HIV Diagnosis and Treatment

HIV diagnosis increased in 2010 by almost 50%. 3080 of the 3780 cases diagnosed were in gay men.

HIV testing now be done through venous sampling or, where facilities exist, a finger-prick test. Venous sampling is now more sensitive so that it can detect the virus within a month of the exposure. The finger-prick test however, can yield a result after 20 minutes. In some instances a saliva test may be used.

CD4 cells are immune cells which become infected with HIV. The level of CD4 cells in a person newly diagnosed with HIV can be as low as 200 mm3 per  of blood (the normal count is 500-1600). If the count is below 350, the British HIV Association (BHIVA) recommends starting highly active antretroviral therapy (HAART). When the count is below 200, the risk of developing AIDS is significant.

Because of the estimate that around a quarter to a third of those with HIV are unaware they have the virus (HPA figures – but I don’t know how they calculated it!) testing is becoming more important. Previously, because of the stigma of HIV it was necessary to provide counselling before the test was carried out. Now, although there is still a stigma with HIV, public awareness is improved, which has made an ‘opt out’ system of testing possible withcounselling provided where necessary. This has led to much improved testing rates, which enables quicker diagnosis and therefore starting trestment quicker, which leads to a better outcome.

Patients with clinical indicator diseases ought to be tested (these are: TB, pneumocystis, bacterial pneumonia, aspergillosis, cerebral toxoplasmosis, primary cerebral lymphoma, cryptococcal meningitis, progressive multifocal leucoencephalopathy, aseptic meningitis/encephalitis, cerebral abcess, space-occupying lesions of an unknown cause, Guillain-Barré syndrome, transverse myelitis, peripheral neuropathy, dementia, leucoencephalopathy, Kaposi’s sarcoma, severe or recalcitrant seborrhoeic dermatitis, severe or recalcitrant psoriasis, multidermatomal or recurrent herpes zoster, persistent cryptosporidiosis, oral candidiasis, oral hairy leukoplakia, chronic diarrhoea of unknown cause, weight loss of unknown cause, salmonella, shigella, campylobacter, hepatitis B, hepatitis C, non-Hodgkin’s lymphoma, anal cancer, anal intraepithelial dysplasia, lung cancer, seminoma, head and neck cancer, Hodgkin’s lymphoma, Castleman’s disease, cervical cancer, vaginal intraepithelial neoplasia, cervical intraepithelial neoplasia grade 2 or above, any unexplained blood dyscrasia (including thrombocytopenia, neutropenia, lymphopenia,) cytomegalovirus retinitis, infective retinal diseases including herpes viruses and toxoplasma, any unexplained retinopathy, lymphadenopathy of unknown cause, chronic parotitis, lymphoepithelial parotid cysts, mononucleosis like syndrome (primary HIV infection) pyrexia of unknown origin, any lymphadenopathy of unknown cause, any sexually transmitted infection). Community testing with the finger-prick system has meant a greater take-up of the test in harder to reach communities.

If indicated, (CD4 level below 350), treatment with HAART can begin as soon as the patient is ready (patient commitment is vital as treatment requires strict adherence to the treatment programme (at least 95%). Traditionally, up to three antiretroviral tablets were prescribed for daily administration. However, latterly they have been made available to many patients as a combined tablet to be taken once daily, which has improved adherence rates.

Post exposure prophylaxis (PEP) is a four week programme of HAART. This was initially available to healthcare workers after sustaining needlestick injuries; however, this has now been rolled out to those who in the last 72 hours have undertaken high risk sexual activity and therefore potentially may have been exposed to HIV.

Ref: JONES, M. 2011, Diagnosing and Treating HIV Infection. Nursing Times 107:11, 12-14.

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