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eWellness: HIV Update

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Dr KK Aggarwal    04 October 2017

• Over 200 diseases can be transmitted from exposure to blood. • The most deadly diseases transmitted by blood are hepatitis B, hepatitis C and HIV. • Co-infection with HIV and hepatitis C or HIV with hepatitis B is common. They share similar routes of transmission. Thirty percent HIV-positive patients are also co infected with HCV and 10% with chronic hepatitis B infection. • In HIV-positive cases, hepatitis C seroprevalence is up to 73% in injection drug users compared to 4% in patients at low risk. • Injection drug users acquire hepatitis C virus before HIV infection while MSM typically acquire HIV before they acquire hepatitis C virus infection. • Hepatitis C virus is transmitted efficiently via percutaneous routes, so seroprevalence rates are highest in intravenous drug users. • Injection drug use is the leading route of HCV transmission. • Hepatitis B virus is the most infectious virus that can be transmitted through the blood or bodily fluids. • A healthcare worker stuck with a needle containing blood infected with hepatitis B virus has 6-30% chance of developing hepatitis B. The risk of hepatitis C virus and HIV in the same situation is 1.8 and 0.3% respectively. • The hepatitis B virus can survive on counter tops for 7 days and remain capable of causing infection. • Hepatitis C virus can survive on environmental surfaces for at least 16 hours. • Transmission of hepatitis C virus from blood splashes to the conjunctiva has been described. • Alcohol kills HIV, hepatitis B virus and hepatitis C virus. • The risk of becoming infected with hepatitis B is greater than the risk of becoming infected with other viruses. • For HIV, treatments are available to reduce the risk of becoming infected with HIV after exposure. • The risk of becoming infected with HIV as a result of exposure to rape is even lower than the risk of infection after a needle stick. All rape victims should be given anti-HIV drugs. • The CDC recommends a combination of 2 or 3 medications to prevent developing HIV after exposure. Four weeks of treatment is generally recommended. • Condoms reduce, but do not completely eliminate, the chances of transmitting hepatitis B, hepatitis C, or HIV infection to others. • New weapons of war are HIV kanya, HIV blood transfusions after kidnapping, HIV positive syringes for extraction of money and infected hepatitis C, hepatitis B and HIV combined blood (most deadly weapon ever possible). • The average risk of seroconversion after a needle stick injury is about 3 per 1000 with no prophylaxis. This risk is reduced at least 80% when post exposure prophylaxis (started within 3 hours) is administered in a timely fashion. • Infection is high with hollow needle, high bore needle and if the needle is inserted in the artery or the vein. • Start antiretroviral therapy (ART) in nearly all HIV-infected individuals regardless of their CD4 count. Previous recommendations for delayed ART (unless CD4 count < 350) were heavily influenced by drug toxicities, the potential risk for drug resistance if virologic suppression was not achieved, and limited treatment options for patients who failed therapy. Therapeutic options have expanded, and the available agents are more potent, better tolerated, and associated with less toxicity compared with earlier agents. In addition, simplified regimens have led to improved adherence • If a patient has a mixed infection (HIV, Hepatitis B and Hepatitis C), always treat all of them together; do not treat one particular infection. • If a person is diagnosed to have HIV and an opportunistic infection, treat the opportunistic infection first. For example, if the patient has TB, give ATT for two weeks and then start ART.

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