HIV Clinical Overview Flashcards
Defining HIV over 18months
ELISA test reactive and another ELISA test reactive
Then confirmed
Below 18 months
Maternal ABs could complicated the test so need to test at multiple stages
1st and 2nd gen ELISA
Use IgG…problem is that you had to wait too long after acquisition
3rd gen ELISA
Looked at IgG and IgM
4th gen ELISA
Measures p24 antigen…now only 10-14 days after acquisition
HIV diagnositc algorithim
If positive 4th gen immunoassay, then test for HIV-1, HIV-2…if that is negative, check the viral load
How can you measure actual amount of HIV?
4th gen with viral lload
Progression of HIV
Primary infection around 1000 CD4s, rapid drop then maybe increase during latency…eventually hits 0
Acute HIV test
Detectable RNA, but negative or indeterminate AB test
4 important HIV symtoms (acute)
Fever, lymphadenopathy, sore throat, rash
What differentiates HIV from EBV
Mucocutaneous ulcerations
Defining AIDS
HIV positive with CD4 ever below 200 OR
HIV positive and AIDS defining illness
Individuals at risk for HIV screening
Yearly
Most common HIV defining infection
PCP
Oral candidiasis common in HIV positive, even early stages
BActerial HIV dz
Strep pneumo
H influenzae
P aeruginosa
S aureus
Pneumo jiroveci phrophylaxis
CD4<200, use bactrim 1qd
Toxo gondii prophylaxis
CD<100, use bactrim 1qd
Mycobacterium avium complex prophylaxis
CD<50, azithromycin 1200 1qweek
Candida albicans prophylaxis
Fluconazole used
CMV can lead to
Blindness
HIV most common in who and most common mode of transmission
Southern black males
MSM
Most common methods of transmission
Needles, unprotected sex
Other modes of transmission
Maternal or blood products
Most important factor for maternal
Maternal HIV 1 RNA levels (viral load)
Perinatal HIV treatment
Mother should take AZT…AZT should be used at time of delivery depending on viral load…baby takes 6 weeks of AZT no matter what
Follow up schedule for HIV exposed infant
Rule out at 4 weeks so that you can get vaccines…if not ruled out then need PCP prophylaxis
Screening recommmendations
All patients 13-64 years should be screening using HIV AB
Pregnant screening
Repeat in 3rd trimester for high rates of HIV
OraQuick
20 minute fingerstick/ELISA test
Goal of HIV tx
Primary - reduce and maintain plasma HIV RNA levels below point of detection
Secondary - preserve CD4 cell count
Adequate ART response
Increase in 50-150 cells per year
When to start ART
Should use with all diagnosed…evidence supports starting at higher CD4 counts
Recommended for prevention and treatment
Infectious material
Anything with blood, semen, vaginal secretions, breast milk
PEP management
Clean site, irrigate eyes
Timing of PEP
Within hours…then test 6 weeks, 3 months, 6 months
PrEP
Not good enough by itself
Tenofovir/emtricitabine
Only give for 30 days and then have them come back, then give 560, then can give 90 days
Medical contraindicationsd to PrEP
Documented HIV infection
Creatinine clearance <60 mL/min
Lack of readiness to adhere to therapies
