HIV and HIV testing in clinical practice Flashcards
What does HIV stand for?
human immunodeficiency virus
- human =affects humans and is transmitted between humans
- immunodeficiency = weakens the immune system by depletion of CD4 helper cells
- virus = retrovirus = infects lymphocytes and turns them into virus producing factories
What does AIDs stand for?
acquired immune deficiency syndrome
- clinical syndrome of illness caused by HIV
- AIDs defining illness = PCP, kapsosi’s, TB
- CD4 count<200
aim is to prevent AIDS by early diagnosis of HIV
How is HIV transmitted?
Sexual transmission
Parenteral transmission - direct inoculation by contaminated needles or infected blood products
Vertical transmission - mother-child during pregnancy, delivery or breastfeeding
In the UK what is considered high prevalence for HIV?
> /= 2 PER 1000
What is the natural history of HIV infection?
Primary HIV/HIV seroconversion
- flu like or non-specific viral illness
- high viral load in blood or other body fluids
- initial depletion of CD4 cells
Chronic HIV infection
- asymptomatic = vary from months to years
- symptomatic: HIV indicator diseases
- AIDs: AIDs defining conditions
What are the advantages of early diagnosis?
access to anti-retroviral treatment = with appropriate treatment HIV patients have a near normal life expectancy
reduced morbidity- less illness
reduced mortality - less death
reduced transmission - less HIV = PUBLIC HEALTH DRIVE = U=U => undetectable = untransmissible
What do the majority of HIV patients die from?
something unrelated to HIV
if diagnosis is too late though then they will likely die from HIV
How does treatment reduce transmission?
lower viral load means less transmission
also behaviour change
What target did the UK hit in the last 12 months?
90% of HIV +ve people being diagnosed
Why is HIV diagnosed late?
not enough people are tested
- on average HIV pts had 4 medical visits in the 12 months prior to diagnosis
- in the 2yr prior to diagnosis - 60% late presenters seen in secondary care (25% with HIV related condition), 80% late presenters seen in primary care (60% with HIV related condition)
How do we increase HIV testing?
best results from opt out testing strategies
- antenatal screening
- GU screening
HIV testing should be “normal” not “exceptional”
- CF screening for diabetes
- cf CXR in a smoker
no counselling needed to just informed consent
clinicians need to know who to test
Who should be tested for HIV?
universal / opt out testing
- GUM clinic
- antenatal clinics
- termination of pregnancy services
- drug dependency programmes
- healthcare systems for those diagnosed with tb, hep b, hep c and lymphoma
Which groups of people are part of the targeted testing?
in settings where prevalence is high -ALL men and women registering at GP - ALL general medical admissions Blood donors Dialysis patients Organ donors Organ recipients ALL pts where risk is identified: - STI - partner of known HIV - MSM - Female contact with MSM - Drug users - from high prevalence country - sexual contact with person from high prevalence country
What testing recommendations have been offered for GPs?
indicator condition from (or partner) area of high prevalence MSM Trans women who has sex with men high risk sexual practice diagnosis or test for other STI hx IDU partner of known HIV
What testing recommendations are advised to secondary care?
drug dependency programmes termination of pregnancy services services for: - hep b - hep c - lymphoma - TB \+ all indications of GPs
