HIV II

Question 1

What are some targets of antiretroviral drugs?

Answer 1

Reverse transcriptase, integrase, protease, entry (fusion, CCR5 receptor)

Question 2

What kind of activity do nucleotide analogues reverse transcriptase inhibitors (NRTI) have against HIV?

Answer 2

Have in vitro activity against HIV = zidovudine monotherapy didn’t improve survival but dual NRTI therapy reduced mortality by 33%

Question 3

What is HAART?

Answer 3

Highly active anti-retroviral therapy = combo of 3 drugs from at least 2 classes to which the virus is susceptible

Question 4

What are the purposes of HAART?

Answer 4

Reduce viral load to undetectable
Restore immunocompetence
Reduce morbidity and mortality

Question 5

What are some features of HAART toxicity?

Answer 5

GI side effects (protease inhibitors)
Mood and psychosis (efavirenz)
Proximal renal tubulopathies (tenofovir, atazanavir)
Osteomalacia (tenofovir) and anaemia (zidovudine)
Increased MI risk (abacavir, lopinavir, maraviroc)

Question 6

What are some skin manifestations of HAART toxicity?

Answer 6

Rash, hypersensitivity, Stevens-Johnsons = abacavir, nevirapine

Question 7

What are some aspects that will have an influence on the psychosocial wellbeing of a patient with HIV?

Answer 7

Adjustment to diagnosis, confusion/guilt, impact of HIV on health, concerns about future, feelings of isolation

Question 8

What are some features of partner notification?

Answer 8

Voluntary process = partner, provider or conditional referrals
Duty of care to known third party
Barriers = fear, confidentiality, stigma

Question 9

What are some methods of preventing sexual transmission of HIV?

Answer 9

Condom use and STI screening/treatment
HIV treatment and sero-adaptive sexual behaviours
Post/pre-exposure prophylaxis and disclosure

Question 10

How is reproduction managed in a couple with an HIV+ male and an HIV- female?

Answer 10

Treatment as prevention +/- timed condomless sex

Possibly HIV PrEP for female partner

Question 11

How is reproduction managed in a couple with an HIV+ female and an HIV- male?

Answer 11

Treatment as prevention +/- timed condomless sex
Possibly self insemination
May give HIV PrEP to male partner

Question 12

What are some ways of preventing mother to child transmission of HIV?

Answer 12

HAART during pregnancy
4 weeks PEP for neonate
Exclusive formula feeding

Question 13

How does viral load of HIV affect delivery?

Answer 13

Vaginal delivery if undetected viral load

C-section if detected viral load

Question 14

What are some HIV prevention strategies that have been used in previous years?

Answer 14

Treatment of herpes, needle exchange, STI testing, condom programmes, PEPSE, circumcision, PrEP, treatment as prevention

Question 15

What are the eligibility criteria for PrEP?

Answer 15

HIV+ partner with detectable viral load
Male/male sex or transwoman
Other high risk factor agreed with another clinician

Question 16

What criteria must male/male sex or transwomen meet to be eligible for PrEP?

Answer 16

UPAI >= 2 partners in last year and likely to do so again in next 3 months OR confirmed bacterial rectal STI in last year

Question 17

What are the conditions that someone must meet once they have been identified as high risk in order to receive PrEP?

Answer 17

Aged >= 16 and HIV negative
Can commit to 3 monthly follow up
Willing to stop if eligibility criteria no longer apply
Resident of Scotland