HIV/GUM/ID Flashcards
What minerals cause issues with ART absorption?
particularly bivalent cations e.g. Mg2+, Ca2+, Fe 2+
Mx of urethritis
7d of doxycycline BD po
or
single dose of azithromycin po
Hep B Serology
ALT raised - what does
3x upper limit of normal becomes problematic
5x upper limit -> admit
ALT - 1560
AST - 2650
ALP - 206
Bilirubin - 120
what is this picture called?
transaminitis
transaminases in the liver
ALT and AST
(alanine amniotransferase and aspartate aminotransferase)
What puts your ALT >1000
viral hep
ischaemic hep
AI hep
drug induced
Why do we worry about snorting drugs?
transmission risk of viral hepatitis C
marker of acute hep A infection
IgM
can also be present in v recent immunisation
Mx of hep A
transient self-limiting condition
supportive care if needed
many asymptomatic
f/u fortnightly until transaminases are normal
notify PHE - contact tracing and vaccination
How can you get Hep A
faeco-oral
-> food, water, sex (oro-anal, digits-rectal contact)
close contact In the household, child daycare centres
in UK most commonly associated with travel and sexual outbreaks
incubation period for Hep A
15-45 days
does Hep A have chronic sequelae?
none
can Hep A causes fulminant hep A?
<0.1% - very rare
mire common if there is confection with hepB/C
Hep E incubation period
40
Hep E dx
PCR hep E virus RNA
Hep E Ab
marker for active Hep B
surface Ag positive (Hep B s Ag +ve)
also Hep B DNA +ve
Which Hep do you need to have to get Hep D infection?
B
Hep B DNA quantity
used to monitor the infection and
if Hep B DN A
When in Hep B cAb +ve ?
past infection
or
chronic infection (not seen in acute infection)
can you self clear Hep B?
yes - it’s common to self clear it
HbeAg +ve
highly infective
high viral load
usually also high DNA
HbeAb +ve
Mx of Hep B
no cure (yet)
refer all HepBAg+ pts to hepatologist
HIV test will alter therapy
- see if they self-clear
- if not: you can consider treatment
Fibroscan
commonest cause of HCC
UK - alcohol
worldwide - Hep B
drugs used to treat Hep B (if indicated)
Lamivudine
Emtricitabine
Tenofovir (most common)
Telbivudine
Entecavor
Adefovir
historic: pegylated iFN alpha
if HIV - tenofovir (will make sure that HIV therapy also covers for HepB)
Hep B crosses the placenta
can have vaginal delivery
can breastfeed
low transmission rate
Hep B PEP
is acute Hep B notifiable?
yes
how is hep D transmitted?
percutaneous (IVDU)
permucosal (sex)
confection with hep B needed
Who do you worry about hep D in?
someone with Hep B who is unwell/not improving
Hep C
Mx for Hep C
DAA (direct acting antivirals) - 99% success rate
12 week course
(used to be pegylated IFN)
Which drugs are injected?
heroin
crystal meth
how is GHB taken
drink
(gamma-hydroxybutyrate)
how is Crystal meth used?
injection
smoking
effects of GHB
disinhibition (increased sex drive as well)
euphoria
how does GHB appear?
colourless odourless liquid
why is GHB a date rape drug?
- colourless odourless liquid
- not included in the standard NHS tox screen
- leaves the system quite quickly
Hep C virus type
+ve strand RNA virus
Flaviviridae
Hep C RNA testing
PCR
not used to screen in A&E because PCR is expensive
it is a better test then Anti-HCV so some poeple are missed
which Hep C test is done in A&E to screen?
anti-HCV
Do we treat everyone with Hep C?
we wait 12w to see if they are getting better
otherwise we start DAA
depending on genotype, there are resistance patterns so the genotype pattern
there are also pangenotypic treatmments
pangenotypic treatment of Hep C
in the UK genotype testing is done and a treatment is selected
in some countries you don’t genotype and just give pan-genotypic treatment
Can you get re-infected with Hep C?
yes
the majority of people who re-present are reinfected, not treatment failure
where do you see HIV 1 and 2?
1 - global
2 - west Africa
AIDS - ground 0
Cameroon
blood to blood transmission from chimpanzees
moved to DRC - sex work prevalent there, virus spread
first HIV case
June 5th 1981
in 1983 first started isolating virus
how effective is HIV PrEP?
86% effective in RCTs
when after HIV exposure will Ab be positive?
45d
if still -ve bring back at 3 months (also good for HepB/C and syphilis)
4th gen HIV tests
Ab and Ag
standard HIV therapy
2 NRTI (backbone)
+ 3rd agent (integrates inhibitor, protease inhibitor + booster/ NNRTIs)
they work on unaffected cells and protect them from infection
normal CD4+ count
500 or above
why is the timeframe to give PEP 72h?
72 h
it takes 72 h for the virus to integrate into the human DNA
PrEP - how can you take it?
Truvada - OD (for regular exposure)
2 tablets - 2-24h before sex
1 tablet 2h post exposure
1 tablet 48 post exposure
PCP test
serum BD Glucan
Mx of PCP
Septrin (caan cause kidney issues)
2nd line: clindamycin and primaquine
O2
supportive mx
IRIS
immune reconstitution inflammatory syndrome
types of IRIS
paradoxical - worse when the ART is started
unmasking - CD4 are finding new pathogens in the body that wasn’t there before
more likely to happen if CD4 counts are low
rule of 2s - how to remember
2 in the brain
eye - CMV, too
mouth
skin
lung - PCP, TB
liver - Hep B/C
GI - cryptosporidium
Kidney - HIVAC
spleen - NHL, xx
GU - cervical cancer, anal carcinoma
highest prevalence of TB in London?
east London
TB testing
gene Xpert (can detect resistances as well)
quantiferon
ziehl-neelsen
non-TB mycobacteria
night sweats
lumps and bumps
weight loss
happens when CD4+ under 50
ring enhancing lesion on CT dx
toxoplasmosis
multiple ring enhancing lesions of CT -dx
toxoplasmosis pathogen type
parasite
toxoplasmosis pathogen type
parasite
Mx of toxoplasmosis in brain
2w treatment for too and re-scan
if responds, dx confirmed.
otherwise consider other differentials (e.g. abscess, tb, primary cerebral lymphoma)
PML
progressive multifocal leucoencephalopathy
cryptococcus - pathogen type
fungus
cryptococcus LP
really high pressure on LP
..
-> india ink stain
CRAG
cryptococcal antigen
check eye for CMV retinitis if CD4 count under 50
why do you check mouth in someone with Kaposis sarcoma?
if there are oral lesions it is more likely that the patient has visceral lesions too e.g. in their lungs
NAAT which STIs?
gonorrhoea
chlamydia
