HIV Flashcards
What is late diagnosis of HIV?
CD4<350
Advanced (or very late diagnosis) CD4<200
When should you start ART?
As soon as the person is ready but strongly recommended if:
Neurological involvement
AIDS defining illness
CD4<350
PHI within 12 weeks of previous negative test
Why start ART during PHI?
Enhance immune recovery
Limit size of HIV viral reservoir
Reduce risk of onward transmission
AIDS defining illnesses
TB Pneumocystis jiroveci PCP Cerebral toxoplasmosis Primary cerebral lymphoma Cryptococcal meningitis PML NHL Kaposi’s sarcoma CMV retinitis Cervical Ca Persistent cryptosporidiosis Recurrent pneumonia Oesophageal or pulmonary candidiasis MAC .......more
Which ARV can you not use oral/implant hormonal contraceptives with?
Efavirenz
Nevirapine
PIs boosted with ritonovir (darunavir, lopinavir, fosamprenavir)
Elvitegravir/cobicistat
In what conditions can health care workers with HIV do EPPs?
If viral load is consistently <50 and
must have 3 monthly viral loads
Be supported by occupational health consultant and HIV consultant
OI prophylaxis
Co-trimoxazole for PCP if CD4<200
What is KS?
Linked to human herpesvirus 8
Multi centric, non blanching painless lesions
Good prognosis if confined to skin, LN or minimal oral involvement, CD4>150
Poor prognosis if CD4<150, tumour associated with oedema, ulceration or KS in viscera
Testing for HIV in unconscious patient
Defer test if possible
Can perform if immediately necessary to save patients life or prevent serious deterioration
If retains consciousness give result as soon as practicable
When should you use a POCT for HIV?
High risk/high prevalence individuals
Has low specificity so poor PPV esp in low prevalence areas
Baseline tests for newly diagnosed HIV
If repeat HIV not done then repeat to confirm diagnosis HIV 1/2
Then Plasma viral load Resistance test CD4 count STI screening Hep A B C Syphilis FBC Renal profile Liver profile Bone profile Dipstick urine for proteinuria Measles varicella ab (according to vacc or infection hx)
What monitoring should done for HIV pregnant woman commencing on ART?
CD4 at minimum start of pregnancy and at delivery
Viral load 2-4 weeks after starting, every trimester, 36 weeks and at delivery
Risk of MTCT of HIV
If viral load <50 then 0.1%
If unaware of status 20-35% (but may be greater if high viral load, obstetric factors and breastfeeding)
What monitoring does a HIV positive mother and her baby need if breastfeeding.
Viral load at delivery and every month of breastfeeding and 4 a
