HIV Clinical Overview

Question 1

Defining HIV over 18months

Answer 1

ELISA test reactive and another ELISA test reactive

Then confirmed

Question 2

Below 18 months

Answer 2

Maternal ABs could complicated the test so need to test at multiple stages

Question 3

1st and 2nd gen ELISA

Answer 3

Use IgG…problem is that you had to wait too long after acquisition

Question 4

3rd gen ELISA

Answer 4

Looked at IgG and IgM

Question 5

4th gen ELISA

Answer 5

Measures p24 antigen…now only 10-14 days after acquisition

Question 6

HIV diagnositc algorithim

Answer 6

If positive 4th gen immunoassay, then test for HIV-1, HIV-2…if that is negative, check the viral load

Question 7

How can you measure actual amount of HIV?

Answer 7

4th gen with viral lload

Question 8

Progression of HIV

Answer 8

Primary infection around 1000 CD4s, rapid drop then maybe increase during latency…eventually hits 0

Question 9

Acute HIV test

Answer 9

Detectable RNA, but negative or indeterminate AB test

Question 10

4 important HIV symtoms (acute)

Answer 10

Fever, lymphadenopathy, sore throat, rash

Question 11

What differentiates HIV from EBV

Answer 11

Mucocutaneous ulcerations

Question 12

Defining AIDS

Answer 12

HIV positive with CD4 ever below 200 OR

HIV positive and AIDS defining illness

Question 13

Individuals at risk for HIV screening

Answer 13

Yearly

Question 14

Most common HIV defining infection

Answer 14

PCP

Oral candidiasis common in HIV positive, even early stages

Question 15

BActerial HIV dz

Answer 15

Strep pneumo
H influenzae
P aeruginosa
S aureus

Question 16

Pneumo jiroveci phrophylaxis

Answer 16

CD4<200, use bactrim 1qd

Question 17

Toxo gondii prophylaxis

Answer 17

CD<100, use bactrim 1qd

Question 18

Mycobacterium avium complex prophylaxis

Answer 18

CD<50, azithromycin 1200 1qweek

Question 19

Candida albicans prophylaxis

Answer 19

Fluconazole used

Question 20

CMV can lead to

Answer 20

Blindness

Question 21

HIV most common in who and most common mode of transmission

Answer 21

Southern black males

MSM

Question 22

Most common methods of transmission

Answer 22

Needles, unprotected sex

Question 23

Other modes of transmission

Answer 23

Maternal or blood products

Question 24

Most important factor for maternal

Answer 24

Maternal HIV 1 RNA levels (viral load)

Question 25

Perinatal HIV treatment

Answer 25

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

Question 26

Follow up schedule for HIV exposed infant

Answer 26

Rule out at 4 weeks so that you can get vaccines…if not ruled out then need PCP prophylaxis

Question 27

Screening recommmendations

Answer 27

All patients 13-64 years should be screening using HIV AB

Question 28

Pregnant screening

Answer 28

Repeat in 3rd trimester for high rates of HIV

Question 29

OraQuick

Answer 29

20 minute fingerstick/ELISA test

Question 30

Goal of HIV tx

Answer 30

Primary - reduce and maintain plasma HIV RNA levels below point of detection
Secondary - preserve CD4 cell count

Question 31

Adequate ART response

Answer 31

Increase in 50-150 cells per year

Question 32

When to start ART

Answer 32

Should use with all diagnosed…evidence supports starting at higher CD4 counts

Recommended for prevention and treatment

Question 33

Infectious material

Answer 33

Anything with blood, semen, vaginal secretions, breast milk

Question 34

PEP management

Answer 34

Clean site, irrigate eyes

Question 35

Timing of PEP

Answer 35

Within hours…then test 6 weeks, 3 months, 6 months

Question 36

PrEP

Answer 36

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

Question 37

Medical contraindicationsd to PrEP

Answer 37

Documented HIV infection
Creatinine clearance <60 mL/min
Lack of readiness to adhere to therapies