Infectious Diseases

Question 1

Prophylaxis for opportunistic infections?

Answer 1

PJP when < 200 with Bactrim, Pentamidine or Dapsone

Toxoplasma when <100 with bactrim

Mycoplasma gondii when <50 with Azithromycin or clarythromycin

Reduces risk by 50-80% risk reduction.

Although new evidence suggests that if viral load is suppressed may not need prophylaxis.

Question 2

Co infection with HIV

Answer 2

Hep C / Hep B - will progress quicker with HIV

Herpesvirus 1 and 2

CMV

Question 3

Physical examination

Answer 3

Lipodystrophy
Weight, height, BP, pulse
Fundoscopy
Oral:
- Periodontal disease, oral hairy leukoplakia
Dermatological
Neurological:
- Dementia screen
- Peripheral neuropathy
- Myopathy

Question 4

Ongoing monitoring of HIV Patients

Answer 4

Monitor HIV viral load and CD4 3 monthly
Sexual risk and STI screening 3-6monthly
Vaccinations - MenB/ACYW, HPV
Cardiovascular risk factors
Osteoporosis
Cancer screening - Cervical, Colon, Breath, Prostate, Skin, Anal

Question 5

Cancer screening for HIV patients:

Answer 5

“ENHANCED CANCER SCREENING”
Cervical Cancer testing HPV 3 yearly
CRC - >50 FOBT 2 yearly
Breath Ca - >50 mammogram 2 yearly
Prostate >50 consider PSA
Skin Ca - regular skin checks
Anal Ca - >50, DRE annual

Question 6

Biktarvy

Answer 6

Bictegravir/TAF/Lamivudine

Triumeq - Dolutegravir/abacavir/lamivudine

(need to be HLAB5701 negative)

Question 7

HIV and Pregnancy

Answer 7

Avoid Dolutegravir due to risk of neural tube defects.

Question 8

Causes of failure of therapy

Answer 8

Adherence
Drug interactions
Drug absorption
Resistance

Question 8

Causes of failure of therapy

Answer 8

Adherence
Drug interactions
Drug absorption
Resistance

Question 8

Causes of failure of therapy

Answer 8

Adherence
Drug interactions
Drug absorption
Resistance