HIV/AIDS

Question 1

What type of virus is HIV

Answer 1

RNA retrovirus

Question 2

HIV pathophysiology

Answer 2

Virus enters and destroys CD4 T helper cells

Initial seroconversion flu-like illness within a few weeks

Infection is then symptomatic until it progresses and patient becomes immunocompromised

Question 3

HIV transmission

Answer 3

Unprotected anal, vaginal or oral sexual activity

Mother to child at any stage of pregnancy, birth or breastfeeding (vertical)

Mucous membrane, blood or open wound exposure to infected blood or bodily fluids such as through sharing needles, needle-stick injuries or blood splashed in an eye

Question 4

AIDS-defining illnesses

Answer 4

Kaposi’s sarcoma

Pneumocystis jirovecii pneumonia (PCP)

Cytomegalovirus infection

Candidiasis (oesophageal or bronchial)

Lymphomas

Tuberculosis

Question 5

HIV screening

Answer 5

Patients with any risk factors should be tested

Antibody tests can be negative for 3 months following exposure so repeat testing is necessary

Patients need to give consent for test

Question 6

Testing for HIV

Answer 6

Antibody blood test (used in hospitals, option for self sample with online kit)

Testing for the p24 antigen (checks directly for this specific HIV antigen in the blood, can give earlier result)

PCR testing for the HIV RNA levels tests directly for quantity of the HIV virus in the blood and gives a viral load

Question 7

CD4 count

Answer 7

500-1200 cells/mm3 is the normal range

Under 200 cells/mm3 is considered end stage HIV/AIDS

Question 8

HIV treatment

Answer 8

Coordinated by specialist HIV or GUM centres

Combination of antiretroviral therapy ART medications

Offered to everyone with a diagnosis of HIV irrespective of viral load or CD4 count

BHIVA guidelines (2015) recommend a starting regime of 2 NRTIs (e.g. tenofovir and emtricitabine) plus a third agent

Aim of treatment is to achieve a normal CD4 count and undetectable viral load

Question 9

What other treatment is given to HIV patients?

Answer 9

Prophylactic co-trimoxazole (Septrin) to protect against PCP

Close monitoring of CV risk factors

Yearly cervical smears

Up to date vaccinations & avoiding live vaccines

Question 10

Reproductive health in HIV patients

Answer 10

Condoms for vaginal and anal sex & dams for oral sex even when both partners positive

Partners should have regular HIV tests

Where affected partner has undetectable viral load pregnancy may be considered

Caesarean should be used unless mother has undetectable load

Newborns should receive ART for 4 weeks after birth

BF only considered where viral load is undetectable

Question 11

Post-exposure prophylaxis for HIV

Answer 11

Not 100% effective

Must be commenced within 72hrs

ART therapy - Truvada and raltegravir for 28 days

HIV tests initially and a minimum of 3moths post exposure

Abstain from unprotected activity for a minimum of 3 months until confirmed negative