HIV clinical aspects I

what is the total world population with AIDs?
33.4 million
what race has the highest prevalence of AIDs in the US?
african americans, even though they only make up 12% of the american population
who did AIDs affect primarily when it was first diagnosed in june 1981?
gay white men
do men or women contract HIV through injection drug use more often?
women
how do men commonly contract HIV? women?
males often contract HIV from other male sexual partners, while with women HIV infection is usually resultant from heterosexual contact
can men get HIV from females through sexual contact?
yes
what are US AIDs prevention efforts?
education (ABCs – abstinence, be faithful, condoms), expansion of HIV testing/screening, expansion of ARV (antiretroviral tx both therapeutic and prophylactic – PREP) which can be challenging/expensive
what are global AIDs prevention efforts?
ABCs, circumcision, STD tx
what are historical indicators for HIV testing?
IVDU (past/current IV drug users in the last 6 mo), MSM (men who have sex w/men – tested annually), mult sexual partners, HIV+ sexual partners, pregnancy
what are clinical indicators for HIV testing?
sexually transmitted infection (GC, HSV), opportunisitic infections (PCP, KS), unexplained lab findings/clinical symptoms such as anemia, leucopenia, thrombocytopenia, abnormals renal function, diarrhea, weight loss, fatigue, or neurological problems
what are the CDC recommendations for HIV testing?
routine voluntary testing for pts 13-64 (not based on risk), opt-out rather than opt-in testing, no separate consent for HIV test, no pretest counseling requirement, repeat testing based on risk
what are criteria justify routine screening, do they apply to HIV testing?
yes; HIV is a serious disorder that can be detected before symptoms develop (HIV testing more preventative than other preventative healthcare measures:colonoscopies, pap smears, etc), HIV treatment is more beneficial before symptoms develop, the test is reliable/inexpensive, and the costs of screening are reasonable in relation to anticipated benefits
what does data show in terms of people aware vs unware of their HIV infection transmitting it?
~25% of total HIV patients were unaware of their HIV and accounted for approximately 54% of new infections where approximately 75% of total HIV patients were aware of their HIV and accounted for approximately 46% of new infections
what two groups in terms of gender/sexual orientation have the highest rate of undiagnosed HIV infection?
MSMs, heterosexual males
what is a “late tester”? what percent of HIV diganoses do these case make up?
an pt with an AIDs diagnosis within one year of being tested, means they probably have been infected for over 5 years (mostly decided to get tested because they became sick). these cases account for ~40% of HIV diagnoses
what are the current methods for diagnostic HIV testing?
ELISA with confirmatory western blot (combined specificity: 99%, the 1% is usually seen w/pregnancy), positive test = 2+ bands from p24, gp41, gp120, or gp160
what is nucleic acid testing used for? what should it not be used for?
nucleic acid testing is used most commonly to test the viral load (either HIV-RNA via PCR/bDNA). it can be used to dx acute HIV infection, but not for general dx due to high level of false positive results. its primary role is to help with tx decision and ART management
how many rapid HIV tests (in-office) are available as of 2009? what is their sensitivity/specificity? is confirmatory serological testing recommended?
6, sensitivity/specificity is 99%. confirmatory serological testing necessary.
how does the oraquick advance rapid HIV test work?
oral fluid is swabbed and tested for HIV antibodies (saliva is not contagious, but will still carry HIV IgA)
where are the CDC revised recommendations for HIV testing?
private physician offices, inpatient/acute care settings, EDs/urgent care clinics, STD clinics, TB, community and public health clinics which should provide HIV care or establish referral to appropriate providers/tx centers.
where is written consent required for HIV testing? why is this still the case?
MA, MI, NE, OR, NY, PA, WI, RI. this is a separate form of consent which was initially helpful for pts because there was a stigma associated with being HIV+ and people wanted to know what they were getting into (risk of a lost job etc)
what are the requirements for HIV testing in PA?
written consent, pre-test counseling, confirmatory western blot, in-person notification of results, post-test counseling
what are the “big four” signs of acute HIV infection? what are other symptoms? why are all these seen?
fever (96%), lymphadenopathy (74%), pharyngitis (70%), rash (65%). other symptoms include : myalgia/arthralgia, headache/diarrhea, nausea/vomiting, hepatosplenomegaly, meningits, opportunistic infections (listed in order of appearance). the immune system takes a tremendous hit in acute HIV infection
what are differential dx’s w/acute HIV infections?
group A strep infection, acute mononucleosis (EBV/CMV), viral syndrome (coxsackie/adenovirus), malignancy, and connective tissue disease
what is important in diganosis of acute HIV? why?
a high index of suspicion is important in diganosis of acute HIV b/c HIV-antibody testing will usually be negative (+ ELISA/- indeterminant WB) – HIV-RNA (viral load) testing needs to be done via PCR/bDNA
what is the important of IDing acute HIV infections?
neccessity of getting pts into medical care/education, decrease HIV transmission to partners, long asymptomatic/latent peroid (5-10 yrs) -> antiretroviral therapy should be considered
what are the possible benefits of anti-retroviral infection with HIV?
decrease severity of acute disease, alter the viral “set point”, reduce the rate of mutation, preserve immune function, reduce risk of viral transmission
what are the possible risks of antiretroviral acute tx?
drug-related toxicty, earlier emergence of drug resistance, limitation of future tx options, potential need for indefinite tx, adverse effects on quality of life