HIV Part 1 Flashcards
Which HIV type is the MAJOR cause of AIDS?
HIV-1
Globally, what percentage of ppl living wiht HIV were accessing antiretroviral therapy?
75%
GLOBALLY, what percentage of ppl living with HIV KNEW their status?
85%
GLOBALLY, how many ppl became NEWLY infected with HIV in 2021?
1.5 million
What are the 2020 targets regrading:
- HIV treatment.. 1) for ppl living with HIV who know their status 2) ppl with HIV who are ON trx 3) for ppl living with HIV who are VIRALLY SUPPRESSED. —> What are the 2019 GLOBALY stats on this? What are the 2020 stats on this for CANADA?
- new infections among adults?
- discrimination?
- What are the 2030 targets?
by 2020:
- 90,90,90/
- 500 000 new infectiosn among adutls
- 0 discrim
by 2023:
- 95,95,95
- 200 000
- 0 discrim
–> 2019, 2020 Stats respectively:
1) for ppl living with HIV who know their status - 81, 90** (met for first time)
2) ppl with HIV who are ON trx - 67, 87
3) for ppl living with HIV who are VIRALLY SUPPRESSED. - 59, 95 met
what proportion of canadians are not aware of their HIV status in 2020?
1 in 8.
What are they KEY pops disproporitioantely affected by HIV?
– Indigenous peoples
– Gay and bisexual men
– People who use drugs
– People with experience in the prison system
– People from countries where HIV is endemic
which province has highest incidence of HIV?
Sk followed by MB.
What are the 3 modes of transmission for HIV?
sexual, parenteral, perinatal.
Categories of Risk that a person has TRANSMISSIBLE HIV infection:
- what are the 2 criteria associated with SUBSTANTIAL RISK?
SUBSTANTIAL RISK:
- HIV positive and viremic (i.e. viral load > 40 copies/ml)
or
- HIV status unknown, but from a pop with HIGH HIV prevalnce (ie/ MSM, injection drug useers).
Categories of Risk that a person has TRANSMISSIBLE HIV infection:
- what is the criteria associated with LOW BUT NONZERO RISK?
LOW BUT NONZERO:
- HIV Positive but viral load < 40 copies/mL WITH concomittant STI present at time of exposure.
** STIS incr risk of transmission.
** higher viral load increases risk of transmission.
Categories of Risk that a person has TRANSMISSIBLE HIV infection:
- what is the criteria associated with NEGLIGIBLE OR NONE RISK?
NELIGIBLE OR NONE:
- confirmed HIV negative
OR
- HIV positive with confirmed viral load < 40 AND no known concurrent STI present at time of exposure.
OR
- HIV status unknown for someone of the general pop
What are the 2 highest risk exposure types?
anal receptive and needle sharing.
What are the 3 moderate risk exposure types?
anal insertive, vaginal receptive, vaginal insertive
What are the 3 low risk exposure types?
All types of oral (giving, receiving, oral-anal contact), sharing sex toys and blood on compromised skin.
What is the PERINATAL risk of HIV transmission in absence of treatment?
25%.
What are 6 strategies for HIV prevention?
- Safer sex practices (e.g. condom use)
- Identifying and treating STIs
- Needle exchange programs, sterilized
equipment, opiate agonist therapy - Pre-exposure prophylaxis (PrEP)
- Post-exposure prophylaxis (PEP)
- Treating individuals living with HIV
– includes pregnant individuals (perinatal)
Which group of HIV infected indivdiuals is responsible for highest numbers of transmissions?
those who are UNAWARE Of HIV infeciton. That’s why testing is imp!!
Recreate the diagram showing Clinical Progression of HIV. (slide 23)
After initial infection Get really high rates of HIV RNA replication (flu like sx, etc), seeds many organs (HIV resevoir). –> Then After acute syndrome, viral load tends to go down and reach a set point. Goes into clinicl latency for a number of years. –> w/o intervention, by 8 years, start getting more opp. Infecitons, immune system loses contorl, and deaht occurs in 10 years. CD4 count drops down to really low.
What are the most common symptoms of Acute Retroviral Syndrome?
– Fever
– Maculopapular rash
– Lymphadenopathy
– Myalgia or arthralgia
– Pharyngitis
– Oral ulcers
– Weight loss
nothing specific screams HIV
What is the definition of AIDS>
AIDS is diagnosed when an individual with HIV develops a severe opportunistic infection or cancer, or when their CD4 cell count drops below 200 cells/uL.
How does HIV establish infection?
HIV initially attaches to CD4 T lymphocytes and stimulates T cell to replciate new viral particles that go on to infect more T cells. Once gets to lymphoid tissues, virus seeds the body. over time, virus destroys CD4 T cells.
How often should EVERYONE be tested fro HIV?
- what about ppl at high riks?
- good practice to screen for HIV when screenign for what else?
- Everyone should be tested for HIV min. once in a Lifetime.
- but if higher risk, then should be multiple times a year or at least yearly.
- Good practice is to screen HIV when screening for other STIs.
- Earlier dx dcr morbity/mortality and transmission to others.
When should females be tested for HIV during pregnancy?
1) all pregnant ppl shoudl be offered HIV testing at FIRST PRE-NATAL VISIT (sometimes ppl opt out tho).
2) pregnant ppl who test NEGATIVE but conitnue to be at risk of HIV acquisition (i.e. ongoing risk behaviour, HIV + partner) should have REGULAR RE-TESTING and testing at POINT of delivery.
3) pregnant ladies who arrive to delivery w/o having done a prenatal HIV test should be offered rapid HIV testing at delivery.
When should females be tested for HIV during pregnancy? (3)
1) all pregnant ppl shoudl be offered HIV testing at FIRST PRE-NATAL VISIT (sometimes ppl opt out tho).
2) pregnant ppl who test NEGATIVE but conitnue to be at risk of HIV acquisition (i.e. ongoing risk behaviour, HIV + partner) should have REGULAR RE-TESTING and testing at POINT of delivery.
3) pregnant ladies who arrive to delivery w/o having done a prenatal HIV test should be offered rapid HIV testing at delivery.
Describe the GOLD STANDARD HIV test.
- when are results reported?
- how long does it take to return results?
- can be ordered through what 4 avenues?
Involves a venous blood draw and 2 steps:
Step 1) Antibody/antigen screen (4th gen tests) –> ifpositive, do confirmatory test for HIV RNA.
Step 2) Confirmatory HIV RNA testing.
- results only reported once step 2 is complete for positive results. (i..e reflects TRUE POSITIVE).
- 1 wk/
- can be done through GP, STI clinic, ER, hopsitals.
What is the only health canada approved POINT OF CAIR HIV TEST?
- how quickly are results availble?
- requires what kind of sample?
- equivalent to what gen GOLD STD test?
- does it need confirmatoyr testing?
INSTI HIV-1/HIV-2 aby test.
- Takes 1 min to read
- Requires a fingerpick blood sample
- Equivalent to 3rd gen std test. (>99% sensitivity and specificity)–> If exposed in past 2-3 mos or longer, then it will pick it up. Not good if exposed any earlier tho.
- Need confirmatory blood test to confirm dx.
What is the only health canada approved POINT OF CAIR HIV TEST?
- how quickly are results availble?
- requires what kind of sample?
- equivalent to what gen GOLD STD test?
- does it need confirmatoyr testing?
INSTI HIV-1/HIV-2 aby test.
- Takes 1 min to read
- Requires a fingerpick blood sample
- Equivalent to 3rd gen std test. (>99% sensitivity and specificity)–> If exposed in past 2-3 mos or longer, then it will pick it up. Not good if exposed any earlier tho.
- Need confirmatory blood test to confirm dx.
Can a negative INSTI test be considered a TRUE NEGATIVE? what is the exception?
yes!, unless person is in the WINDOW PERIOD OF INFECTIVITY.
What can HIV Dried Blood Spot Testing detect?
Abys ot HIV AND HIV RNA**
What test do you use to MONITOR HIV infection?
VIRAL LOAD: quanitfies amount of HIV RNA in copies/mL.
What are the indications for Viral Load testing? (3)
– diagnosing acute HIV infection
– surrogate marker for treatment response
– assess risk of HIV transmission (e.g. perinatal,
sexual etc)
Whti is the VIRAL LOAD (HIV RNA) goal?
HIV RNA below limit of detection (aka: VL < 20-50 copies/mL)
How oftne should HIV RNA/Viral Load be measured?
for the average person?
vs a very stable pt with supressed VL?
at baseline, then 1-2 mos after starting treatmetn; then repeated q3-4 months.
in very stable pts with suppressed VL –> may repeat q6months.
CD4+ T cel count is a major indicator of what?
- waht is it a strong predictor of?
IMMUNOCOMPETENCE!!
- disease progression and survival.
How often is a CD$+ T cell count lab ordered?
baseline, then q3-6 months initially.
–> in stable pts with suppressed VL, yearly CD4 monitoring is adequate.
