HIV epidemiology and confidentiality

Question 1

What were the UNAIDS goals?

Answer 1

90% of people living with HIV being diagnosed
90% diagnosed on ART
90% viral suppression for those on ART by 2020

Question 2

What do the two blood tests done for HIV measure?

Answer 2

CD4 count

viral load

Question 3

Do more males or females have HIV in the UK?

Answer 3

males

Question 4

Why do older people in the UK have more HIV?

Answer 4

didn’t have sex ed at school
may not use condoms as infertile anyway
divorce rate high

Question 5

In the UK, which group of people has highest rates of HIV?

Answer 5

homosexual men

Question 6

Why is there low HIV from drugs in the UK?

Answer 6

needle exchange programme

Question 7

What needs to be improved in the UK in terms of HIV?

Answer 7

timely diagnosis - need to increase the number of people being diagnosed and people being diagnosed earlier rather than later

Question 8

What CD4 count is classed as a late diagnosis?

Answer 8

CD4 < 350

Question 9

What CD 4 count is termed AIDS?

Answer 9

CD4< 200

Question 10

What age group + gender + sexuality are likely to be diagnosed late?

Answer 10

over 60s
females
heterosexuals

Question 11

What is the chance that a mother who isn’t on ART will transmit HIV to their child?

Answer 11

35%

Question 12

What is the chance that a mother who is on ART will transmit HIV to her child?

Answer 12

0.5%

Question 13

What does PEP stand for?

Answer 13

post-exposure prophylaxis

Question 14

Which part of the world has the highest number of people with HIV?

Answer 14

Africa

Question 15

Which part of England has the highest rate of HIV?

Answer 15

London

Question 16

Has diagnosis of HIV increased or decreased in the uk?

Answer 16

decreased

Question 17

What are the routes of transmission of HIV?

Answer 17

blood
sexual
vertical (mother to child)

Question 18

List the methods to prevent HIV transmission

Answer 18

circumcision
PEP
PreP
STI control
[vaccines (not available)]
microbicides
HIV diagnosis and partner notification
HAART
behavioural
screen blood products
needle exchange

Question 19

By what percentage does circumcision protect against HIV?

Answer 19

60%

Question 20

if you have a needle stick injury what do you need to take and for how log for and in what space of time do you need to take it?

Answer 20

PEP
within 72 hours
take for 1 month

Question 21

What does PEPSE stand for?

Answer 21

post-exposure prophylaxis after sexual exposure (to HIV)

Question 22

What is the risk of getting HIV from a needle stick injury?

Answer 22

0.3%

Question 23

What is the risk of getting HIV from mucocutaneous exposure?

Answer 23

0.09%

Question 24

Why is there not much evidence for PEPSE (PEP in general)?

Answer 24

unethical to conduct trial to expose people to HIV and then test half the group with the drug

Question 25

What are the two ways to take PreP?

Answer 25

everyday | before sex and a couple of days after

Question 26

How effective is PreP?

Answer 26

HIGHLY effective

Question 27

List behavioural changes that can be made to reduce spread of HIV

Answer 27

sex ed reduce frequency of partner change reduce number of partners at the same time reduce high risk sexual practices eg traumatic anal sex use condoms

Question 28

What does TASP means?

Answer 28

Treatment as prevention - ie use of HAART to get the viral load so low that transmission to sexual partners is negligible

Question 29

By what percentage does HAART reduce transmission from serodifferent couples?

Answer 29

96%

Question 30

What are the advantages of knowing HIV status?

Answer 30

``` access to appropriate treatment and care reduction in morbidity and mortality reduction in MTCT reduction of sexual transmission public health cost-effective ```

Question 31

How are HIV drugs cost effective?

Answer 31

``` Savings on: lost work days social care infecting other people AIDS related diseases benefits claimed ```

Question 32

Should a positive HIV result be disclosed to insurers?

Answer 32

yes

Question 33

Should having an HIV test be disclosed to insurers?

Answer 33

no

Question 34

Give reasons why someone might get an HIV test

Answer 34

clinician initiated - as pt comes with AIDS defining illness screening in pregnancy to reduce MTCT screening in high risk groups pt initiated

Question 35

What are the AIDS defining conditions?

Answer 35

``` TB pneumocystis cerebral toxoplasmosis primary cerebral lymphoma cryptococcal meningitis progressive multifocal leucoencephalopathy Kaposi's sarcoma Persistent cryptosporidiosis Non-hodgkin's lymphoma ```

Question 36

Why do doctors not test for HIV?

Answer 36

underestimate risk misconception that pre-counselling is needed misunderstanding of insurance implications anxiety about false positive

Question 37

What are the risk factors for HIV?

Answer 37

``` sexual contact with people from high prevalence groups multiple sexual partners rape sharing needles iatrogenic MTCT ```

Question 38

what are the symptoms of seroconversion illness?

Answer 38

occurs in most individuals 2-4 weeks after infection fever maculopapular rash myalgia headache aseptic meningitis usually lasts 3 weeks and have complete recovery

Question 39

Where in particular should you look for the rash of seroconversion illness?

Answer 39

palms

Question 40

What should the differential diagnosis of rash on the palms be?

Answer 40

secondary syphilis

Question 41

What types of conditions should you have a high index of suspicion for?

Answer 41

``` gereralised lymphadenopathy acute generalised rash glandular fever prolonged episodes of herpes simplex perisistent and recurrent oral candidiasis new skin conditions/ worsening - psoriasis and moluscum mouth lesions - oral hairy leukoplakia uneplained weight loss or night sweats persistent diarrhoea gradually increasing SOB and dry cough recurrent bacterial infections recurrent/multidermatomal shingles lymphoma PUO flu-like illness meningitis unexplained blood dyscrasias ```

Question 42

What differentiates oral candida from oral hairy leukoplakia?

Answer 42

can't move the hairy leukoplakia with a brush, but can move oral candida

Question 43

Which virus causes oral hairy leukoplakia?

Answer 43

EBV

Question 44

What fungus causes pneumocystis pneumonia?

Answer 44

Pneumocystis jirovecii/carinii

Question 45

What blood picture is seen in HIV?

Answer 45

raised protein lymphopenia low platelets low WBCs

Question 46

Which healthcare professionals can offer a HIV test?

Answer 46

ANY

Question 47

Which antigen does the fourth generation HIV test look for?

Answer 47

p24

Question 48

What are the advantages of POCT?

Answer 48

``` outreach increases pt choice increased access to testing earlier diagnosis reduce complications reduce transmission ```