Infestation and Treatment Quiz

Epidemiology and Pathogenesis of HIV/AIDS

• More than 78 million people are estimated to have been infected with HIV since 1981.
• 39 million have died from HIV/AIDS.
• In 2017, 36.9 million people globally were living with HIV, representing 0.8% of adults aged 15-49.
• 21.7 million accessed anti-retroviral therapy (ART).
• ART has dramatically reduced HIV mortality, transforming it from a fatal infection to a manageable chronic condition.
• Global HIV infections have decreased by 38% since 2001, but rates remain high in Eastern Europe and Central Asia.
• HIV is a leading cause of disability-adjusted life-years for those aged 30-45 and a leading cause of death for women aged 15-49.

Transmission Routes

• HIV is primarily transmitted sexually, through semen, cervical secretions, and blood.
• Viral load is highest during acute infection and reduced by effective ART.
• HIV acquisition risks are heightened by stigma, discrimination, gender-based violence and legal restrictions limiting access to services.
• Heterosexual intercourse is the main route in many regions, including sub-Saharan Africa.
• Transmission is more efficient from men to women and during receptive anal intercourse.
• Males' circumcision reduces HIV acquisition and transmission.

Vertical Transmission

• Vertical transmission (transplacental, perinatal, breast-feeding) is a frequent route for HIV transmission to children.
• Without interventions, 15% of infants born to HIV-positive mothers may become infected.
• Risk factors include advanced maternal HIV stage, high maternal viral load and prolonged/premature rupture of membranes.
• Breastfeeding doubles the risk of vertical transmission in the pre-ART era, but ART strongly reduces this risk.
• In high-income countries, interventions like antenatal screening, ARV use and avoiding breastfeeding have significantly lowered vertical transmission rates.

HIV in High-Income Countries

• Although new diagnoses are declining in high-income countries, HIV prevalence is rising.
• In the UK, 101,600 people were estimated to live with HIV in 2017; 92% were diagnosed, and 98% of those diagnosed were on treatment, 97% of whom were virally suppressed.
• Late diagnosis (CD4 count <350 cells/mL within 3 months of diagnosis) remains high in the UK, at 43% in 2017, down from 52% in 2004.
• Continued high diagnostic and treatment accessibility is critical in high prevalence areas to reduce late diagnosis.

Other STIs

• Other STIs, such as syphilis, gonorrhea, and Chlamydia, can increase the likelihood of HIV transmission.
• Ulcerative STIs and HIV transmission are directly correlated.
• Testing for other STIs and HIV should be part of the initial diagnosis for genital ulcers.

Pediculosis Pubis

• Pubic lice (Phthirus pubis) attach to pubic hair, body hair, eyelashes, and eyebrows, typically from physical contact.
• The primary symptom is itching due to hypersensitivity to louse bites.
• Diagnosis involves visual inspection and observation of nits.
• Treatment includes topical application of permethrin (10 mins) or malathion (12 hours), with a second application after 7 days. Precaution must be taken on pregnant women.

Donovanosis

• Donovanosis (granuloma inguinale) is rare, predominantly in South-East Asia.
• It is caused by Klebsiella granulomatis.
• Friable ulcers or hypertrophic lesions develop at the inoculation site, with inguinal lymph node enlargement possible.
• Diagnosis is based on identifying Donovan bodies (encapsulated Gram-negative bacteria) in scrapings or biopsies.
• The treatment consists of antibiotics given until ulcer healing.

Scabies

• This topic is discussed on page 674 of the document.

Test your knowledge about the treatment duration for various infestations and sexually transmitted infections. This quiz covers permethrin and malathion application durations, as well as recommendations for pubic lice and Donovanosis treatments. Enhance your understanding of effective methods for managing these conditions.