HIV

Question 1

What does HIV stand for?

Answer 1

Human Immunodeficiency Virus

Question 2

How is HIV transmitted?

Answer 2

• Unprotected sexual intercourse: Increased risk if receiving, or trauma
• Mum to child transmission: can pass on in delivery or breastfeeding if uncontrolled/undiagnosed
• IVDU
• Occupational exposure:needle stick or mucosal exposure
• Blood transfusion: products screened now since 80s

Question 3

What does HIV do?

Answer 3

• HIV binding and integrating in human DNA can take 3-5 days after exposure
• HIV virions budding out destroys the hosts CD4 T lymphocytes

Question 4

What is the epidemiology of HIV?

Answer 4

Prevalent in:

• Gay and bisexual men
• Black african men
• Black african women
• People born outside the UK

Question 5

What is seroconversion?

Answer 5

• Time period during which a specific antibody develops and become detectable in the blood
• After seroconversion occurs, disease can be detected in blood tests for the antibody

Question 6

What is one measurable HIV antigen called? What is detected first, antigen or antibody in HIV after exposure?

Answer 6

• Called p24 antigen

* p24 Ag detected before HIV ab following exposure

Question 7

What are the stages of HIV presentation?

Answer 7

1. Primary HIV
2. Asymptomatic stage
3. Symptomatic Stage
4. Advanced HIV

Question 8

During the primary stage of HIV, what happens to the HIV plasma viral load and the CD4 count?

Answer 8

• Viral load goes up

* CD4 count goes down

Question 9

During asymptomatic stage of HIV, what happens to the HIV plasma viral load and the CD4 count?

Answer 9

• Viral loads goes down after primary stage

* CD4 count rises and stays stable (lower than normal but higher than was before)

Question 10

During late stages of HIV, what happens to the HIV plasma viral load and the CD4 count?

Answer 10

*Viral load dramatically goes up
*CD4 count drops significantly
(Opportunistic infection occurs)

Question 11

When does the primary HIV infection occur? What happens? HIV test reveals?

Answer 11

• Diagnosis within 6months of exposure
• Recent negative HIV test supports diagnosis
• Symptoms begin 2-6weeks after infection, lasting 5-10days
• Symptoms: fever, pharyngitis, lymphadenoapthy, rash
• HIV test revels: positive p24 Ag and negative Ab

Question 12

When does the asymptomatic stage of HIV infection occur? Lasts? How do you tell?

Answer 12

• After primary infection
• Lasts 5-10years
• only way to tell is by having HIV test
• although asymptomatic, on-going viral replication cause immune system damage

Question 13

What are the presentations possible in the symptomatic stage of HIV infection?

Answer 13

Non-specific:
*persistant lymphadenopathy, fever, myalgia, diarrhoea

Skin lesions:
*folliculitis, multi-site herpes zoster, myalgia, diarrhoea

Oral lesions:
*Candidiasis, oral hairy leukoplakia

Recurrent bacterial infections:
*pneumonia, impetigo

Abnormal blood results:
*thrombocytopenia, lymphopenia

Question 14

What happens in advanced HIV? How does it present?

Answer 14

• Linked to low CD4 (T lymphocytes)

* predisposes patients to opportunistic infections and certain cancer e.g. B cell lymphoma

Question 15

What investigations and monitoring should be done for a HIV patient?

Answer 15

Routine:
*U&Es, LFTs, FBC, lipid/bone profile, glucose

Serology:
*Hep A, B (SurfaceAg and core Ab), Hep C, syphilis

HIV viral load:
*Informs of disease progression rate, and monitors treatment response

CD4 cell count
*Main indicator of risk of opportunistic infections

Question 16

How is HIV treated?

Answer 16

*Treatable chronic condition, not curable
*Highly active antiretroviral therapy (HAART)
=3 different drugs in combination
*Patient commitment essential, good adherence needed

Question 17

How well are HIV drugs tolerated?

Answer 17

Generally very well

Question 18

What drugs interact and affect HIV medication?

Answer 18

*Steroids
*Statins
*Anti-anxiety/sedative
*Anticoagulants
*Chemotherapy
*Anti-TB
*Recreational drugs
*Antacids and multivitamins
(Liverpool drug interaction checker)

Question 19

When is standard HIV testing done?

Answer 19

• Test through opt out screening: Sexual health clinics, antenatal screening
• Mandatory screening: blood and organ donation
• Should test if in region of high HIV prevalence i.e. >2/1000
• Anyone with clinical indicators

Question 20

What is the window period for HIV testing?

Answer 20

• p24 antigen detected 2-4weeks after exposure
• HIV antibody present 4-8weeks after exposure
• 4th generation test (Ag/Ab) detect most infections at 4weeks
• 3rd generation test window period 12 weeks

Question 21

What HIV tests are available?

Answer 21

• Rapid point of care test =bedside test (like blood glucose test)
• Blood test sent off (v. accurate but not instant result)

Question 22

What is used for HIV prevention?

Answer 22

• Barrier contraceptive, condoms
• PrEP (Pre-exposure prophylaxis)
• PEPSE (Post Exposure prophylaxis)

Question 23

What should be done following a positive HIV result?

Answer 23

• Assess ongoing need for psychological support
• Explain HIV
• Explain ways it can be transmitted
• refer to HIV specialist clinic
• Explain anonymous partner notification

Question 24

What is PrEP? Used for?

Answer 24

• Pre-exposure prophylaxis
• Given to HIV negative people
• Taken before, during and after sex
• Can be taken daily, or around sexual activities

Question 25

What is PEPSE?

Answer 25

• HIV medication taken after high risk sex/exposure
• Within 72hours of risk (ideally 24hours
• Take for 28days
• 3 tablets
• Need for baseline HIV test and monitoring

Question 26

How do we prevent mother to child transmission of HIV?

Answer 26

• manage positive mum to make viral load low
• PEP for baby 4 weeks after birth
• Formula feeding (Low income =milk vouchers)