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DipGUM 🤦‍♀️ > PREP > Flashcards

PREP Flashcards

1
Q

Drugs in Prep

A

Tenofovir and Emtricitabine

TDF-FTC

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2
Q

Offer prep to…

A
  • Hiv neg MSM with condomless anal sex in past 6/12 and ongoing condomless sex
  • hiv neg MSM condomless sex with HIV pos partner not suppressed on ART
  • combination of risk factors
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3
Q

When can you consider Tenofovir alone prep?

A

Heterosexual men and women where FTC is contraindicated

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4
Q

Prep and breastfeeding/ pregnancy

A

All ok
V little found in breast milk
No congenital anomaly from TDF during pregnancy

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5
Q

Three specific drugs used in chemsex

A

1) methamphetamine (Crystal/meth/Tina)
2) mephedrone (meph, miaow miaow, m-cat)
3) GHB/GBL (G, Gina)

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6
Q

PWID and prep

A

Low hiv prevalence in PWID
Don’t give prep where needel exchange and opiate substitution is available and accessed
Chemsex - different and high risk of HIV. Give prep

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7
Q

Trans prep prescribing recommendations

A
  • Daily prep to hiv neg trans women having condomless anal sex in past 6/12 and ongoing
  • prep for trans women and men with positive hiv partner not on ART
  • if trans and only having anal sex - can consider EBD
  • discuss unknown efficacy for vaginal sex and prep
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8
Q

Considerations for young people and prep

A

No need for routine BMD scan - evidence is all returns to normal on stopping
Teenagers critical peak of bone mass
Fraser guidance etc

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9
Q

Anal sex prep regime

A

Double dose 2-24 hours before sex
Single dose at 24 and then 48 hours
Continue daily until 48hours post last sex

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10
Q

If taking prep for anal sex and interrupted then what’s the advice

A

If less than 7 days since last dose- single dose to restart

If more than 7 days since last dose - double dose to restart. Consider need for pep

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11
Q

Vaginas sex and prep regime

A

Takes 7 days until working (still take double dose incase can’t wait 7/7) and then continue for 7/7 post last sexual risk

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12
Q

Prep regime for PWID

A

7 days to work, 7 days after last risk to stop

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13
Q

Population risk factors for HIV acquisition

A 
Heterosexual black African men and women
Recent migrant to UK
Transwoman 
PWID
Sex work/ transactional sex
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14
Q

Clinical indicators for increasing HIV risk

A

Rectal bacterial STI in past year
Baceterial STI or HCV in past year
Pepse in previous year (repeated courses particularly)

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15
Q

Sexual behaviours and risks for HIV acquisition

A

Condomless sex with unknown HIV status of partner (particularly if anal or multiple partners)
Condomless sex from high risk country
High risk behaviour - chemsex/ group sex
Reports anticipated high risk sex

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16
Q

Drug use risk factors for HIV

A

Sharing kit
Unsafe setting for injecting
No needle exchange or opiate sub programme

17
Q

Sexual health autonomy risk factors for HIV

A 
No option for condoms
Coercive violent relationship
Homelessness or precarious housing
Sex exploration risk or trafficking
Drug/alcohol/ mental health impact
18
Q

WHO definition of hiv substantial risk of acquiring?

A

Incidence greater than 3 per 100 person years

19
Q

Predictors of HIV infection associations

A

Concurrent rectal STI
2 or more condomless acts in past 90 days
Prev pep in past 90 days
Chemsex

20
Q

What to cover in discussion re prep and educating patient

A 
Hiv transmission
Testing and window periods
Side effects of prep
Efficacy and adherence
Regime
Pep for risks
Sti testing and prevention
Resources I want prep now
Referral for any support services e.g drugs
21
Q

How to transition from pep to prep and testing times

A

Test after pep finishes (4 weeks)

Then test again 4 weeks after starting prep

22
Q

Hiv testing required to start prep

A

Must have baseline 4th generation or negative result in past 4 weeks
Can do a poct and wait results (higher false positives and false neg in early infection)

23
Q

What to send if starting prep and high risk exposure in past 4 weeks

A

Hiv viral load

Start prep if no Sx, negative poct and ongoing risk and then retest in 4/52

24
Q

Symptoms of acute HIV infection

A

Commonly rash and fever

Also headache, malaise, arthralgia, sore throat

25
Q

Risk factors for renal disease to consider

A

Nephrotoxic meds
>40 years old
Diabetic/HTN

26
Q

Egfr when ok to start prep

A

> 60

If less than - renal consultant

27
Q

Considerations if patient on prep and also chronic Hep B

A

Don’t suddenly stop as risk of rebound viraemia and hepatic flare - slowly with LFTs
Don’t give event based dosing
Vaccinate

28
Q

Daily dosing - minimum no of tablets per week

A

4 at least ( do alternative days)

29
Q

When to give pep after prep not used correctly?

Anal and vaginal

A

If less than 3 tablets taken in last 7 days or if last dose was more than 7 days ago
If 3 tablets taken in past 7/7 - just have single dose now and covered
If vaginal sex - give pep if less than 6 tablets in past 7/7 or more than 48hours since last dose

30
Q

Follow up schedule for prep

A

1/12 - phone or text to check adherence/ ses
3/12 - hiv, sts, stis, Hep c
Annual egfr, creatinine if no renal concerns

31
Q

Side effects of prep

A 
Nausea
Flatulence
Abdo pain
Dizziness
Headache
Most disappear in 1/12
Renal and bone longer term
32
Q

What to discuss at prep first visit and to do

A 
Prep
Medical Hx
Drug hx
Risk assessment and prep eligibility
Acute hiv infection (Sx in past 4/52?)
Pepse
Any HIV pos partners?
Testing hx last 1 year
Sex hx ans when last sex
EBD vs daily
Adherence
Renal/ bone
Results
Follow up schedule
Short term side effects
33
Q

Baseline prep tests

A 
Hiv 4th gen plus POCT for same day
Sti screen
Hep b and c screen for those at risk
Serum creatinine, egfr and urinalysis
Pt if needed
Hep a vaccination
34
Q

Quarterly visit prep

A 
? Need to continue
Adherence
Risk reduction advise
Improve adherence
Rec drugs alcohol support
Results
Hiv/ Hep c sti screen
Px for 90 days
F/u 3/12
Annual bloods
35
Q

If seroconversion on prep

A

Baseline resistance testing ASAP - check for mutations to prep
Consider drug levels
Public health questionnaire

36
Q

If renal concerns then minimum testing frequency for hep c when on prep?

A

6monthly
No need for routine urinalysis at follow up if renal function ok and no additional risk factors as low PPV for proteinuria and raised creatinine

37
Q

Bone risk and prep

A

Reduction in BMD of 1.5-2% at hip and spine after 48 weeks prep
No routine bone monitoring
If have osteoporosis consider vit d and ca
Use frax tool to indicate need for dexa

38
Q

When to stop prep

A

Change in risk behaviour
Renal function <60 egfr
Poor adherence and no improvement with support ( risk of resistance)
Hiv pos
Always check for active hep b before stopping

DipGUM 🤦‍♀️ (29 decks)

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