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Human immunodeficiency virus (HIV)
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Richard Basilan, William Salzer
The CDC recommends HIV screening for all patients aged 13 to 64 in health-care settings (18). Repeat HIV testing should be offered at least annually to women who use injection drugs, have had an STD in the past year, have had more than one sexual partner since their most recent HIV test, engage in sexual intercourse in exchange for drugs or money, or are partners of injection drug users or HIV-infected persons. Opt-out screening, in which the patient is notified that HIV testing be performed as a routine part of gynecologic and obstetric care unless she declines, should be performed (19). HIV-uninfected women with a known HIV (+) partner should be counseled regarding the risk for acquiring the infection and should have a second HIV test during the third trimester, before 36 weeks if possible. If such a patient presents in labor without a second HIV test, a rapid test should be done. Suspicion for acute seroconversion should prompt both rapid HIV testing and checking for plasma HIV RNA levels (20).
General healthcare of drug users
Published in Berry Beaumont, David Haslam, Care of Drug Users in General Practice, 2021
It is important that issues such as the likelihood of a positive test result, the potential social and financial implications of a positive result, the patient’s understanding of what a positive test means medically and what supports are available to him or her are discussed and documented before testing is undertaken. Many drug users are unclear of the difference between an HIV test and a diagnosis of AIDS; others may ask for an HIV test hoping to be reassured by a negative result without having fully contemplated the possibility that the test could be positive. Sometimes an HIV test is requested immediately after an episode of high-risk behaviour such as needle sharing and the patient then needs to be advised that testing may not provide a reliable result until sufficient time has elapsed for the development of antibodies. A wait of three months between the last episode of risk taking and the performing of the test is advisable and provides an accurate result in 99% of cases.
Sexually transmitted infections
Published in Suzanne Everett, Handbook of Contraception and Sexual Health, 2020
Blood tests for HIV and syphilis (serum treponemal serology – STS) should be discussed with all patients; a fourth-generation HIV test will give the result of HIV infection from four weeks ago. Fourth-generation HIV tests are the most sensitive form of testing for HIV antibodies and P24 antigens, and have a 99–100% sensitivity. Third-generation HIV tests are still available but not first choice as they are less accurate. You should be aware of the type of screening available in your area. Third-generation HIV tests have a window period of three months and so will give a result from three months prior to the test; they only screen for HIV antibodies as these are detectable only after three months and 98.9% sensitive. HIV screening should be encouraged in all men and women, but those who are particularly at risk are those who come from geographical areas where HIV is widespread such as sub-Saharan Africa, men who have sex with men (MSM), intravenous drug users (IVDUs), commercial sex workers, victims of sexual assault, those with needle stick injuries and people who have an existing acute episode of an STI.
Awareness of and willingness to use oral HIV self-test kits among Kenyan young adults living in informal urban settlements: a cross-sectional survey
Published in AIDS Care, 2023
Babayemi O. Olakunde, Dawit Alemu, Donaldson F. Conserve, Muthoni Mathai, Margaret O. Mak’anyengo, Larissa Jennings Mayo-Wilson
To address challenges in access to and uptake of HTS among young adults, Kenya has adopted HIV self-testing (HIVST) to supplement CITC and PITC approaches (NASCOP, Ministry of Health, 2017; UNAIDS, 2017). By encouraging individuals to perform an HIV test privately and conveniently at home, studies have shown that HIVST can reduce the social and structural barriers associated with facility- and community-based testing and generate demand among those unreached by existing facility- and community-based testing services (Johnson et al., 2017; Katz et al., 2018; Pettifor et al., 2020; World Health Organization [WHO], 2016). HIVST can be performed using oral fluid (e.g., Saliva and gum particles) or blood (Indravudh et al., 2018; WHO, 2016). However, unlike blood-based HIVST, which involves pricking the finger with a lancet to collect blood, oral-based HIVST involves swabbing the gums with the test device for oral fluid and is less invasive, easier to use, and potentially more preferable to users (Balán et al., 2017; Krause et al., 2013; Stevens et al., 2018).
Mycobacterium avium complex and Cryptococcus neoformans co-infection in a patient with acquired immunodeficiency syndrome: a case report
Published in Acta Clinica Belgica, 2022
Emilien Gregoire, Benoit François Pirotte, Filip Moerman, Antoine Altdorfer, Laura Gaspard, Eric Firre, Martial Moonen, Gilles Darcis
A 28-year-old Belgian Caucasian patient presented at the emergency department complaining about anorexia, dysphagia, weight loss (more than 10% in 6 months), low-grade fever and headache for several weeks. His medical history consisted of uncomplicated gastro-jejunal by-pass surgery at the age of 18. The patient reported unprotected sex, including insertive and receptive anal intercourse with several male partners during the last few years. HIV test was never performed in the past. There was no history of tobacco use nor recreational drug use. Alcohol consumption was occasional. Vital signs at admission showed tachycardia at 130 beats per minute and central temperature of 37.8°C. Arterial blood pressure and oxygen saturation breathing room air were within normal range. At clinical examination, the patient was conscious and well oriented in time and space, but he showed bradyphrenia and irritability. He was cachectic and had pale teguments and dry skin. Oral thrush on posterior tongue and soft palate was a sign of oral candidiasis. Swollen motile sub centimetric lymph nodes were palpable in the neck, axillary pits and groin area. Ophthalmic examination demonstrated deficit in abduction of left eye, sign of palsy of the sixth facial nerve. The rest of the physical examination was normal.
HIV retesting and risk behaviors among high-risk, HIV-uninfected adults in Uganda
Published in AIDS Care, 2021
Kara Marson, Alex Ndyabakira, Dalsone Kwarisiima, Carol S. Camlin, Moses R. Kamya, Diane Havlir, Harsha Thirumurthy, Gabriel Chamie
Following the health evaluation, all individuals completed a short screening questionnaire that asked about mobility, HIV testing history, and risk factors during the past 12 months, including having: >1 sexual partner, a sexual partner living with HIV, diagnosis or treatment of a sexually-transmitted infection (STI), and participation in transactional sex. Transactional sex was defined as either paying or receiving financial compensation or non-financial gifts in exchange for sex, although we did not distinguish between commercial sex work and other forms of transactional sex (Stoebenau et al., 2016; UNAIDS, 2018). We defined “highest risk” as having at least three of the four risk factors and “lower risk” as having fewer than three risk factors within the past year. We defined “frequent testing” as having at least three prior HIV tests within the past year.