HIV and AIDs

Question 1

Mode of spread

Pathophysiology

Answer 1

Unprotected sex
IVDU
Vertical - pregnancy, birth, breastfeeding

HIV preferentially infects and destroys CD4 => IC

Question 2

Presentation of seroconversion illness

• timeline
• symptoms
• diagnosis

Answer 2

3 months post infection

Similar to glandular fever - non specific

• fever, pharyngitis, hepatosplenomegaly
• systemically unwell - joint, muscle pain

GOLD STANDARD - HIV p24 antigen, antibody test
-if positive => repeat

Question 3

HIV screening

-who?

Answer 3

Seroconversion suspected

AIDs defining condition

• PCP, TB
• CMV retinitis
• lymphoma
• Kaposi’s sarcoma
• candida

A&E admissions
Routine antenatal check

Question 4

Management

• supportive
• medical
• pregnancy

Answer 4

Supportive
-safe sex, needle exchange

Medical - ART (2NRTIs, 1PI/NNRTI)
-reduce viral replication and resistance

Pregnancy

• maternal and neonatal ART
• caesarean + bottle feed

Question 5

Monitoring HIV

-aims

Answer 5

CD4 count - 500+ target
-U200 => increased risk of AIDs defining illness

Viral load - PCR

• high viral load - high infectivity
• also a measure of adherence, resistance, medication interaction

Question 6

Prevention of infection

-when to use what

Answer 6

Prep - HIV negative but high risk of receiving virus

HIV exposure at work => ART

PEPSE - unknown exposure within 3 days of exposure
-HIV tested within 3 months of exposure