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HIV clinical aspects I
cmbm exam V
28
Chemistry
Graduate
02/12/2010

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Cards

Term
what is the total world population with AIDs?
Definition
33.4 million
Term
what race has the highest prevalence of AIDs in the US?
Definition
african americans, even though they only make up 12% of the american population
Term
who did AIDs affect primarily when it was first diagnosed in june 1981?
Definition
gay white men
Term
do men or women contract HIV through injection drug use more often?
Definition
women
Term
how do men commonly contract HIV? women?
Definition
males often contract HIV from other male sexual partners, while with women HIV infection is usually resultant from heterosexual contact
Term
can men get HIV from females through sexual contact?
Definition
yes
Term
what are US AIDs prevention efforts?
Definition
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
Term
what are global AIDs prevention efforts?
Definition
ABCs, circumcision, STD tx
Term
what are historical indicators for HIV testing?
Definition
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
Term
what are clinical indicators for HIV testing?
Definition
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
Term
what are the CDC recommendations for HIV testing?
Definition
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
Term
what are criteria justify routine screening, do they apply to HIV testing?
Definition
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
Term
what does data show in terms of people aware vs unware of their HIV infection transmitting it?
Definition
~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
Term
what two groups in terms of gender/sexual orientation have the highest rate of undiagnosed HIV infection?
Definition
MSMs, heterosexual males
Term
what is a "late tester"? what percent of HIV diganoses do these case make up?
Definition
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
Term
what are the current methods for diagnostic HIV testing?
Definition
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
Term
what is nucleic acid testing used for? what should it not be used for?
Definition
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
Term
how many rapid HIV tests (in-office) are available as of 2009? what is their sensitivity/specificity? is confirmatory serological testing recommended?
Definition
6, sensitivity/specificity is 99%. confirmatory serological testing necessary.
Term
how does the oraquick advance rapid HIV test work?
Definition
oral fluid is swabbed and tested for HIV antibodies (saliva is not contagious, but will still carry HIV IgA)
Term
where are the CDC revised recommendations for HIV testing?
Definition
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.
Term
where is written consent required for HIV testing? why is this still the case?
Definition
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)
Term
what are the requirements for HIV testing in PA?
Definition
written consent, pre-test counseling, confirmatory western blot, in-person notification of results, post-test counseling
Term
what are the "big four" signs of acute HIV infection? what are other symptoms? why are all these seen?
Definition
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
Term
what are differential dx's w/acute HIV infections?
Definition
group A strep infection, acute mononucleosis (EBV/CMV), viral syndrome (coxsackie/adenovirus), malignancy, and connective tissue disease
Term
what is important in diganosis of acute HIV? why?
Definition
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
Term
what is the important of IDing acute HIV infections?
Definition
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
Term
what are the possible benefits of anti-retroviral infection with HIV?
Definition
decrease severity of acute disease, alter the viral "set point", reduce the rate of mutation, preserve immune function, reduce risk of viral transmission
Term
what are the possible risks of antiretroviral acute tx?
Definition
drug-related toxicty, earlier emergence of drug resistance, limitation of future tx options, potential need for indefinite tx, adverse effects on quality of life
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