7d of doxycycline BD po or single dose of azithromycin po

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

HIV/GUM/ID Flashcards by Justyna Gromala

What minerals cause issues with ART absorption?

particularly bivalent cations e.g. Mg2+, Ca2+, Fe 2+

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Mx of urethritis

7d of doxycycline BD po

single dose of azithromycin po

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Hep B Serology

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ALT raised - what does

3x upper limit of normal becomes problematic

5x upper limit -> admit

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ALT - 1560
AST - 2650
ALP - 206
Bilirubin - 120

what is this picture called?

transaminitis

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transaminases in the liver

ALT and AST

(alanine amniotransferase and aspartate aminotransferase)

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What puts your ALT >1000

viral hep
ischaemic hep
AI hep

drug induced

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Why do we worry about snorting drugs?

transmission risk of viral hepatitis C

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marker of acute hep A infection

IgM

can also be present in v recent immunisation

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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

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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

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incubation period for Hep A

15-45 days

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does Hep A have chronic sequelae?

none

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can Hep A causes fulminant hep A?

<0.1% - very rare

mire common if there is confection with hepB/C

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Hep E incubation period

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Hep E dx

PCR hep E virus RNA

Hep E Ab

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marker for active Hep B

surface Ag positive (Hep B s Ag +ve)

also Hep B DNA +ve

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Which Hep do you need to have to get Hep D infection?

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Hep B DNA quantity

used to monitor the infection and

if Hep B DN A

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When in Hep B cAb +ve ?

past infection

chronic infection (not seen in acute infection)

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can you self clear Hep B?

yes - it’s common to self clear it

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HbeAg +ve

highly infective
high viral load

usually also high DNA

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HbeAb +ve

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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

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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