovir
Significantly lower plasma concentrations of tenofovir
Hypothesis = lower plasma concentrations
should = less negative impact on renal and bone markers

More potential drug interactions for tenofovir-AF that do not apply to tenofovir-DF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Which nucleoside reverse transcriptase inhibitor backbone is commonly used for starting ARVs in treatment naive HIV patients?

A

Tenofovir-DF and emtricitabine
or
Tenofovir-AF and emtricitabine

Alternative - Abacavir and lamivudine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Which third agent is commonly used for starting ARVs in treatment naive HIV patients?

A 
start combination ART containing one of 
atazanavir/r, 
darunavir/r, 
dolutegravir, 
elvitegravir/c, 
raltegravir 
rilpivirine

or efavirenz is an acceptable alternative third agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Main adverse events from efavirenz-based regimens

A

Potential for significant CNS toxicity

Higher risk of suicidality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what is Cobicistat

A

Cobicistat is an inhibitor of CYP3A isozymes

Used as a pharmacokinetic booster of other antiretroviral drugs
Alternative to ritonavir- boosted PI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is the current evidence regarding PI monotherapy for initial HIV treatment

A

Data limited

Associated with lower rates of virological suppression at 48 weeks
Emergence of PI mutations

No significant differences in tolerability
NOT recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the risk of low adherence to ART for HIV treatment

A

Associated with:

  • drug resistance
  • risk of disease progression
  • risk of progression to AIDS
  • death
  • increased risk of HIV transmission to others
  • increased costs of treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What factors may cause non-adherence

A

Both intentional and unintentional causes

Unintentional non-adherence is linked to limitations in capacity or resources that reduce the ability to adhere to treatment as intended.

Intentional non-adherence is a result of a decision informed by beliefs, emotions or preferences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Benefits of using single tablet regimens for HIV treatment

A

Improved adherence
Reduced selective adherence
Patient preference
Improvement in quality of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What drug interactions should be considered when dispensing ARVs

A 
methadone 
contraceptives
anti-epileptics
antidepressants
lipid-lowering agents
acid-reducing agents
certain antimicrobials (e.g. clarithromycin, minocycline and fluconazole)
some anti-arrhythmics
TB therapy
anti-cancer drugs
immunosuppressants
phosphodiesterase inhibitors
anti-hepatitis C virus therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

For what reasons may ART need to be interrupted?

A

Once ART has been started it should be continued.

frequent interruptions or interruptions >1-2 days should only be considered in exceptional circumstances.

e. g.
- Severe drug toxicity (e.g. hepatotoxicity).
- Severe psychological distress.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

How long of an interruption in ART use is usually ok

A

An interruption of 1–2 days can usually be managed

Unlikely to be associated with adverse outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Causes of virological failure on ART

A 
Partial HIV drug resistance
Extensive resistance
X4 tropic virus
Poor adherence 
Unsuccessful retention in care
Sporadic detectable HIV RNA “blips”
intolerance to the current regimen  
pharmacokinetics drug interactions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is the virological failure rate on first-line NNRTI-based regimens in the UK

A

18%

Approximately 4% fail in the first year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Definition of virological suppression

A

Achieving and maintaining a VL level <50 copies/mL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Definition of virological failure

A

Virological failure = incomplete virological response after commencing treatment or evidence of confirmed virological rebound to >200 copies/mL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Definition of incomplete virological response

A

Incomplete virological response = 2 consecutive VL >200 after 24 weeks
without ever achieving VL <50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Definition of virological rebound

A

Virological rebound = failure to maintain a VL <50 on two or more consecutive occasions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Definition of Low-level viraemia

A

Low-level viraemia = a persistent VL between 50–200

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Definition of a Virological blip

A

Virological blip = after virological suppression, a single VL between 50 and 200 copies/mL followed by an
undetectable result

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Management of a virological blip

A

Virological blip = A single VL 50–200 copies/mL preceded and followed by an undetectable VL
Usually not a clinical concern

  • clinical vigilance
  • adherence reinforcement
  • check for possible interactions
  • repeat testing within 2–6 weeks depending on ARV regimen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Management of a virological blip where a single VL is >200

A

investigate
rapid re-test
+/- genotypic resistance test

May be indicative of virological failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Management of HIV and TB co-infection

A

All patients with HIV TB co-infection should start ART

If CD4 count <50 start ART as soon as TB treatment is
tolerated - wherever possible within 2 weeks

If CD4 count ≥50 defer ART until 8 - 12 weeks of TB treatment. - esp if difficulties with drug interactions / adherence / toxicities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Which ART combination is recommend first-line in TB/HIV co-infection

A

Tenofovir-DF + emtricitabine (Truvada)

+ Efavirenz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

When do you start ARVs for HIV and HBV coinfection when HBV requires treatment

A

Start ART promptly
Include tenofovir-DF and emtricitabine
or tenofovir-AF and emtricitabine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

When do you start ARVs for HIV and HBV coinfection when HBV does not require treatment

A

Start ART - not as urgent
Include tenofovir-DF and emtricitabine
or tenofovir-AF and emtricitabine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

When do you start ARVs for HIV and HCV coinfection when HCV treatment is to start start immediately

A

Start ART before HCV treatment commenced

Acceptable to defer if CD4 cell count >500 cells/μL - discuss viral hepatitis specialist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Which ARVs have good antiviral activity against both HIV and HBV.

A

Tenofovir-DF
tenofovir-AF
emtricitabine
lamivudine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Impact of HIV confection on HCV infection

A

HIV impacts HCV infection.

  • higher HCV viral loads,
  • faster rates of fibrosis progression
  • increased risk of cirrhosis
  • more frequent development of end-stage liver disease / hepatocellular carcinoma / liver-related death
  • The efficacy of pegylated interferon (PEG-IFN) lessens as the CD4 cell count declines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

When to start ART in patients with AIDS-defining malignancies = Kaposi sarcoma, high-grade B-cell non-Hodgkin lymphoma and invasive cervical cancer a

A

Commence ART promptly regardless of CD4 cell count or HIV viral load
Kaposi sarcoma
High-grade B-cell non-Hodgkin lymphoma
Invasive cervical cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

When should we start ARVs in patients with HIV-associated nephropathy

A

start ART immediately irrespective of CD4 cell count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

When should we start ARVs in patients with end-stage kidney disease who are suitable candidates for renal transplantation

A

start ART immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Effect of starting ARVs in patients with HIV-associated nephropathy

A

HIV-associated nephropathy - typically encountered in black individuals with advanced immunodeficiency and detectable HIV RNA levels

ART = renal histological improvement, trend towards delayed progression to end-stage kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Which ARVs are associated with reductions in eGFR

A

tenofovir-DF
atazanavir
lopinavir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Which ARVs are recommended for patients with CVD risk factors

A

individuals with a high CVD risk:

First-line ARV therapy = tenofovir-DF + emtricitabine
or lamivudine and dolutegravir
or raltegravir
or rilpivirine

87
Q

What is the START study?

What did it show?

A

study of 4685 adults with CD4 >500 in 35 countries
Randomised to start ARV immediately or delayed until CD4 <350
Reduced adverse events by 57% at 3 years in immediate group (relative risk)
ARR = 2.3%

Similar between high and low income countries

88
Q

Define primary HIV infection

A

HIV within 6 months of transmission

89
Q

In primary HIV infection when should ART initiation be prioritised

A

All patients should be offered immediate ART.
Prioritise primary HIV if
- low CD4
- high VL (>100,000)
- short test interval (e.g within 12 weeks of prev negative test)

90
Q

Which ARV is the only ARV with a licence for use during pregnancy?

A

zidovudine

91
Q

What proportion of HIV +ve pregnant women are diagnosed before the current pregnancy?

A

80%

of whom 60% were already on ART at conception

92
Q

Which ARV should be avoided in patents with current or past mental health issues

A

Avoid efavirenz

If a current or past history of depression, psychosis, suicidal ideation, attempted suicide, risk of self-harm

93
Q

Impact of HIV on BMD

A

HIV-1-positive individuals have lower BMD at the femoral neck, hip and lumbar spine

HIV is an independent risk factor for low BMD

94
Q

What impact does initiation of ART have on BMD

A

Initiation of ART is associated with a reduction in BMD of 2–6%

bone loss is generally restricted to the first year with a relatively stable pattern thereafter
Intermittent use of ART is associated with reduced bone loss during follow up

95
Q

For women conceiving on cART what is the minimum number of CD4 cell tests taken during pregnancy

A

women conceiving on cART
Minimum of 1 CD4 cell count at baseline
and one at delivery

96
Q

Recommended ARV combination in pregnancy

A 
Abacavir / lamivudine 
OR 
Tenofovir DF / emtricitabine
AND
Efavirenz
OR
Atazanavir/r
97
Q

For women diagnosed with HIV in pregnancy when should ARVs be started

A

Start cART as soon as possible if baseline viral load >100,000

Or at the start of the second trimester if baseline viral load 30,000 - 100,000

Or as soon as able to in second trimester where the baseline viral load ≤30,000

All women should have commenced cART by week 24 of pregnancy

98
Q

What impact may hyperemesis have on timing of starting ARV for newly diagnosed HIV in pregnancy

A

May need to defer treatment to the start of the second trimester if the woman is experiencing nausea and/or vomiting of pregnancy

99
Q

What is the timeframe for the cut off of a ‘late-presentation’ of HIV in pregnancy

A

HIV diagnosed or HIV +ve patient presenting at 28/40 + = late presentation

Should commence cART without delay.

100
Q

What is the deciding factor for whether a HIV +ve pregnant patient can have a vaginal birth

A

vaginal delivery is possible if the woman commences cART and achieves a viral load of <50 HIV RNA copies/mL by 36 weeks

101
Q

Management of an untreated HIV +ve woman presenting in labour at term

A

STAT dose of nevirapine 200 mg
and commence oral zidovudine 300 mg and lamivudine 150 mg bd;
and raltegravir 400 mg bd;
and IV zidovudine for the duration of labour - until cord clamped

And high risk neonatal management by paediatric team

If delivery is not imminent, a CS should be considered.

102
Q

Why is a STAT dose of nevirapine advised for untreated HIV +ve women presenting in labour at term

A

Nevirapine rapidly crosses the placenta
achieves effective concentrations within 2 hours
and maintains concentrations in the neonate for up to 10 days

103
Q

Management if a woman’s HIV status is unknown during labour

A

a point-of-care test (POCT)
If test is positive (reactive) perform a confirmatory test Start treatment to prevent vertical transmission immediately

Baseline samples for CD4 cell count, viral load and resistance should be collected. T

Three-drug PEP should be given to the neonate

104
Q

Can HIV positive pregnant women have invasive diagnostic tests if required?
e.g. Amniocentesis

A

Deferr until HIV viral load suppressed to <50 HIV RNA copies/mL

If not on cART and the invasive procedure cannot be delayed until viral suppression is achieved - recommended to start cART to include raltegravir and give a STAT dose nevirapine 2–4 hours prior to the procedure

105
Q

Can HIV positive pregnant women have an ECV if required?

A

Yes

if plasma viral load <50 HIV RNA copies/mL.

106
Q

Mode of delivery for pregnant HIV +ve women with plasma viral load of 50–399 HIV RNA copies/mL at 36 weeks

A 
pre-labour CS should be considered
taking into account:
- the actual viral load
- the trajectory of the viral load
- length of time on treatment
- adherence issues
- obstetric factors 
- woman’s views
107
Q

Mode of delivery for pregnant HIV +ve women with plasma viral load of ≥400 HIV RNA copies/mL at 36 weeks

A

pre-labour CS

108
Q

Can HIV positive pregnant women be offered Vaginal birth after CS

A

VBAC can be offered if

VL <50 HIV RNA copies/mL

109
Q

Can HIV positive pregnant women have a water birth after CS

A

Scant safety evidence to support water births I

Women who choose a water birth should be supported
where the viral load is <50 HIV RNA copies/mL

110
Q

Neonatal management for the prevention of vertical transmission of HIV
for Very low risk infants

A

Infant PEP should be started within 4 hours of delivery

VERY LOW RISK
If ALL of the following criteria are met:
• The woman has been on cART >10 weeks
• 2 documented maternal HIV VL <50 HIV RNA during pregnancy at least 4 weeks apart;
• Maternal HIV viral load <50 HIV RNA copies/mL at or after 36 weeks

= 2 weeks zidovudine monotherapy recommended i

111
Q

Neonatal management for the prevention of vertical transmission of HIV
for low risk infants

A

LOW RISK = Not all criteria for very low risk are met.
BUT maternal VL <50 HIV at time of delivery
OR infant born prematurely (<34 weeks) but most recent maternal HIV viral load is <50 HIV RNA copies/mL.

= zidovudine monotherapy extended to 4 weeks

112
Q

Neonatal management for the prevention of vertical transmission of HIV
for high risk infants

A

HIGH RISK = maternal birth HIV viral load is known or likely to be >50

Use combination PEP

113
Q

What factors increase the risk of HIV transmission via breast milk when women are not on cART

A

Detectable HIV viral load
Advanced maternal HIV
Longer duration of breastfeeding
Breast and nipple infection/inflammation
Infant mouth or gut infection/inflammation
Mixed feeding, in particular solid food given to infants <2 months age

114
Q

What treatment should be offered to women with HIV who are advised not to breastfeed

A

offere cabergoline to suppress lactation

115
Q

In what circumstances may HIV positive women be supported to breastfeed in the UK

A

Women virologically suppressed on cART
+ good adherence
+ who choose to breastfeed
should be supported t

Inform about the low risk of transmission of HIV through breastfeeding
and the requirement for extra maternal and infant clinical monitoring - monthly review incl VL

116
Q

For women living with HIV when should cervical Cytology should be scheduled post-partum

A

Cytology should be scheduled 3 months post-delivery

117
Q

SE of nevirapine

A

Nevirapine = NNRTI (non-nucleoside reverse transcriptase inhibitor)

10% experience grade 3 - 4 hepatotoxicity
some require liver transplant or die

118
Q

What is in kaletra

A

Kaletra = lopinavir + ritonavir

= PI (protease inhibitor)

119
Q

SE of kaletra

A

nausea and vomiting
diarrhoea
hyperlipidaemia

co-adminisgtered with an anti-emetic and anti-diarrhoea if used for PEPSE (not first line for PEPSE)

120
Q

What class of ARV is Maraviroc

A

CCR5 receptor antagonists

121
Q

SE of Maraviroc

A

few SE

well tolerated

122
Q

If a HIV +ve patient has a CD4 count <200/mm3 what should they recieve in addition to ARVs?

A

CD4 count < 200/mm3
should receive prophylaxis against Pneumocystis jiroveci pneumonia
= co-trimoxazole

123
Q

Signs of PCP infection

A

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)

124
Q

Symptoms of PCP

A 
SOB
dyspnoea
dry cough
fever
very few chest signs

HIV +ve patient - CD4 <200

125
Q

Treatment of PCP

A

co-trimoxazole
IV pentamidine if severe

steroids if hypoxic ( reduce risk of respiratory failure and death)

126
Q

What additional baseline

investigations do pregnant women who are newly diagnosed with HIV require (BHIVA)

A

No additional baseline investigations

Those routinely offered

127
Q

What proportion of children diagnosed with HIV in the UK were born abroad?

A

2 / 3

128
Q

what psychosocial issues may exist around HIV and pregnancy

A

The majority engage well with care during pregnancy

psychosocial challenges may exist such as:
stigma
discrimination 
poor mental health 
unemployment
lack of financial resources 
immigration status 
housing concerns
lack of social support
intimate partner violence /  gender-based violence
substance misuse
129
Q

Recommendations regarding psychosocial care of women newly diagnosed with HIV during pregnancy

A
  • significant psychosocial stress / trauma
  • complex mix of emotional, psychosocial, relationship, economic +/- legal issues.
  • prompt link to HIV care
  • offer psychological support soon after diagnosis
  • support to inform others - partner / social support network
  • encourage timely partner testing during the pregnancy
  • HIV testing of existing children should be raised
130
Q

Recommendations regarding perinatal mental health assessment in HIV positive pregnant women

A

Assessment of antenatal and postnatal depression should be undertaken
at booking
4–6 weeks postpartum
3–4 months postpartum

131
Q

what sexual health screening is recommended for pregnant women newly diagnosed with HIV

A

Screen for STIs

and for BV

132
Q

Management of a HIV positive pregnant women with abnormal cervical cytology

A

undergo colposcopy in late first or early second trimester

For low-grade changes triaged to colposcopy on the basis of a positive HPV test - the assessment may be delayed until after delivery.

133
Q

Management of a HIV positive pregnant women who requires colposcopy or cervical cytology after cervical treatment but becomes pregnant in the interrim?

A

assessment may be delayed until after delivery

Do not delay, (unless CI) if it is follow-up after treatment for cervical glandular intraepithelial neoplasia

134
Q

Recommendations regarding resistance testing for women newly diagnosed with HIV during pregnancy

A

HIV resistance testing should be completed and results available prior to initiation of ARVs
EXCEPT - late-presenting women (after 28 weeks)

135
Q

Recommendations regarding resistance testing and ART initiation for women newly diagnosed with HIV during pregnancy - presenting after 28 weeks

A

Start cART without delay

modify regimen once the resistance test is available

136
Q

Recommendations regarding CD4 cell count testing for women newly commencing ART during pregnancy

A

CD4 cell count at initiation of cART
Plus at delivery
even if starting at CD4 >350 cells

137
Q

Recommendations regarding HIV VL testing for women newly commencing ART during pregnancy

A

HIV viral load performed 2–4 weeks after commencing cART
at least once every trimester
at 36 weeks
at delivery

138
Q

Management of a woman who has initiated cART during pregnancy and has not suppressed plasma
viral load to <50 HIV

A
  • Review adherence
  • Review concomitant medication;
  • Perform resistance test if appropriate;
  • Consider therapeutic drug monitoring (TDM);
  • Optimise to best regimen;
  • Consider intensification
139
Q

If a HIV positive pregnant woman is not on ART when should it be commenced?

A
  • 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

140
Q

If ART commenced in pregnancy what should be started?

A

Start Tenofovir DF or Abacavir
with Emtricitabine or Lamivudine

Third agent - efavirenz or atazanavir

141
Q

when is the only time that Zidovudine monotherapy is considered in HIV +ve pregnant women

A

only used in women declining cART
with a viral load of <10,000
and willing to have a caesarean section

142
Q

Management of an untreated HIV +ve woman presenting in labour at term

A

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

143
Q

Management of a women presenting in labour or with spontaneous rupture of the membranes (SROM) without a documented HIV test result?

A

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

144
Q

recommended investigations on diagnosis of new HBV infection in a pregnant F with HIV co-infection?

A

Confirm viraemia
Quantitative HBV DNA,
‘e’ antigen status
AND hepatitis A, C and D tests
Test to assess hepatic inflammation/fibrosis and liver function
LFTs repeated at 2 + 4 weeks after commencing ART then monitored regularly throughout pregnancy and postpartum

145
Q

Which ARVs are recommended for treatment of pregnant women with HIV and HBV co-infection?

A

Tenofovir DF and emtricitabine or lamivudine should form the backbone

146
Q

What is the recommendation regarding delivery route for a pregnant woman with HIV and HBV co-infection

A

Vaginal delivery can be recommended
IF the HIV VL is fully suppressed on ART,
Irrespective of HBV viral load

147
Q

When is HAV vaccination recommended in pregnancy non-immune women with HBV and HIV co-infection

A

HAV vaccine recommended after the first trimester
- 0 and 6 months

UNLESS CD4 count <300 = give an additional dose = 0, 1 and 6 months

148
Q

Management of an infant born to a woman with HBV

A

Neonatal immunisation +/- hepatitis B immunoglobulin commenced within 24 hours of delivery

149
Q

BHIVA recommendations on invasive pre-natal diagnostic tests for women who are HIV +ve

A

Deferred until HIV viral load suppressed to <50 HIV RNA copies/mL

150
Q

Can ECV be offered to HIV +ve pregnant women

A

Yes - if on ART and plasma viral load <50 HIV RNA

copies/mL.

151
Q

HIV +ve pregnant women can be offered a vaginal delivery if the VL is less than……

A

plasma viral load of <50 copies/mL at 36 weeks

planned vaginal delivery should be supported

152
Q

Recommended delivery method for HIV +ve pregnant women with a plasma viral load of 50-399 copies/ml at 36 weeks?

A 
Consider pre-labour CS 
Take into account the actual viral load
VL trajectory 
Duration on treatment
Adherence issues
Obstetric factors
Patient preference and views
153
Q

For a HIV +ve patient with SROM in what timeframe should delivery be aimed for?

A

In all cases of term pre-labour SROM in HIV +ve women

Aim for delivery within 24 hours

154
Q

When is Intrapartum intravenous zidovudine infusion recommended?

A
  • 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.
155
Q

BHIVA advice re PEP for infants of HIV +ve mothers

A

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

If infant at HIGH RISK - Use combination PEP = zidovudine, lamivudine and nevirapine
- maternal VL is >50 on day of birth, uncertain or unknown VL

156
Q

when should neonatal PEP should be commenced?

A

As soon as possible after birth

At least within 4 hours

157
Q

Maximum duration of infant PEP advised by BHIVA

A

4 weeks

158
Q

Factors which reduce vertical transmission of HIV

A

Reduce risk from 25-30% to 1-2%

  • maternal antiretroviral therapy
  • mode of delivery (caesarean section)
  • neonatal antiretroviral therapy
  • infant feeding (bottle feeding)
159
Q

Toxoplasmosis accounts for what % of cerebral lesions in patients with HIV

A

50%

160
Q

Symptoms of toxoplasmosis in patients with HIV

A

constitutional symptoms
headache
confusion
drowsiness

161
Q

CT findings of toxoplasmosis in HIV +ve patient

A

CT head
single or multiple ring enhancing lesions
mass effect may be seen

162
Q

management of toxoplasmosis

A

management: sulfadiazine and pyrimethamine

163
Q

What stains with India ink

A

Cryptococcus neoformans

164
Q

Most common cause of diarrhoea in HIV +ve patients

A

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

165
Q

in what % of patients is HIV seroconversion symptomatic

A

60 - 80%

166
Q

typical presentation of HIV seroconversion illness

A

Occurs 3-12 weeks after infection

sore throat
lymphadenopathy
malaise, myalgia, arthralgia
diarrhoea
maculopapular rash
mouth ulcers
rarely meningoencephalitis
167
Q

Window period for HIV testing

A

4 weeks for 4th generation tests

12 weeks for all other tests

168
Q

In patients with HIV

which infections pose a greater risk of complications

A

hepatitis B
hepatitis C
syphilis
herpes simplex virus

169
Q

How often should HIV+ ve positive patients be offered an STI screen

A

Annually - regardless of history

or more often based on risk / history

170
Q

How often should HIV+ve positive patients be offered a syphilis blood test

A

at baseline

and 3-monthly intervals - taken as part of the routine HIV blood set to detect asymptomatic syphilis

171
Q

How often should HIV+ve positive patients be offered an Hep B / C blood test

A

screen at baseline
If HBV negative offer vaccination
then offer Hep B / C screen annually in those who have exposure risks and are not immune to HBV

172
Q

BHIVA recommendations for STI and hepatitis screening at Baseline in patients diagnosed with HIV

A

Baseline

  • full STI screen
  • include syphilis serology f
  • include pharyngeal and rectal NAAT for MSM ( heterosexual women depending on history)
  • Hepatitis A ( gG or total)
  • Hepatitis B (Surface antigen - HBsAg, Anti-core total antibody - anti-HBc, Anti-surface antibody - anti-HBs)
  • Hepatitis C (antibody)
173
Q

BHIVA recommendations for STI and hepatitis screening annually in patients diagnosed with HIV

A

Annually

  • NAAT for GC / CT
  • Syphilis serology if partner change since the last test;
  • Hepatitis B
  • Hepatits C (in at-risk patients)
174
Q

BHIVA recommendations for STI and hepatitis screening Three-monthly in patients diagnosed with HIV

A

3-monthly screening for STIs
if high risk factors for acquisition
e.g. MSM / frequent partner change / chemsex / IVDU / chaotic lifestyle / CSW / recent tattoo abroad / recent blood transfusion abroad

175
Q

BHIVA recommendations for Hep C screening in patients diagnosed with HIV

A

HCV antibody at baseline
at least annually
Anti-HCV and HCV-PCR if raised transaminases or recent high-risk exposure
(If prior HCV clearance do HCV-PCR only)

176
Q

recommendation for cervical screening frequency in women living with HIV

A

annually

177
Q

Advice for patients living with HIV regarding conception options when partner is HIV-negative

A

If VL suppressed on ART for at least 6 months
and no evidence of an STI
- timed (with ovulation) condomless sex can be recommended

If detectable HIV-RNA despite optimal ART - consider PrEP-C ( for Conception)

178
Q

Pre-pregnancy health recommendations for women living with HIV

A
  • Folic acid (400mcg daily) commenced prior to conception If on folate antagonists (e.g. co-trimoxazole) or has other indications give folic acid 5mg throughout pregnancy.
  • general lifestyle advice - alcohol, smoking, recreational drugs, ideal weight
  • vitamin D supplementation
  • sexual health screens
  • if CD4 count <200 advise deferring pregnancy until virological suppression and immune reconstitution are attained
179
Q

What is TOCS and when can it be recommended

In context of HIV

A

timed ovulatory condomless sex (TOCS)

can be recommended if HIV VL undetectable for >6 months
adherence is good
no concomitant STI in either partner

Based on HPTN 052 and PARTNER studies

180
Q

What is sperm washing

A

HIV positive partner’s sperm is centrifuged to separate spermatozoa from seminal fluid and associated non-sperm cells.

181
Q

When may sperm washing be recommended

A

HIV plus coinfection with Hepatitis B or C

182
Q

What investigations are recommended for women attempting to conceive via timed UPSI in a zero-discordant couple

A

Blood Tests

  • HIV
  • Hepatitis B + C
  • Syphilis
  • FSH, LH and Oestradiol days 2-5 of cycle
  • Progesterone 7 days before expected day of next period (usually day 21)
  • Prolactin & thyroid function if history of amenorrhoea/oligomenorrhoea
  • Rubella serology
  • STI Screen - NAAT chlamydia + gonorrhoea
183
Q

what is the recommended timeframe to try to conceive for before referral to fertility team for women attempting to conceive via timed UPSI where their partner is HIV + ve

A

F <35yo - try for 6-12 months

F >35 - try for 6 months

184
Q

What investigations are recommended for the man when attempting to conceive via timed UPSI (in serology-discordant couples)

A

Blood Tests

  • HIV
  • Hepatitis B + C
  • Syphilis
  • semen analysis
  • STI Screen - NAAT chlamydia + gonorrhoea
185
Q

Which contraceptives can be used with NRTI ARVs?

A 
NRTI class of ARVs are renally eliminated 
are not metabolised by CYP450 nor glucuronidation pathways

can be used with ALL contraceptives

186
Q

which contraceptive methods can be used with the NNRTI - efavirenz
and why

A

efavirenz
both inhibits and induces enzyme pathways involved in metabolising ethinyl estradiol (EE) = net neutral effect
BUT
significantly lowers progestogen levels

Hence only safe to use with IUD, LNG-IUS and POIC

187
Q

FSRH advice on women using enzyme inducing ARTs and requiring EC

A

recommend IUD
if declined - offer double dose levonorgestrel
UPA should be avoided

188
Q

What psychological factors may erectile dysfunction be associated with in the context of HIV

A 
fear of onward transmission of HIV
disclosure concerns
changes in body image
stigma
issues around condom usage
189
Q

What % of HIV diagnoses are made via partner notification?

A

<3% only

190
Q

History to be taken for all newly diagnosed HIV-positive patients

A 
• General medical (including symptoms)
• Psychosocial
• Sexual and reproductive health
• Past and current co-morbidities
• Concomitant medications
• Lifestyle
• HIV status of sexual partners and children
• Conception issues
• Knowledge and beliefs about HIV infection, HIV
transmission and HIV treatment
• Partner notification
• HIV testing of children
• Current or previous intimate partner violence
• Vaccination
• Lifetime travel
  • current or previous mental health problems
  • neurocognitive problems
  • current social and welfare situation
  • employment status
  • immigration status
191
Q

Baseline examination for all newly diagnosed HIV-positive patients

A

weight, height, BMI,
blood pressure
waist circumference

192
Q

Baseline investigations for all newly diagnosed HIV-positive patients

A 
• Confirmation of HIV-1/-2 status
• Test for primary HIV infection (PHI)
• HIV-1 plasma viral load
• HIV-1 drug-resistance test
• CD4+ T cell count (absolute and percentage)
• Hepatitis A virus IgG (or total)
• Hepatitis B tests
• Hepatitis C virus antibody
• full STI screen (including syphilis)
• Measles/varicella antibodies (according to
vaccination/infection history)
• Full blood count
• Renal profile
• Liver profile
• Bone profile
• Dipstick urinalysis +/-  urine protein/creatinine ratio
  • HLA-B*57:01 if abacavir therapy being considered
  • Viral tropism test if a CCR5 inhibitor being considered
  • Cardiovascular risk assessment if >40yrs (QRISK2)
  • FRAX tool if >50 years / post-menopausal F or other high risk

And for women:
• Cervical cytology (if aged 25-65 and not done in the last 12m or never done)
• Rubella in women of child-bearing potential

193
Q

Monitoring in the first 6 months after starting ART

A
  • Adherence and tolerability check
  • Examination according to any symptoms
  • U+Es
  • LFTs
  • Urine dipstick
  • FBC: only if patient is unwell or started zidovudine
  • CD4 count - After 3 months if baseline <350
  • CD4 count at 6 months if it was still <350 at 3 months post-ART.

• HIV viral load - Measure at 1, 3 + 6 months

194
Q

Monitoring of patients established on ART and with the viral load suppressed

A

Annual
• HIV viral load
• CD4 count
• FBC / renal / liver / bone profiles
• urine dipstick
• STI screen
• Hepatitis A/B /C infection/immunity status
• Cervical smear for women if not done by GP
• Metabolic assessment: (if age >40 years) lipid profile, HbA1c

History at each visit:
• medication history + recreational drug use
• Understanding of dosing instructions
• Adherence
• Mood
• Adverse effects
• Patients’ concerns about medication

Examination - based on symptoms

195
Q

Additional monitoring of patients presenting with advanced disease (CD4 cell count <200 at first presentation)

A

If symptoms test for:
Toxoplasma
Cryptococcus
mycobacterial infection

Monitor for IRIS - esp within 3 months of starting ART

196
Q

What does NRTI stand for

A

Nucleoside reverse transcriptase inhibitors = NRTI

e.g. Truvada = Tenofovir DF and emtricitabine
Abacavir
lamivudine
zidovudine

197
Q

What does INI stand for

A

Integrase inhibitors = INI

E.g. Raltegravir
Elvitegravir
Dolutegravir

198
Q

What does NNRTI stand for

A

Non-nucleoside reverse transcriptase inhibitors = NNRTI

E.g. Nevirapine
Efavirenz
etravirine
rilpivirine

199
Q

Serious side effect reported of etravirine

A

Stephens Johnson Syndrome

200
Q

What does PI stand for

A

Protease Inhibitors = PI

E.g. Kaletra (lopinavir/ritonavir)
darunavir
atanzavir

201
Q

Side effects of Kaletra (lopinavir / ritonavir)

A

hyperlipidaemia

frequently causes gastrointestinal disturbances

necessitating provision of anti-diarrhoeal and antiemetic medication

202
Q

Side effects of daurnavir

A

frequently causes gastrointestinal disturbances

May require provision of anti-diarrhoea and antiemetic

203
Q

Which medication is a CCR5 receptor antagonist

A

Maraviroc

well tolerated

204
Q

worldwide what % of HIV is transmitted by IVDU

A

1 in 10 new diagnoses worldwide due to IVDU

205
Q

Outside of the African continent what % of HIV is transmitted by IVDU

A

1 in 3 new diagnoses

206
Q

Complications of PCP

A

Respiratory failure / ARDS
Requiring ventilation
Death
Worsening symptoms after treatment started
Pulmonary cyst formation
Harmatogenous spread to - bone marrow, liver, spleen, eyes, GI tract, Lymph nodes

207
Q

Mortality from PCP

A

10 -20%

Increases to 65% if ventilation is required

208
Q

Risks of dolutegravir in pregnancy

A

?increase in birth defects
Tsepamo study - Botswana

Neural tube defects

209
Q

Opportunistic infection prophylaxis

A

Trimethoprim + sulfamethoxazole - for PCP and toxoplasmosis prophylaxis

Dapsone + pyrimethamine = alternate PCP prophylaxis

Azithromcyin or Clarithromycin - MAC prophylaxis

Itraconazole - histoplasmosis, penicilliosis prophylaxis

Atovoquone - alt for PCP prophylaxis

Isoniazid + pyridoxine - for latent TB prophylaxis
Rifampicin / rifabutin - for isoniazid resistant latent TB prophylaxis

210
Q

What vaccinations should be offered to HIV +ve patients

A 
Hep A
Hep B
Pneumococcal PCV13
Diptheria
Tetanus
HPV
Meningococcal ACWY
Flu

AVOID live vaccines
EXCEPT - do give - MMR and varicella vaccines if CD4 >200

211
Q

Management of a HIV +Ve patient exposed to chickenpox / shingles when CD4 <200

A

Give aciclovir or valaciclovir 7 - 10 days

212
Q

What 2 types of HIV POCT exist

A

INSTI - 20 second result - tests for HIV ab only = 3m window period

Determine (biosure) - 20 minutes result - tests for HIV ab and p24 antigen = 4 week window period

213
Q

How to perform the INSTI HIV POCT

A

patient wash and warm hands
Fingerprick + bleed
add a drop of blood to bottle 1 + shake
Pour bottle 1 into the well + wait until soaked in
Add bottle 2 into the well + wait until soaked in
Add bottle 3 to the well
wait ~20 seconds

1 dot = non reactive
2 dots = reactive
no dots = invalid

214
Q

How to perform the determine HIV POCT

A 
patient wash and warm hands
Fingerprick + bleed
use capillary tube to collect blood
touch capillary tube to the sample pad on the test strip
wait 1 minute and add buffer solution 
wait 20 minutes and read result

1 line = control
2 lower lines = for antibody and antigen

Dip GUM (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions