Hiv/aids

Front 1

In 2012, the FDA approved this drug for pre-exposure prophylaxis against HIV infection in uninfected individuals who are at high risk of HIV infection and who may engage in sexual activity with HIV-infected partners. The drug is contraindicated for pre-exposure prophylaxis in persons with unknown or positive HIV status.

Back 1

emtricitabine/tenofovir disoproxil fumarate

Front 2

What % of patients who become infected with HIV experience an acute symptomatic illness within 2 to 4 weeks of infection, although an accurate diagnosis is not established in most patients during this time.

Symptoms of acute retroviral syndrome typically last 2 to 3 weeks and may range from a simple febrile illness to a full-blown, mononucleosis-like syndrome.

Back 2

90%

Front 3

How do you diagnose someone with acute retroviral syndrome with recent HIV exposure?

Back 3

Patients presenting with symptomatic acute HIV infection (the acute retroviral syndrome) are usually in the “window period,” which may extend for 3 to 6 weeks, during which time seroconversion of the disease has not yet occurred and results of HIV antibody testing are negative. However, viral-specific tests, such as those for nucleic acid, are usually positive at quite high levels during this time frame and can be used to establish the diagnosis.

Front 4

Diagnosis of AIDS?

Back 4

An AIDS diagnosis is established when certain AIDS-indicator opportunistic infections or malignancies develop or when the CD4 cell count falls below 200/microliter.

Front 5

General population screening recommendations for HIV testing

Back 5

All persons aged 13 to 64 years are recommended to undergo HIV testing at least once unless the prevalence in the specific population is less than 0.1%.

In addition, the American College of Physicians has issued a guidance statement recommending that this age range be expanded to include persons through age 75 years because of increased rates of infection in this population.

Front 6

HIV screening recommendations in high risk populations?

Back 6

Persons likely to be at high risk for HIV infection should undergo repeat HIV testing at least annually.

Front 7

Diagnosis of AIDS

Back 7

Established by a 2-stage serologic testing process. The initial test is an enzyme immunoassay. A negative EIA is generally considered adequate to exclude infection except during the acute phase following primary infection (The Window Period) before seroconversion occurs and when serologic testing, including Western Blot assay, may be falsely negative. In these patients, EIA testing should be repeated 6-12 weeks later when seroconversion is established. If an acute diagnosis is necessary during the window period, a specific viral test such as the quantitative RNA polymerase chain reaction assay may be useful; in acute infection, the viral load is usually very high (often >100,000 copies/mL). However, use of a viral load study for routine diagnosis or in situations other than during the acute phase of infection is discouraged because of decreased sensitivity and specificity of the test at lower viral loads and the significant cost relative to EIA. In a patient with a positive EIA, the test should be repeated. Repeatedly positive EIA results are confirmed by Western blot assay. Combination testing with EIA followed by Western blot assay has a sensitivity of 99.5% and specificity of 99.99%. Rapid HIV tests are now available in kits that can be used in the clinical setting. These are EIA tests, and positive results require standard follow-up confirmatory testing. Because the EIA requires confirmatory testing, it is never appropriate to tell patients they have HIV infection based on results of any EIA alone before the Western blot results are known.

Front 8

Indications for HIV testing

Back 8

(1) Symptoms/Signs of Acute Retroviral Syndrome
(2) Sx/Si of chronic HIV infection
(3) Opportunistic infection
(4) Severe, recurrent, or persistent infection that does not qualify as opportunistic
(5) Presence of TB, HBV, HCV infection, other STDs, hemophilia
(6) History of at-risk behavior (multiple sex partners, MSM, IVDA) or sexual partner of someone who engages in at-risk behavior
(7) All persons ages 13-64 years, unless in population areas with low (<0.1%) prevalence
(8) Known or suspected HIV exposure
(9) Patient request
(10) All pregnant women
(11) Child born to mother infected with HIV
(12) Occupational exposure to blood/body fluid (both source patient and exposed worker)
(13) Blood/semen/organ donor

Front 9

Laboratory Testing as Part of the Evaluation of HIV infection

Back 9

- Repeat HIV antibody testing if no documentation
- Viral resistance testing at baseline and for treatment failure (now recommended!)
- Quantitative HIV RNA assay (Viral Load)
- CBC with diff
- BMP
- LAEs
- TB skin test or IFN-gamma release assay
- Serologic testing for hepatitis A, B, and C infection
- Serologic testing for syphilis; testing for other STDs
- PAP test
- Toxoplasma serology
- Varicella and cytomegalvirus serologies in high risk individuals

Front 10

Recommended frequency of CD4 and Viral load monitoring

Back 10

Repeat testing of CD4 cell count, viral load, complete blood count, and kidney and liver function should be performed whenever HIV regimens are begun or modified, 2 to 8 weeks after therapy is changed, and every 3 to 6 months in patients whose regimens remain stable.