Venereum
Lymphogranuloma
↳ PAIN
_
ESS
genital ulcer +
inguinal Lymphadenopathy
↳ 21
day course of doxycycline
Chancroid
↳ PAINFUL genital ulcer +
inguinal Lymphadenopathy
↳ caused
by Haemophilus ducreyi
Animal/Human Bites (Pasteurella multocida)
• 1ST LINE = co-amoxiclav
• Alternatives = doxycycline + metronidazole
Bedbugs = topical hydrocortisone
SEXUAL HEALTH
CD4 Count -
500-1200 cells/mm3 = normal range
200 cells/mm3 = ↑ risk
of infection
Testing for HIV RNA indicates viral load Good
↳ Undetectable Viral load-level below recordable range
, Zidovudine
↳
Post-exposure prophylaxis in an infant born to a low-risk mother aginal Load 38 Vaginal delivery
> associated
- with anal , Liver
Lung Burkitt's Lymphoma Kaposi's
S Sarcoma
HIV
50 = CS cancers ,
, ,
↳ untreated in Labour at term
Management of given IV
women L
,
yearly cervical smears
↳
Newly diagnosed HI in
pregnancy =
Triple therapyCART
↳ 2 NRTIS +
Integrase Inhibitor
OR Protease Inhibitor
↳
Tenofovir & Entricitabine OR Abacavir & Lamivudine +
Doltegravir Atazanavir/Ritonavir
Features
OR
• Sore throat, lymphadenoapthy, malaise, myalgia, arthralgia Pnumocystis Jirovecii Pneumonia (PCP)
• Diarrhoea, maculopapular rash, mouth ulcers • Dry cough, exertion dyspnoea
• Gold standard = bronchoalveolar lavage
pts with
• Investigations = silver stain -Given to all
Diagnosis 200/mm3 CD4 <
• HIV antibodies - majority develop at 4-6 months, and all by 3 months - CXR = bilateral perihilar + interstitial infiltrates
• Screening ELISA test and a confirmatory Western Blot Assay • Management = co-trimoxazole - 1ST LINE
• Gold standard test = HIV RNA PCR test (HIV antibody + antigen) - Side effects: SJS/TEN, drug-induced lupus, agranulocytosis
- If +ve = repeat to confirm diagnosis • Adjunctive steroids if PaCO2 < 8kPa or hypoxia
• Test for HIV in asymptomatic patients at 4 weeks post-exposure
- If -ve = repeat test at 12 weeks Toxiplasmosis
• Features = confusion, dysphagia, abnormal gait, rapid onset
Initial Treatment of HIV • Imaging = multiple ring-enhancing lesions in basal ganglia
• 2 NRTIs + 1 NNRTI • Management = pyrimethiamine and sulfadiazine - 6 weeks
• 2 NRTIs + 1 integrase inhibitor = most common CMV Retinitis
• 2 NRTIs + 1 boosted PI
Rapid Loss of vision
-
• Dolutegravir + Lamivudine -> integrase inhibitor + NRTI
Haemorrhagic pizza-like lesions
-
-
Treatment = IV
ganciclovir
• NRTIs = abecavir, tenofovir, lamivudine, emtricitabine
• NNRTIs = efavirenz, rilpivirine, doravirine
• Integrase inhibitors = raltegravir, dolutegravir, bictegravir, elvitegravir
• Protease inhibitors = darunavir, atazanavir, ritonavir (as a booster)
* All HIV pts should be started
PEP
on
count
• 28 day course - used post sex
cART
therapy irrespective of CD4
↳ rise ischaemic and
• 1 Truvada tablet OD (245mg tenofocir disoproxil fumerate / 200mg of both
emtricitabine) haemorrhagic strokes
• + 2 Raltegravir tablet (1200mg) OD
PrEP
• Tenofovir-df/emtricitabine before and after sexual activity to prevent HIV
Lymphogranuloma
↳ PAIN
_
ESS
genital ulcer +
inguinal Lymphadenopathy
↳ 21
day course of doxycycline
Chancroid
↳ PAINFUL genital ulcer +
inguinal Lymphadenopathy
↳ caused
by Haemophilus ducreyi
Animal/Human Bites (Pasteurella multocida)
• 1ST LINE = co-amoxiclav
• Alternatives = doxycycline + metronidazole
Bedbugs = topical hydrocortisone
SEXUAL HEALTH
CD4 Count -
500-1200 cells/mm3 = normal range
200 cells/mm3 = ↑ risk
of infection
Testing for HIV RNA indicates viral load Good
↳ Undetectable Viral load-level below recordable range
, Zidovudine
↳
Post-exposure prophylaxis in an infant born to a low-risk mother aginal Load 38 Vaginal delivery
> associated
- with anal , Liver
Lung Burkitt's Lymphoma Kaposi's
S Sarcoma
HIV
50 = CS cancers ,
, ,
↳ untreated in Labour at term
Management of given IV
women L
,
yearly cervical smears
↳
Newly diagnosed HI in
pregnancy =
Triple therapyCART
↳ 2 NRTIS +
Integrase Inhibitor
OR Protease Inhibitor
↳
Tenofovir & Entricitabine OR Abacavir & Lamivudine +
Doltegravir Atazanavir/Ritonavir
Features
OR
• Sore throat, lymphadenoapthy, malaise, myalgia, arthralgia Pnumocystis Jirovecii Pneumonia (PCP)
• Diarrhoea, maculopapular rash, mouth ulcers • Dry cough, exertion dyspnoea
• Gold standard = bronchoalveolar lavage
pts with
• Investigations = silver stain -Given to all
Diagnosis 200/mm3 CD4 <
• HIV antibodies - majority develop at 4-6 months, and all by 3 months - CXR = bilateral perihilar + interstitial infiltrates
• Screening ELISA test and a confirmatory Western Blot Assay • Management = co-trimoxazole - 1ST LINE
• Gold standard test = HIV RNA PCR test (HIV antibody + antigen) - Side effects: SJS/TEN, drug-induced lupus, agranulocytosis
- If +ve = repeat to confirm diagnosis • Adjunctive steroids if PaCO2 < 8kPa or hypoxia
• Test for HIV in asymptomatic patients at 4 weeks post-exposure
- If -ve = repeat test at 12 weeks Toxiplasmosis
• Features = confusion, dysphagia, abnormal gait, rapid onset
Initial Treatment of HIV • Imaging = multiple ring-enhancing lesions in basal ganglia
• 2 NRTIs + 1 NNRTI • Management = pyrimethiamine and sulfadiazine - 6 weeks
• 2 NRTIs + 1 integrase inhibitor = most common CMV Retinitis
• 2 NRTIs + 1 boosted PI
Rapid Loss of vision
-
• Dolutegravir + Lamivudine -> integrase inhibitor + NRTI
Haemorrhagic pizza-like lesions
-
-
Treatment = IV
ganciclovir
• NRTIs = abecavir, tenofovir, lamivudine, emtricitabine
• NNRTIs = efavirenz, rilpivirine, doravirine
• Integrase inhibitors = raltegravir, dolutegravir, bictegravir, elvitegravir
• Protease inhibitors = darunavir, atazanavir, ritonavir (as a booster)
* All HIV pts should be started
PEP
on
count
• 28 day course - used post sex
cART
therapy irrespective of CD4
↳ rise ischaemic and
• 1 Truvada tablet OD (245mg tenofocir disoproxil fumerate / 200mg of both
emtricitabine) haemorrhagic strokes
• + 2 Raltegravir tablet (1200mg) OD
PrEP
• Tenofovir-df/emtricitabine before and after sexual activity to prevent HIV
