HIV Intro Flashcards
Life expectancy for HIV pts is going up, but it is contingent on a number of things, such as: (3)
- Timely diagnosis
- CD4 count at time of treatment initiation
- Access to treatment
What are the 95-95-95 targets?
95% of all people living with HIV to know their status
95% of people diagnosed on antiretroviral treatment
95% of all people receiving antiretrovirals to be suppressed by 2025
(This approach aims to end HIV/AIDs as a public health threat)
What is the most common risk for transmission of HIV in Sask?
People who inject drugs is #1, but heterosexual sex is rising too
Why is routine HIV testing important? (5)
- An estimated 20% of ppl with HIV are unaware that they have HIV. In spite of UNAIDS/WHO recommendations, people who should be tested are still being missed
- Stigma and discrimination will lessen when testing is routine
- Routine testing gives clients earlier opportunities for support, services, and care
- Earlier treatment results in improved outcomes. Clients live longer and healthier lives with early treatment
- Testing and awareness help prevent transmission to others
What information do patients require to give consent (to test for HIV)? (6)
- Clinical and prevention benefits of testing
- Right to refuse
- HIV is reportable to the MHO
- Follow-up services will be offered
- If positive, identify others who have been exposed
- Person testing positive must inform sexual and drug using partners
What are the HIV testing options in Saskatchewan? (4)
- Standard Screen
- Point of Care (POC)
- Dried Blood Spot (DBS)
- Self testing kits
How does standard screen testing work? (5)
- Uses the 4th generation Ab + Ag screen
- Nearly 100% sensitive and specific for chronic HIV
- Results take a few days to 2 weeks (official turn around time is 3 days)
- Window period cut to 15 to 20 days
- Positive confirmed with Geenius 1/2
What is the negative of standard screen testing?
- Roche duo test we use generates results for HIV1 p24 antigen & HIV1/2 antibodies then combines into a final result
- There isn’t a way to separate out HIV1 and HIV2 with this assay
How does HIV Point of Care work? (4)
- Rapid antibody screen for HIV 1+2
- Results in minutes
- Negative result = no HIV
- Positive result = need for confirmatory testing (4th gen + Geenius)
How does Dried Blood Spot testing work?
Blood is collected using a finger prick and placed on a sheet of paper that is sent away for testing
What are the advantages of Dried Blood Spot testing? (3)
- Better confidentiality
- Multiplex testing
- No immediate results (some individuals prefer not to have instant results)
Where are some places to get tested for HIV? (4)
- POC testing-Westside Community Clinic on 20th St, STC Health Centre on 20th St, Saskatoon Sexual health, Sexual Health clinic on Idylwyld, several community agencies including the street van, SCC, Urban Camp, Brief and Social Detox, STC emergency wellness center
- Community Agencies are supported by the “street team”
- Street team and any community lab can do 4th gen testing
- Self-test kits for the pilot project are all gone
What is HIV?
HIV-Human Immunodeficiency Virus
- HIV targets CD4 T lymphocytes (T cells), cells that help coordinate an immune response by stimulating other immune cells such as macrophages, B cells, and CD8 T lymphocytes
What is AIDS?
AIDS = Acquired Immunodeficiency Syndrome
- End or advanced stage of HIV infection
- Defined as a CD4 count of less than 200 or presence of 1 or more AIDS-defining illnesses or OI’s-Pneumocystis pneumonia, Mycobacterium Avium Complex, Cytomegalovirus etc.
- We don’t tend to use the term “AIDS” anymore
What is HIV-1?
HIV -1 is the most common type of HIV and occurs all over the world. It is estimated that around 95 percent of people living with HIV have HIV-1
What is HIV-2?
HIV-2 is mainly present in West Africa. There may be some differences between the rates of transmission of HIV-1 and HIV-2, and the treatments that work best for each of them.
How is HIV spread? (2)
- HIV is spread by contact with HIV-infected body fluids
- Blood
- Semen
- Vaginal fluid
- Rectal fluid
- Breastmilk - These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to occur. Mucous membranes are found inside the rectum, vagina, penis, and mouth.
What are 3 modes of transmission of HIV?
- Sexual transmission
- Unprotected sexual contact with someone with HIV
- Insertive and receptive sex (anal, vaginal) - Blood contact
- Sharing needles or other drug equipment such as spoon, water, cookers, etc.
- Sharing personal equipment such as tattoo and piercing equipment, razors
- Blood transfusion (in Canada, prior to 1985)
- Occupational exposure such as needle stick injuries - Vertical transmission
- To fetus/infant in utero, at delivery, or through breast milk
When is vertical transmission risk highest? (3)
- Seroconversion occurs during pregnancy due to higher VL
- Pregnant person is HIV+ but not diagnosed
- Pregnant person is HIV+ and not on antiretroviral therapy (ART)
What does U=U mean?
Undetectable = Untransmittable
- Risk of passing on HIV sexually is effectively zero in those taking ART and maintaining an undetectable viral load
What are some potential symptoms of HIV? (8)
Flu-like symptoms within 2-4 weeks after infection
1. Fever
2. Sore throat
3. Enlarged lymph nodes
4. Night sweats
5. Chills
6. Fatigue
7. Muscle aches
8. Rash
(Many have no symptoms at all)
What is CD4 count? (5)
- Marker of immune system health
- 800-1200 is considered to be normal
- Different “normal” values seen in the literature - Highlights urgency to start ARVs and if OI proph is necessary
- Indicates disease progression
- If improving, marks therapeutic response
When looking at CD4 lab results what two results do we care the most about?
- CD4/CD3 %
- CD4/CD3 Absolute
What is viral load? (6)
- Amount of virus present in the blood- measured in copies/mL
- THE most important lab we’re interested in
- Newest platform can test down to 20 copies/mL
- Less than 50 copies is considered “suppressed”
- A result that is “undetected” means zero copies were found
- Typically most patients are suppressed in 1-2 months with consistent antiretroviraltherapy, this can vary based on viral load however
At any CD4 count, what opportunistic infection is always a risk?
Tuberculosis
What opportunistic infection is most likely at CD4 levels <250
Coccidiomycosis
What opportunistic infection is most likely at CD4 levels <200
Pneumocystis
What opportunistic infection is most likely at CD4 levels <150 (2)
- Histoplasmosis
- Cryptococcus
What opportunistic infection is most likely at CD4 levels <100
Toxoplasmosis
What opportunistic infection is most likely at CD4 levels <50 (3)
- MAC
- CMV
- PML
