HIV + SRH Flashcards
What should Hepatitis C testing be if raised transaminases or high risk exposure?
Anti-HCV and HCV PCR
repeat HIV PCR 1 month if negative
Cervical smear screening recommendation and programme for WLHIV?
Annual
age 25 - 65
At what CD4 count might the rate of HPV related CIN/cancer for WLHIV be similar to women without HIV?
> 500
What FOUR factors should be considered when giving advice on mode of CONCEPTION for PLW HIV?
HIV status of couple (serodiscordant or concordant)
Treatment status of PLWHIV (recommend ART)
Viral load of PLWHIV (PrEP may be indicated for partner)
Fertility of the couple (may require assisted reproduction)
Which ART class can be used with all contraceptives?
NRTI - renally eliminated
Which TWO hormonal contraceptives are generally ok with all ART?
Progestogen only injectables
levonorgestrel IUS
What impact does efavirenz have on ethinyl estradiol (EE)?
inhibits and induces the metabolism pathways therefore neutral effect on EE however lowers progestogen and therefore CHC not suitable if on efavirenz
What combined oral contraceptive could be used with boosted PI?
Oestrogen >30 microgram
+
NORGESTIMATE as progestogen
Which ART drugs can be used safely with all hormonal contraception?
all NRTI Etravirine Rilpivirine Maraviroc Raltegravir Dolutegravir
What hormonal contraceptive pill could be used with boosted elvitegravir?
Combined pill with:
oestrogen >30microgram
+
norgestimate
What is the pathophysiological theory of how hormonal contraception could increase a woman’s risk of HIV acquisition?
Hypo-oestrogenic state and vaginal mucosal thinning
Cervical ectopic
Alteration in immune mediators
Alteration in vaginal microbiome
What is the recommendation for use of DMPA by women who are higher risk of HIV acquisition?
Benefit outweighs risk (UKMEC 2)
How is menopause diagnosed?
Amenorrhoea >12 months, not on contraception
or
symptoms of menopause without a uterus
What impact does peri-menopause have on bone mineral density?
accelerates bone loss
