HIV & Tuberculosis Flashcards
Spread of HIV
Unprotected anal, vaginal or sexual activity
Mother to child at any stage of pregnancy, birth or breastfeeding (vertical)
Mucous membrane, blood or open wound exposure to infected blood or bodily fluids e.g. sharing needles, needle-stick injuries or blood splashed in an eye
Preventing HIV transmission during birth
Normal vaginal delivery - viral load <50 copies/ml
Caesarean sections - considered if >50 copies copies/ml and all women >400 copies/ml
IV zidovudine given during caesarean if viral load unknown or >10000 copies/ml
HIV prophylaxis for babies whose mothers have HIV
Dependent on viral load
Low risk - mums viral load <50 copies/ml givenzidovudinefor 4 weeks
High risk - mums viral load >50 copies/ml givenzidovudine,lamivudineandnevirapinefor 4 weeks
HIV and breastfeeding
Can be transmittable through breastfeeding even if mother’s viral load undetectable
Options for HIV testing
Antibody screen
Viral load
When to test for HIV
Babies to HIV positive parents
When immunodeficiency suspected e.g unusual, severe or frequent infections
Young people who are sexually active can be offered testing if there are concerns
Risk factors such as needle stick injuries, sexual abuse or IV drug use
Testing babies with HIV positive parents
HIV viral load at 3 months
HIV antibody test at 24 months
Why is HIV antibody test sometimes false positive?
Can be positive in infants who do not have HIV for up to 18 months of age due tomaternal antibodiesthat have crossed the placenta during pregnancy
Pathophysiology of HIV
RNA retrovirus
Virus enters and destroys CD4 T Helper cells
An initial seroconversion flu-like illness occurs within a few weeks of infection
Infection is then asymptomatic until it progresses and patient becomes immunocompromised
Key principles of HIV management
Antiretroviral therapy(ART) to suppress the HIV infection
Normal childhood vaccines, avoiding or delaying live vaccines if severely immunosuppressed
Prophylacticco-trimoxazole(Septrin) for children with low CD4 counts, to protect againstpneumocystis jirovecii pneumonia(PCP)
Treatment of opportunistic infections
Clinical features of TB
Typically non-specific symptoms
prolonged fever
Malaise
Anorexia + weight loss
Investigations in TB
Mantoux test (can be false + due to BCG)
IGRA
Management of TB
Triple or quadruple therapy
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
TB prevention
BCG vaccination
