HIV Flashcards by Romy Nicholson

Is HIV nationally notifiable?

Yes - routine, labs and doctors

AIDS not notifiable in Tas - only HIV

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What organism causes HIV?

Human immunodeficiency virus (a retrovirus)

Types I (main) and 2

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How is HIV transmitted?

Blood and bodily fluids.

Blood - needle-sharing, skin penetrating procedures, iatrogenic (blood transfusion, organ transplant)
Sexual contact
Vertical (< 2% with interventions)

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What is the most important determinant of HIV transmission risk?

Viral load.

Undetectable viral load = untransmissible via sexual contact

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What are the clinical features of HIV?

Seroconversion illness (1-4wks post exposure) - fever, myalgia, malaise, LA, sore throat, anorexia, headache; mild and self-limiting lasting 2-3 weeks then ASx for years

AIDS - CD4 depletion results in HIV-related illnesses. E.g. LA, weight loss, neurological disorders, opportunistic infections, malignancy.

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How common is AIDS in Australia?

Rare

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T/F: HIV is considered a chronic condition?

True - HIV considered a chronic condition requring lifelong treatment.

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What is the life expectancy of someone with HIV?

Close to uninfected person with effective treatment.

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Who are high-risk groups for HIV?

Sexual partners of people with HIV
MSM (80%)
Sexual partners of those from high prevalence countries
Having other STIs (either partner) increases risk
PWID
Female sex workers

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What are the case definitions for HIV?

Based on age.

Age < 18mo: p24 antigen or NAT
* Probable = single specimen +
* Confirmed = multiple + specimens on different days

Age > 18mo:
* Confirmed: reactive antibody assay AND Western blot or p24 antigen or NAT
* Probable: p24 antigen or NAT

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How is HIV diagnosed?

4th generation **combination screening test **(HIV antibody / p24 antigen) - positive after 3-6 weeks

Confirmation by Western blot, PCR

POC testing - for harder to reach high-risk groups

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What is the incubation period of HIV?

1-4 weeks to Sx

Antibodies develop usually < 1mo but up to 3mo

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What is the infectious period?

Lifelong, infectivity dependent on viral load

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What is the trend in HIV prevalence in Australia?

Low prevalence and declining.

By 50% in the last 20 years.

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Which groups account for the most HIV notifications in Australia?

MSM - 2/3rds of notifications; 7.3% prevalence; incidence declining
PWID - prevalence 1.4%

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Where is HIV still a major global health problem?

Africa and Asia.
Heterosexual transmission most common.

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What is the SDG 3.3 goal for HIV?

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End HIV epidemic by 2030 - aim for:
* 95% diagnosed
* 95% on ART
* 95% suppression

What resources are available for public health management of HIV?

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SoNG.
DH protocol.
HCW BBV guidance.
ASHM guidance.

Who are key organisational stakeholders for HIV?

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ASHM
NAPWHA - National Assocition of People with HIV Australia
Positive Lives Tasmania
TasCAHRD - Tasmanian Council for AIDS, Hepatitis, and other Related Diseases
Kirby Institute (surveillance / research)
Australian Federation of AIDS Organisations (AFAO)
Scarlet Alliance (sex workers)
AIVL
UNAIDS

How is HIV prevented?

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PrEP - reduces risk from sexual contact by 99%, IVDU by 75% (see ASHM guidance - tenofovir/emriticitabine co-formulation)

PWID - harm reduction; NSPs, MSICs

Testing - universal screening in pregnancy; MSM test q3mo (STIGMA guidelines); female partners of MSM, people from high prevalence countries; lab or rapid test (needs confirmation with lab test)

HCWs - EPPs - tested for BBVs every 3 years

Screening - donated blood, blood products, organ/tissues for transplant

**Education **- public awareness: safe sex, safe injecting

IPC - healthcare and skin penetrating premises; sharps handling and disposal

Cases - dx/rx of other STIs, treatment (cART) as prevention (U=U)

U=U - undetectable = undetectable»_space; almost zero risk of transmission

How are cases of HIV managed?

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Responsibility varies between jurisdictions (PHU, clinicians)

Interview - confirm dx, rfs / exposure hx including sexual
Testing - other BBVs (HBV, HCV, STIs, TB)

T - combination ART; specialists; undetectable viral load in 6mo
I - no blood / semen domation
E - transmission, safer sex/injecting

How are pregnant women with HIV managed?

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Specialist referral, treatment, c-section, PEP for infants, no BF

How are HCWs with HIV managed?

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CDNA guidelines.

EPP requires specialist care with viral load monitoring 3/12, on cART, viral load < 200 copies/mL

https://www.health.gov.au/resources/publications/cdna-national-guidelines-healthcare-workers-who-live-with-blood-borne-viruses-perform-exposure-prone-procedures-or-are-at-risk-of-exposure-to-bbvs?language=en

Who manages HIV contacts?

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Varies between jurisdictions - PHU, clinicians, sexual health

What is the aim of contact management?

Identify people potentially exposed, enable counselling, testing, management, education

What is the definition of a HIV contact?

* Sexual - unprotected anal/vaginal sex * IVDU - sharing drug equipment * Vertical - newborn to HIV+ mother (including BF) * Transfusion * Occupational exposure

How is contact tracing conducted?

Complex. Consider psychosocial issues, stigma. Australian Contact Tracing Guidelines (ASHM) Timeframe varies by case - start with recent contacts, outer limit is onset of risk behaviour or last known negative test

How are contacts notified?

Case or provider. Provider notification preferred - allows more oversight, case safety, and education. Requires consent from case to notify contacts. Ensure communication is culturally appropriate.

How are contacts managed?

T - PEP (28d ART) for sexual / blood exposure in last 72hrs (ASHM PEP guidelines); counselling and referral to support services I - NA E - transmission, minimising risk, seroconversion sx, window period

How are needlestick contacts managed?

Transmission risk very low. See Australian IPC guidelines. SHs: OH&S, IPC, ID T - testing, PEP, counselling I - NA M - monitoring for sx E - transmission, minimising risk, seroconversion sx, window period

How involved are PHUs in HIV cases?

Minimum involvement. Support clinicians as required, conduct investigations when required or when requested by clinician.

Under which circumstances are PH investigations conducted?

* Suspected nosocomial acqusition * Acquisition via skin penetrating procedure * Blood transfusion donor / recipient * HCW performed EPP while infectious * Cluster/suspect common source

How is acquisition via suspected nosocomial or via skin penetrating procedure investigated?

Urgent PH investigation. Review of IPC practices. May need a lookback.

How is acquisition via blood transfusion investigated?

Notify Red Cross and DH. Consider lookback.

How is an infectious HCW permorming EPPS investigated?

Investigation and potential lookback required. Risk extremely low (8 cases ever worldwide, many lookbacks with thousands tested) Viral load increases risk.

How are clusters / suspected common sources investigated?

Investigation, consider tailored questionnaire

What legislation is important to frame response to PH management of HIV?

**Public Health Act Tas** 1997 **Privacy Act 1988** (Commonwealth) **Disability Discrimination Act 1992** (Commonwealth): illegal to discriminate against an individual on the basis of their HIV status

What is the guiding document for public health management of HIV in Australia?

National HIV Strategy. Contains: guiding principles, goals and targets, priority populations and settings, priority areas for action, and implementation/monitoring

Who are priority populations in the National HIV Strategy?

PLHIV, trans/gender diverse, MSM, Indigenous people, CALD people from high prevalence countries, sex workers, PWID, custodial settings

What are priority action areas in the National HIV Strategy?

Education/prevention Testing/Rx/Mx Equitable access to care Workforce Addressing stigma Data/surveillance/research/evaluation

What is the BBVSTI Standing Committee?

Key advisory body on BBVSTI social issues, programs and policies; reports to AHPC

HIV Flashcards

(41 cards)