HIV Statistics and Treatment Quiz 2023

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Questions and Answers

What was the national rate of new HIV diagnoses per 100,000 population in Canada for 2023?

13.9

7.9

6.1 (correct)

4.6

Which age group had the highest rate of new HIV diagnoses according to the data?

25 to 29 years

30 to 39 years

≥ 60 years (correct)

40 to 59 years

What percentage of new HIV diagnoses in adults was attributed to male-to-male sexual contact?

26.5%

2.0%

39.4% (correct)

1.3%

How many infants were born with HIV transmitted perinatally in 2023?

5 Signup and view all the answers

What percentage of pregnant people living with HIV received perinatal antiretroviral therapy (ART)?

97.1% Signup and view all the answers

Which exposure category had the lowest rate of new HIV diagnoses among females?

Heterosexual contact Signup and view all the answers

What was the overall percentage of new HIV diagnoses attributed to injection drug use?

26.5% Signup and view all the answers

What is the most likely treatment for a patient with PJP pneumonia with a CD4 count of 120 cells/mm³?

Oral or IV Trimethoprim/Sulfamethoxazole Signup and view all the answers

Which statement accurately describes the presentation of PJP pneumonia in HIV-positive individuals?

Hypoxia is a common feature associated with the condition. Signup and view all the answers

What finding is most characteristic on a high-resolution CT scan in a patient with PJP pneumonia?

Ground glass opacities with interlobular septal thickening Signup and view all the answers

What is the significance of a CD4 count below 50 cells/mm³ in an HIV-positive patient regarding MAC prophylaxis?

Requires prophylaxis with Azithromycin or Clarithromycin. Signup and view all the answers

What would be the priority action for a non-adherent HIV-positive patient presenting with worsening dyspnea and a significant viral load?

Immediate hospitalization for antibiotic therapy. Signup and view all the answers

What is the main reason HIV treatment should be started as soon as possible after diagnosis?

To reduce the risk of transmission to others. Signup and view all the answers

What is the purpose of assessing for HIV viral genotype at baseline?

To assess for resistance to antiretroviral therapy. Signup and view all the answers

Which of the following is a reason why a delay in initiating HIV treatment might be warranted in some cases?

The patient is experiencing a new, severe opportunistic infection like cryptococcal or TB meningitis, due to concerns re: immune reconstitution inflammatory syndrome (IRIS). Signup and view all the answers

Which of the following statements about antiretroviral therapy (ART) is true?

ART is effective for all people with HIV infection. Signup and view all the answers

What is the significance of the statement 'Undetectable means Untransmittable'?

People with undetectable viral loads cannot transmit HIV to others. Signup and view all the answers

What is the role of HLA B*5701 testing in the management of HIV infection?

To assess for risk of abacavir hypersensitivity. Signup and view all the answers

What is the mechanism of action of NRTIs (Nucleoside Reverse Transcriptase Inhibitors) in HIV treatment?

They interfere with the conversion of HIV RNA into DNA. Signup and view all the answers

What is the role of attachment inhibitors in HIV treatment?

They block the entry of HIV into the cell. Signup and view all the answers

Which of the following is NOT a component of the baseline assessment for a patient newly diagnosed with HIV infection?

Assessment of a patient's adherence to their medications over the last year. Signup and view all the answers

When is primary prevention for Toxoplasmosis indicated?

CD4 <100 and serum Toxo IgG positive Signup and view all the answers

What is the initial treatment for herpes simplex virus infections?

Valacyclovir, famciclovir, acyclovir Signup and view all the answers

What type of lesions are characteristic of Toxoplasmosis on imaging?

Ring-enhanced lesions Signup and view all the answers

Which of the following is a major symptom of disseminated MAC?

Night sweats Signup and view all the answers

Which drug regimen is preferred for treating cryptococcal meningitis during the induction phase?

Amphotericin B + Flucytosine Signup and view all the answers

In what scenario is suppressive treatment for herpes simplex virus indicated?

For frequent recurrences Signup and view all the answers

What life-threatening condition can arise when CD4 counts drop below 50?

Disseminated MAC Signup and view all the answers

Which treatment is indicated for candida esophagitis?

Fluconazole Signup and view all the answers

What is the appropriate regimen for primary prevention of PJP?

Cotrimoxazole in DS tablets daily or 3 times a week Signup and view all the answers

How long should treatment for disseminated MAC generally be maintained?

At least 12 months Signup and view all the answers

Which of the following is a potential complication associated with oral hairy leukoplakia?

Non-Hodgkin's lymphoma Signup and view all the answers

Which of the following is a primary prevention therapy for opportunistic infections in HIV patients?

Antiretroviral therapy Signup and view all the answers

Which opportunistic infection is most commonly associated with a CD4 count below 200?

Pneumocystis pneumonia Signup and view all the answers

What is the recommended treatment for a patient with tuberculosis who is HIV positive?

Treatment regimen similar to non-HIV patients Signup and view all the answers

Which of the following is NOT true regarding secondary prevention therapies for opportunistic infections?

They are always used prophylactically, regardless of CD4 count. Signup and view all the answers

Which of the following is a distinguishing feature of oral hairy leukoplakia compared to thrush?

Oral hairy leukoplakia manifests as white patches that are difficult to remove, while thrush presents as easily removable white patches. Signup and view all the answers

Which of the following is NOT a key factor in determining the need for secondary prevention therapy?

Patient's age and gender Signup and view all the answers

Antibiotic prophylaxis is recommended for HIV patients with a CD4 count below 200 to prevent which opportunistic infection?

Pneumocystis jirovecii pneumonia Signup and view all the answers

Which of the following is a potential reason why a patient with HIV may require continued secondary prevention therapy even after their CD4 count increases?

The patient has a history of multiple opportunistic infections. Signup and view all the answers

Study Notes

HIV Care and Prevention

Dr. Debbie Kelly, PharmD, FCSHP, AAHIVP is a Professor and Clinical Pharmacotherapy Specialist at Memorial University, working with the Provincial HIV program.
The presentation dates back to Winter 2025.
Learning objectives include describing HIV epidemiology globally and nationally, discussing public health goals for HIV in Canada, recognizing who, when, and how to test for HIV, describing treatment goals and principles of HIV treatment related to antiretroviral (ARV) therapy, discussing how to monitor ARV therapy for effectiveness and safety, and describing epidemiology of opportunistic infections (OIs) in the context of HIV.
Objectives also cover recognizing and diagnosing major OIs in a patient with HIV infection, describing the management approach for Pneumocystis jirovecii pneumonia, outlining treatment and follow-up methods, and describing methods of HIV prevention and control.

Definitions and Terminology

HIV: Human Immunodeficiency Virus; the virus that causes AIDS.
AIDS: Acquired Immunodeficiency Syndrome; diagnosed by the CDC criteria based on CD4 count or symptoms.
ARV (Antiretroviral) Therapy: Medications for treating HIV infection, always used in combination.
Opportunistic Infection (OI): An infection that takes advantage of a weakened immune system, caused by organisms that don't normally cause problems in healthy individuals.
CD4: Helper T-cell, the primary target cell for HIV infection.
Viral Load (VL): The amount of HIV viral RNA in the blood, measured in copies per mL. "Undetectable" levels are typically below 20 copies per mL.

Global HIV Epidemic (2022)

39.0 million people were living with HIV globally in 2022.
Adults (ages 15+): 37.5 million. Women: 20.0 million; Men: 17.4 million.
Children (<15 years): 1.5 million
1.3 million people acquired HIV in 2022.
630,000 people died from HIV-related causes in 2022.

HIV in Canada (2023)

National rate per 100,000 population: 6.1
2,434 new HIV diagnoses in 2023; 35.2% increase compared to 2022
Rates varied by province and territory
Age/gender variations are seen in diagnoses
Key transmission categories, including male-to-male sexual contact, injection drug use, and heterosexual contact, are highlighted

HIV Transmission

Infectious body fluids include blood, semen/vaginal fluids, internal body fluids, and other body fluids (tears, sweat, urine) if they contain visible blood.
Estimated risk per 10,000 exposures varies significantly by type of exposure (e.g., needle-sharing, different types of sexual contact).

HIV Testing

HIV testing should be part of routine medical care.
Informed consent, verbal consent is sufficient, and public health reporting for HIV is required
People should be tested when requesting, if sexually active and never tested, experiencing unprotected sex or shared drug use equipment with a partner of unknown status, or experiencing sexual assault. Symptoms of acute infection, illnesses connected to immune system compromises, or pregnancy plans, also indicate testing.

Clinical Presentation

HIV clinical presentation varies depending on the stage of disease.
Primary HIV infection often involves an acute seroconversion syndrome, such as fever, lymphadenopathy, pharyngitis, rash, or mucocutaneous ulcers.
AIDS-related symptoms may be present, including myalgia, arthralgia, headache, diarrhea, and nausea and vomiting
Long term HIV infection may cause accelerated aging processes, with early-onset CV disease, neurologic, renal and bone diseases

The Natural History of HIV (without ART)

The natural history of HIV without treatment involves a decline in CD4 count and a rise in viral load over time.

Goals of HIV Treatment

Clinical goals include slowing disease progression and preventing complications such as cardiovascular, renal, neurologic, and malignant diseases.
They also prioritize preventing opportunistic infections, prolonging lifespan and quality of life, minimizing treatment side effects, and preventing the emergence of drug resistant strains.
Virologic goals: Maximal and durable viral suppression (VL<20 copies/mL, ideally within 8-24 weeks)
Immunologic goals: Restore and/or preserve immunologic function, as measured by CD4 count.

Non-Pharmacologic Therapy

Counseling surrounding "safer" sexual and drug use behaviors is essential, along with good nutrition and preventative health measures.
Vaccination guidelines generally follow the general population, but live attenuated vaccines should be avoided in patients with advanced immune suppression. MMR, Varicella, and Zoster (except Shingrix) are typically avoided in patients with CD4 counts under 200.

Baseline Assessment at Diagnosis

Medical history and physical examination
Comorbidities identification
Opportunistic infections assessment
HIV viral load, CD4 count, and assessment for co-infections are all critical.

Initiating ARV Therapy

Treatment is indicated for all patients with HIV infection, and should be started immediately and ideally on the same day, if possible
If an OI is present, the OI treatment takes priority, and HIV treatment can be started simultaneously when possible; otherwise, a delay might be warranted in some rare circumstances (e.g., cryptococcal or TB meningitis).
Caution is urged regarding simultaneous OI treatment and HIV treatment, emphasizing potential drug interactions.
Early ARV treatment has been shown to reduce disease progression and AIDS-related morbidities and mortality.
It also has a role in preventing transmission to others (including perinatal/mother to child), and to sexual partners.

Initial ART Regimens

Combination of INSTI + 2 nRTIs is usually preferred for most patients.
Options, such as Biktarvy®, Dolutegravir and Truvada/Descovy, are presented.
A 2-drug option (Dolutegravir/Lamivudine) may be considered in specific situations (low VL, no HBV, confirmed genotypic sensitivity)

Patient Follow-Up

Check in with patients after one month, to assess adherence, tolerability and adverse effects of treatment.
Regular follow-up, especially concerning NRTIs (long-term), for monitoring renal function, bone mineral density (BMD), lipids, and other conditions.
Long-term follow up on INSTI use to assess for gastrointestinal (GI) effects, headache, sleep disturbances, and weight changes.
Review concurrent medications, and laboratory monitoring for viral load is essential for assessing the initial response to treatment.

Laboratory Monitoring

Specific laboratory monitoring parameters and target ranges for viral load (VL), CD4 count, and other blood tests at different time periods after initiation of treatment are listed.

Opportunistic Infections

Patients die from the complications of HIV infection, not from the HIV infection itself. These complications often include opportunistic infections, malignancies, and ARV toxicities.
Effective ARV therapy helps generate a strong, lasting immune response which helps to prevent OIs.

Prediction of OI Risk

The risk of OIs increases as CD4 counts decrease.
OI prophylaxis is usually started when CD4 counts drop to <200.
Prevention therapies for OIs should be considered and patients should be educated from a non-opportunistic pathogen perspective to avoid infection.
Primary and secondary prevention therapies are critical considerations for managing OI outcomes and preventing the recurrence or reactivation of infections.

"Common" OIs in HIV infection (CD4 count <400)

Different OIs are categorized based on CD4 counts, with specific examples and management, such as thrush (oral candidiasis), oral hairy leukoplakia, Tuberculosis (TB) or bacterial infections.

"Common" OIs in HIV (CD4 count <200)

Pneumocystis jirovecii pneumonia (PJP) is the most common OI in North America in patients with CD4 counts <200.

"Common" OIs in HIV infection (CD4 count <100)

Oral candidiasis, Toxoplasmosis.

"Common" OIs in HIV infection (CD4 count <50)

Disseminated Mycobacterium avium complex (MAC), Cytomegalovirus (CMV), and Cryptococcal meningitis.

Primary Prevention of OIs

Guidelines on when to start prophylaxis are detailed, including CD4 counts and other individual health factors.
Examples of preferred treatment and prophylaxis regimens for the prevention of OIs (PCP, T. Gondii, and MAC) are addressed.

Case Study: FR

A 34-year-old HIV+ male presented with a severe respiratory illness.
His severe condition was likely due to a non-adherence to antiretroviral-related therapies.

In ED

ABG findings, likely showing respiratory compromise.
O2 status results

PJP Pneumonia

Caused by the fungus Pneumocystis jirovecii, mainly affecting the lungs.
A significant cause of mortality before the use of effective highly active antiretroviral therapy (HAART).

PJP Presentation

The symptom presentation.
Imaging results (CXR + HRCT)
Diagnostic testing.

PJP Treatment

First-line treatment is typically cotrimoxazole for 21 days.
Steroid adjunctive therapy is often used for severe respiratory compromise (e.g. PaO2 < 70 or an A-a gradient > 35 mm Hg).

Monitoring

Follow-up to monitor for signs of improvement and treatment toxicity
Long-term CD4 recovery to reassess the need for, and suitability for, potential discontinuation of secondary prevention protocols.

HIV Prevention

Prevention strategies discussed, addressing perinatal transmission, pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP).

Use of ARVs for HIV Prevention

PrEP, and PEP: Antiretroviral therapies used before, and after, exposure to HIV.

Perinatal Transmission of HIV

Risk of transmission and prevention strategies for mother to child transmission, including appropriate therapies to reduce this risk.

Pre-exposure Prophylaxis (PrEP)

PrEP is a strategy for HIV prevention
ART for HIV-negative to reduce risk of becoming infected, typically taken daily.

Who is a Candidate for PrEP?

Patient groups at high risk of acquiring HIV

What Options Exist for PrEP?

Approved oral therapies include TDF/emtricitabine (Truvada), TAF/emtricitabine (Descovy), and cabotegravir.

PrEP is More Than Just a Drug…

PrEP is a programmatic approach to HIV prevention
Emphasis on ongoing assessment of patient needs, adherence monitoring, and regular testing to ensure ongoing negative HIV status.

Post-exposure Prophylaxis

PEP is indicated for both occupational and non-occupational exposures to HIV.
Timing, duration, and the type of therapy is discussed.

When is PEP Indicated?

Factors to consider when identifying if PEP is needed are discussed.

References and Useful Resources

Information on sources for obtaining reliable further information and guidelines concerning HIV.

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Description

Test your knowledge on the latest HIV statistics in Canada for 2023, including rates of new diagnoses and the implications for different demographics. This quiz also covers important aspects of HIV treatment and associated conditions like PJP pneumonia.