HIV, AIDS, STDs

Question 1

Clinical course of HIV

Answer 1

• 6-8 weeks after initial exposure, some may experience vague low grade fever, fatigue, sore throat, or myalgias (seroconversion syndrome)
• latency period of no symptoms 6mo to 10 years (during this time, there is significant decline in T cells and immune function if left untreated)

Question 2

Categories (stages of HIV)

Answer 2

1. no AIDS defining illness and CD4>500 or total lymphocytes> 29
2. no AIDS illness and 200

Question 3

How to diagnose HIV

Answer 3

standard- ELISA for HIV antibodies

then if positive, confirm with WESTERN BLOT TESTING

Question 4

Examples of AIDS defining illnesses

Answer 4

• P jiroveci (ground glass)
• Kaposi sarcoma
• burkitt lymphoma
• Candidiasis of bronchi, trachea, lungs
• Toxo in brain/CMV
• HIV encephalopathy
• recurrent pneumonoia
• recurrent salmonella
• wasting syndrome
• M avium complex
• Cocccidiodomycosis

Question 5

When HIV is diagnosed…what to do next?

Answer 5

Must be reported to local health authorities, but partner notification varies

Question 6

When HIV diagnosed, what labs to draw?

Answer 6

• HIV genotype to identify strains that may be resistant to therapy
• quantitative assay (viral load)
• CD4 AND CD8 every 3-6 months
• CBC, CMP, UA baseline and to monitor for complications
• Serology for toxo and CMV

Question 7

What to also screen for when HIV diagnosed?

Answer 7

other STDs like syphilis, hep B and C, G/C, herpes

offer Hep A and B vaccines, PPD testing, and HPV/pap smears

Question 8

Treatment for HIV

Answer 8

immediate referral to ID specialist and doctor with expertise in treating AIDS related conditions

HAART to keep viral load down

Question 9

What prophylaxis should be done

Answer 9

• annual attenuated influenza vaccine and pneumococcal vaccine (before CD4

Question 10

What preventative measure is CONTRAindicated to HIV patients and their household members/close contacts

Answer 10

LIVE VIRUS VACCINES

Question 11

Stages of syphilis infection

Answer 11

primary - PAINLESS chancre, at site of infxn usually genitals
secondary - skin rash, neuro symptoms, eye abnormalities
tertiary - cardiac or granulomatous lesions (gummas)

Question 12

How to dx syphilis

Answer 12

1st do RPR or VRDL

then confirm with FTA ABS (treponemal antibody)

Question 13

Who should get screened for syphilis

Answer 13

all pregnant women to prevent congential syphilis

anyone found to have another STD or high risk

Question 14

Treatment for syphilis

Answer 14

penicilin G!

doxy, ceftriaxone, tetracycline if allergy to PCN