Monitoring guidelines/hepatitis Flashcards

1
Q

Age based scores/tests as per monitoring guidelines

A
  • FRAX for all>50 and post-menopausal women (or otherwise at risk)
  • QRISK for all >40
  • Cervical screening age 25-65
  • Rubella in women of childbearing age
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2
Q

Blood tests at initial baseline appointment

A
  • Confirmation of HIV status, testing for primary HIV infection
  • HIV VL, HIV resistance test
  • CD4
  • Hepatitis A, B, C
  • Measles, varicella Abs
  • Full STI screen including syphilis
  • General: FBC, LFT, renal, bone
  • (Dipstick urine and UPCR if any protein)
  • (HLAB5701, viral tropism if CCR5 being considered, IGRA if appropriate)
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3
Q

Frequency of monitoring if not on ART depending on CD4

A
  • If CD4>500 annually do: HIV VL, CD4, FBC/renal/liver, STI, hepatitis, cervical smear
  • If CD4 <500 do 6 monthly CD4
  • If CD4<350 do 3 monthly CD4, STI/hepatitis for higher risk

Also annual lipids in patients>40/smoker/BMI>30
QRISK if>40
FRAX if >50 every 3 years

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4
Q

Monitoring in the first 6 months after starting ART

A
  • See them at 2-4 weeks, 3 months and 6 months and do:
  • Take history, adherence/tolerability check
  • Renal/liver/urinalysis (FBC only if unwell or has started zidovudine in which case test after 6 weeks, 12 weeks then 3 monthly)
  • If baseline CD4<350 check at 3 months and repeat at 6 months if still <350
  • Measure HIV VL at 1, 3, and 6 months
    (If VL does not fall at least 10-fold or 1 Log after 1 month, repeat at 2 months post ART start)
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5
Q

Monitoring of patients established on ART with VL<20

A
  • VL every 6 months (could be up to 12 if on PI)
  • If CD4<200 then repeat every 3-6 months
  • If CD4 200-350 test annually
  • If CD4>350 on 2 occasions >1 year apart, no further required
  • 6-12 monthly: FBC/renal/liver/bone/urine dip
  • Annually: UPCR if protein in dipstick, metabolic assessment (if aged>40): lipids and Hba1c
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6
Q

Monitoring of low level viraemia

A
  • VL>50 adherence check then if repeat <50 no further action (one off blip, not associated with increased risk VF)
  • VL repeat 50-200: adherence check/DDI, do resistance test
  • If stable at 50-200 do 3-4 monthly VL
  • Resistance testing if gradual increase inVL, no need for repeat more than once a year if VL stable
  • VL >200: if second result above 200 take action
  • Careful assessment of patients with frequent ‘blips’ and/or one off measurements above 200 as these can sometimes be associated with viral rebound and virological failure
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7
Q

What tests to do if see undetectable HIV VL not on treatment?

A
  • Review HIV 1 and 2 serology
  • Check VL on another assay
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8
Q

Frequency of patient review based on CD4

A

CD4<350: 3-6 monthly
CD4 350-500: 6 monthly
CD4>500: 6-12 monthly

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9
Q

Screening for complications in hepatitis B and C

A
  • In cirrhotics do 6 month HCC screening and then endoscopy at diagnosis, if no varices then repeat 2-3 yearly
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10
Q

Treatment monitoring in hepatitis B

A
  • All patients with both HIV and Hep B should be on treatment for Hep B with ideally TDF/TAF, if cannot use these then entecavir
  • LFTs 3 monthly in the first year and then 6-12 months
  • HBV DNA 4-6 monthly in the first month then 12 monthly
  • HBsAg checked yearly to see if loss of antigen
  • Quantitative HBsAg<1000 predicts loss
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11
Q

HBV reactivation prevention (e.g. HBsAg negative, anti-HBc positive undergoing immunosuppression)

A
  • If severe immunosuppressive therapy such as chemo for lymphoma or stem cell or solid organ transplant, ensure TDF/TAF
  • If B cell depleting agents like rituximab/alemtuzumab then TDF/TAF or if contraindicated entecavir/3tc/ftc
  • In those not on HBV active ART who receive other forms of immunosuppression e.g. anti-TNF alpha, monitor HBV DNA and HBsAg
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12
Q

Definition of SVR

A

Undetectable HCV at 12 weeks after end of therapy

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13
Q

HCV confirmed, repeat HCV RNA at week 4, what log reduction might you repeat RNA at week 12 rather than immediate treatment?

A
  • If >2 log reduction in RNA by week 4, can consider repeating RNA at week 12 to see if spontaneously cleared
  • If negative at week 12, confirm fully with RNA at 24 and 48 weeks
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