HIV/AIDS Flashcards
Incidence (new cases) of HIV in the US
Race, gender, sexual preference demographics in US
- 50,000 new cases in the US each year
- 2/3 new cases in US are gay or bi-sexual men
- HIV in gay male population is trending upward
- 80% of HIV in CO is MSM or Intravenous Drug Use
- 50% of pop with AIDS is > 50 yo
- African Americans at 8X more likely as whites to contract HIV (men and women)
Risks for HIV
- Type of sex - MSM is highest risk
- No condom use
- number of partners
- HIV status
- Meth, cocain, heroin use
- Needle sharing
Typical presentation of acute HIV infection
- Onset of symptoms w/in 14 days
- Fever
- Fatigue
- Weight loss
- Pharyngitis
- Myalgias (muscle pain)
- Rash
- Lymphadenopathy
- Night sweats
- Diarrhea
How to test for acute HIV and when do you test?
- Standard EIA (Enzyme Amino Assay) - HIV Ab and Western Blot; typically (+) 3 weeks to 3 months.
- EIA may be negative in acute infection
- 4th generation NAAT testing now preferred - P24Ag & HIV Ab; (+) in 10 days of infection
- PCR viral load
What is the progression over time of HIV infection wrt antigen and antibody and when/what can you detect with testing
- HIV RNA can be detected 10 days from infection and peaks at 30 days
- HIV p24 antigen follows same curve as RNA
- HIV antibody appears appx day 20 and can be detected by 3rd generation EIA at this time
When is prophylaxis treatment warrented, for how long, what’s the therapy, follow-up testing?
- Within 72 hours of a high-risk sexual encounter
- Triple drug therapy for 1 month
- Test 6 weeks, 3 months, 6 months
HIV(+) patient: In addition to routine Hx/screening that you would do with any other patient, what are specific exams/screens?
- Pelvic exam every 6 months until 2 consecutive negatives - female
- Testicular/rectal exam anually - male
- Hep A, B & C serologies - vaccinate for A,B
- TB testing annually - Quantiferon
- STD and Hep C screen anually
- Depression screen anually
- Genotype
- Toxiplasmosis screen
- Syphilis screen
- Anal and Cervical PAP
- Gonorrhea and Clamydia urine
Describe laboratory criteria for defining AIDS and identify AIDS-defining illnesses
- HIV + (Elisa/Western Blot or NAAT)
- CD4 + T-cell count < 200 (14%) and/or
- Opportunistic infection
- Helpful to do rotine viral load testing in HIV (+) patient
What are the AIDS defining illnesses?
- Pneumocystis Carinii Pneumonia (PCP)
- Kaposi’s Sarcoma (KS)
- HIV wasting syndrome
- Non-Hodgkin’s lymphoma
- Cryptococcosis (extrapulmonary)
- HIV encephalopathy (AIDS Dementia)
- Mycobacterium Avium Intracellulare (MAC or MAI)
More AIDS defining illneses
- Candidiasis of the esophagus, trachea, bronchi, or lungs
- Cryptosporidiosis, chronic intestinal
- Cytomegalovirus disease (CMV)
- Tuberculosis (outside of the lungs)
- Herpes simplex virus infection (disseminated)
- Progressive Multifocal Leukoencephalopathy (PML)
- Primary CNS lymphoma
- CNS Toxoplasmosis
Even more AIDS defining illnesses
- Pulmonary tuberculosis
- Recurrent bacterial pneumonia (two or more episodes in one year)
- Invasive cervical cancer
Prophylactic Tx for various AIDS defining illnesses:
Pneumocystitis
Toxoplasmosis
MAC (Mycobacterium Avium Intracellulare)
- Pneumocystitis -TMP/SMX (Bactrim) 1 tab daily when T-cell count <200
- Toxoplasmosis (for Antibody negative pts) - TMP/SMX (Bactrim) when T-cell count <100
- MAC - clarithromycin or axithromycin when T-cells <100
For HIV patients, who should be on medications?
- All HIV (+) patients should be on HAART....however:
- Definitely all patients with CD4 count <500
- Deferring therapy may be considered for patients with stable CD4 >500 and low viral loads
Others to consider:
•Pregnant women (always in consultation with OB)
•HIV-associated nephropathy
•Co-infected with Hepatitis B or C
•Cardiovascular disease (B rec.)
•Serodiscordant relationships
•Acute HIV infection
