AIDS & HIV - CLINICAL ISSUES

**READ THE DOCUMENTS ATTACHED**

• Something that became apparent during my time in A&E is the lack of awareness of Hep B prophylaxis amongst front-line NHS workers and how virulent yet preventable. 
  
  
• We are all immunised as healthcare workers, but most of the population are not. It can have devastating outcomes for patients, their family and carers - it is MUCH more virulent than HIV.
  
  
• For example - did you know there is Hepatitis B immunoglobulin available as well as the vaccine? Why do we use this?
  
  
• Although unlikely to be direct exam-topics, you ought to know about modern HIV and Hep B issues. HIV, however, in itself seems to be a common exam topic.
  
  
• You should obviously know about HIV HAART regimes and AIDS defining illnesses - but these documents are aimed at addressing PROPHYLACTIC measures aimed at stopping the patient acquiring HIV and/or HEP B.

• Given within 72h of potential exposure, HIV PEP is effective at stopping an individual from becoming HIV positive - it is a month-long course of HAART tablets with close GUM clinic follow-up
  
  
• This has potential impact on GP practices, A&E departments and GUM clinics.
  
  
• The documents focus on assessing the risk of the encounter and stratifies it to a 'PEP Advised/Not advised or 'Consider PEP' category.

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Some prompter-questions:

1. What is an AIDS defining illness? Can you name 5-10?
2. What would a patient's CD4 count be if they had AIDS?
3. What is the difference between HIV and AIDS?
4. Can you name a HAART regime and what the medications individually do?
5. What are the main side effects of PEP or HAART?
6. What is 'PCP' with respect to the respiratory system in the immunocompromised patient? What antibiotic should be considered? What might you see on a chest xray?
7. Are there common micro-organisms in the immunocompromised patient?
8. Where can candidiasis be seen in the immunocompromised patient? What causes this?
9. How would you consent someone for an HIV/Hep B test?
10. When would you offer a patient Hep B immunoglobulin?
11. What medications cause immunocompromise outside the HIV positive population
12. Can you name two skin lesions seen in patients with HIV/AIDS?
13. What is the most common cause of death in the UK for patients with AIDS?