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HIV/AIDS - Coggle Diagram
HIV/AIDS
Signs and Symptoms
40-90% of pt will be symptomatic
Mononeucleosis-like illness
Non specific signs and symptoms
Begin
1-4 weeks post exposure
High index of suspicion
Fever
Lethargy
Myalgias
Rash
Headache
Pharyngitis
Adenopathy
Rash
Trunk and face > limb
Small pink macules
10 .Oral Ulcers in ACute HIV Infx
Differential Diagnosis
Mononucleosis EBV , CMV
2.. Influenza / COVID
URTI
Secondary syphlis
ACute viral hepatitis
Parvovirus
Rubella
Toxoplasmosis
Disseminated gonococcus
Rheumatic disease
Dru reaction
Mode of Attack
RNA retrovirus
Infects CD4 lymphocytes and monocytes / macrophages
Transcribed to DNA via reserse transcriptase enzyme
Incorporated into host genome
REplicates and is released from host CD4 cells
Produced 10 billion viruses per day
Latent reservoi in Cd4+ memory lymphocytes
Risk Groups
Countries of high prevelance
Men sex men
Injecting drug user
COmmercial sex worker
Partner of above
Anyone who is clincally immunosuppressed or who is about to start immunosuppresive therapy should be offered a HIV test
Natural History
Viral transmission - primary HIV nfx 2-3 weeks
Recovery and seroconverion - further 2-3 weeks
Window period 3 months - now 4-6 weeks
Asymptomatic chronic HIC infx lasts average 8 years
5% long term non-progressors
Symptomatic HIV/AIDs - death average 1.3 years
Goals of ART
Prolong live
Improve QOL
Aim for undetectable viral load to halt progression pf diseasea nd stop onward transmission
Aim for normalisation of CD4 count
To reduce opportunitis infx
Choose regimen which is effective has few sides effects and is easy to take
Testing for HIV
Principles
Antibodies typically appear between 4-6 weeks after infx but may take as long as 3 months
p24 antigen usually detected in a blood sample from 2-4 weeks after infection
p24 rapidly becomes undetectable once antibodies to HIV start to develop
Window Period
Dont delay testing - test now and suggest repeat
Ealiest time to test postive is now 2 weeks
Traditionally window period considered 3 months - now 6 weeks with new 4th generation antibody test
Which Test
Combined Antigen Antibody test
HIV antibody
p24 antigen
Reduced time between infx and pos test
Point of Care Tests (POCTs)
Types
Fingerprick
Mouth swabs
Results within minutes
Can be antibody only or Ab/Ag test
Positive tests need labratory confirmation
Considerations
Verbal consent for HIV testing
Know you risk groups
Low threshold for offering
Risk factor may not be initially apparent
Always think could this be HIV
Remeber window period
Liaise with HIV team
Manage acute medical problem with confidence
Be mindful of drug interactions with HIB Emergencies
Epidemiology
People living with HIV 39.9 million
New HIV infections 1.3 million
Deaths due to AIDS 630,000
3600 new infx per day - 50% in SS Africa
UNAIDS 95-95-95 Targets
95% aware of HIV diagnosis
95% treated for HIV
95% virally suppressed - undetectable virus
By 2030
Reduce new HIV infx by 90%
Treatment
When to Start
Considerations
Potency
Tolerability
Co-morbid conditions
COnvenience
Pregnancy
Risk for toxicity
Drug resistance
Individualised Therapy
Comorbidities
Coinfections
Treatment Choices
1 or 2 NRTI
+
Integrase
OR
BpI or NNRTI
OR
Long acting injectable ART
Viral Resistance and Rebound
Periodically inadequate drg levels
Mutant selected with reduced susceptibiloty
REbound with highly resistant virus
Undiagnosed HIV Infection
.>8,000 PLWH in ireland
May be symptomatic or asymptomatic
Issue with Late Diagnosis
OI
Morbidity and mortality
Onward transmission of the virus to others
Universal Screening
Universal HIV opt-out testing meaens all individuals attending specified setting are offered and recommended a HIV test as part of routine care
Individual has the option to reduse a test
Settings
GUM clinics
Those diagnosed with TB, hep B, hep C, Lymphoma
Antenatal and TOP services
Drug dependancy programmes
TB now second most common opportunitic infection in the UK and worldwide - HIV is beiigest risk factor for development of activ eTB
Historical Treatment
EArly Antiretroviral Therapy
1994
Era of HAART
Aim to achieve durable suppression of HIV Viraemia
Striking reductions in HIV related morbidity and morality
Aggressive treatment guidlines
Mode of Transmission
Blood and Bodilt Fluids
Sex
IV drug use
Transfusion
Vertical
Mother to child
Antiretrovirals 2025
1Finish this
Seeking Heathcare PHI
Swiss cohort
87% seroconverters had symptoms
95% of these has medical evaluation
PHI considered in only 5 of 19 pts
PIH is underdiagnosed