HIV Post-Exposure Prophylaxis (PEP)

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Questions and Answers

What is the recommended duration of a course of PEP?

14 days

28 days (correct)

21 days

30 days

What is the goal of promoting the use of barrier protection during sexual encounters?

To prevent HIV transmission (correct)

To cure HIV

To treat HIV

To diagnose HIV

What is the recommended regimen for PEP?

2-drug regimen involving an integrase inhibitor

4-drug regimen involving a protease inhibitor

5-drug regimen involving a non-nucleoside reverse transcriptase inhibitor

3-drug regimen involving an integrase inhibitor (correct)

What is the time frame within which PEP should be started?

As soon as possible, and no later than 72 h Signup and view all the answers

What is the concept that refers to the idea that people living with HIV who have undetectable viral loads are not infectious?

Undetectable = Untransmittable (U=U) Signup and view all the answers

What is the first-line ART regimen for PEP?

Tenofovir disoproxil, lamivudine, and dolutegravir Signup and view all the answers

What is the primary way that HIV can be spread to babies?

Through breastfeeding by an infected mother Signup and view all the answers

What is the enzyme responsible for converting viral RNA into DNA during the HIV life cycle?

Reverse transcriptase Signup and view all the answers

During which phase of HIV infection does the patient experience flu-like symptoms?

Primary infection phase Signup and view all the answers

What is the purpose of the WHO clinical staging system?

To classify patients into four hierarchical stages Signup and view all the answers

What is the result of the integration of viral DNA into the host DNA during the HIV life cycle?

The creation of viral protein chains Signup and view all the answers

What is the average time it takes for an HIV infection to develop into AIDS?

10 years Signup and view all the answers

What percentage of people living with HIV in SA are currently on treatment?

70-75% Signup and view all the answers

What is the purpose of providing additional adherence support to people with HIV?

To address difficulties with adherence to appointments or ART Signup and view all the answers

What is the risk of HIV transmission in a healthcare setting through percutaneous exposure?

0.3% Signup and view all the answers

What is the purpose of UNAIDS 95:95:95 goals?

To improve access to treatment and prevent HIV transmission Signup and view all the answers

What is the primary purpose of PrEP?

To prevent HIV infection in high-risk individuals Signup and view all the answers

What is the administration of a short course of antiretroviral therapy to an HIV-negative person who has been exposed to HIV called?

PEP Signup and view all the answers

Study Notes

Adherence to ART

Adherence to ART should be regularly assessed by self-report at every clinic visit.
People with HIV having difficulties with adherence to appointments or ART should be provided additional adherence support using a constructive, collaborative, non-judgmental, and problem-solving approach.

Treatment Goals

Only 70% to 75% of all people living with HIV in SA are currently on treatment.
UNAIDS 95:95:95 goals: 95% of all people with HIV know their status, 95% of those who know their status are on treatment, and 95% of those on treatment are virally suppressed.
SA's progress towards the UNAIDS goals: 94% (status), 79% (treatment), and 91% (virally suppressed).

Stigma, Discrimination, and Disclosure

Treatment as Prevention (TasP) approach emphasizes the importance of early treatment to reduce HIV transmission.
Pre-Exposure Prophylaxis (PrEP) is not intended for everyone, but for those at high risk of HIV infection.
PrEP does not replace traditional risk-reduction strategies.

Post-Exposure Prophylaxis (PEP)

PEP is a short course of antiretroviral therapy to prevent HIV acquisition after exposure.
PEP should be started as soon as possible, and no later than 72 hours, after exposure.
The global recommendation for PEP is a 3-drug regimen, including an integrase inhibitor, for 28 days.
Almost all PEP is now 28 days of first-line ART (TLD: tenofovir disoproxil, lamivudine, and dolutegravir).

HIV Transmission Prevention

Promote barrier protection (latex condoms and lubricant) during sexual encounters.
Effective use of PrEP can prevent HIV transmission.
Undetectable viral loads in serodiscordant sexual partners living with HIV (U=U) can prevent transmission.
Harm reduction practices in people who inject drugs (PWID) can also prevent transmission.
Strict adherence to universal precautions within the healthcare setting is essential.

Mother-Infant (Vertical) Transmission

HIV can be spread to babies born to, or breastfed by, mothers infected with the virus.
Prevention of Mother-To-Child Transmission (PMTCT) is a crucial aspect of HIV prevention.

Pathophysiology of HIV

HIV is a single-stranded RNA retrovirus that infects and replicates with CD4 cells (T helper cells).
The virus penetrates the host CD4 cell, empties its contents, and converts its RNA into DNA using reverse transcriptase.
The viral DNA is combined with the host DNA using the enzyme integrase.

Phases of HIV Infection

Primary infection: At seroconversion, the patient may experience flu-like symptoms, and CD4 levels fall in response to the initial, rapid replication of HIV.
Latent phase: The infection enters a latent phase, and the patient may initially be asymptomatic, but with CD4 levels falling and viral load increasing.
Chronic infection: The HIV infection can later become symptomatic and eventually develop into AIDS over an average of 10 years.

WHO Clinical Stages

The WHO system for adults classifies patients into one of four hierarchical clinical stages ranging from stage 1 (asymptomatic) to stage 4 (AIDS).

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Description

Assess your knowledge of HIV post-exposure prophylaxis (PEP), a crucial emergency intervention for persons exposed to HIV. Learn about the recommended 3-drug regimen, duration of treatment, and more.