Medical Knowledge

Objectives:

Review the epidemiology and pathophysiology and be able to recognize and initiate evaluation and management plans for the following disease states/clinical presentations adapted from numerous publicly available sources including DHHS guidelines, IAS, AIDSinfo, HIVInSite (UCSF), AAFP, and others.

Epidemiology

1. Local, regional, global;
2. Disproportionate prevalence in minorities, adolescents, women

Science of HIV

  1. Biology of HIV infection and treatment
    1. Virology/immunopathogenesis of HIV
    2. Immunodeficiency
  2. Clinical Laboratory Testing 
    1. Types of tests
      1. HIV antibody assays/confirmatory testing
      2. HIV-1 Viral load Assays
      3. CD4+ lymphocyte count
      4. Resistance testing
        1. Genotypic
        2. Phenotypic
        3. Viral tropism assays
    2. Indications for testing
      1. Risk assessment and voluntary
      2. Universal testing recommendations
      3. Clinical Assessment
        1. Acute retroviral syndrome
        2. Asymptomatic chronic HIV
        3. Symptomatic chronic HIV
        4. AIDS-defining illnesses
    3. Public Health surveillance/reporting
    4. Mandatory testing requirements
    5. Test Results and Counseling
      1.  
      2. Opt-Out
      3. Pre/post-test counseling
      4. How to give patients results
      5. Partner Notification (CARE program)
      6. Disclosure issues

Diagnosis and Clinical Management

  1. Primary Care
    1. Epidemiology and Disease Progression-Staging (WHO, CDC classifications)
    2. Primary Care
    3. Cardiac Risks in HIV
    4. Symptom Management
    5. Immunizations
    6. Infection and Travel
    7. Nutritional Issues
    8. Women and HIV-reproductive issues/pregnancy
    9. Mental Health and HIV
    10. Substance abuse and HIV
    11. HIV and Aging
  2. Antiretroviral Therapy
    1. Overview of ARVs
    2. When to start/counseling to promote adherence
    3. What to start - DHHS guidelines
    4. Monitoring response/side effects/metabolic complications
    5. Switching due to side effects
    6. Virologic Failure - definition, evaluation, and alternative regimens
    7. Clinical Trials
  3. Systems of Care
    1. Critical Care and HIV
    2. Surgery in HIV
    3. Care of IVDU
    4. Palliative care and HIV
    5. Housing/rehab options with HIV
    6. Legal issues and HIV-disclosure, insurance, OSHA
    7. Health Care financing issues - CMS, Ryan White, CADAP
  4. Clinical Manifestations of HIV
    1. Dermatologic Manifestations
    2. Neurologic Manifestations - HAND, PML
    3. HIV-associated psychiatric disorders
    4. Pulmonary Manifestations
    5. Renal disease in HIV
    6. Cardiac disease in HIV
    7. Endocrine Manifestations in HIV
    8. HIV-associated Wasting
    9. Hematologic manifestations
    10. Gastrointestinal diseases
    11. Ophthalmic manifestations of HIV
    12. Otolaryngolic manifestations of HIV
    13. Rheumatologic and Musculoskeletal Manifestations of HIV
    14. Sexually transmitted infections/li>
  5. Specific Infections associated with HIV
    1. Bacterial infection - sepsis, pneumococcal, mycobacterial (MTB, MAC)
    2. Fungal Infections - pneumocystis, candidates, cryptococcal disease, histoplasmosis, other
    3. Viral Infections - CMV, HSV, VZV , EBV, HCV/HBV, JC, HHV8
    4. Parasitic Infections - cryptosporidiosis
  6. Malignancies associated with HIV
    1. KS/HHV8 - associated
    2. Lymphoma
    3. HPV-related - cervical and anal neoplasia

Transmission

  1. Modes of Transmission 
    1. Sexual Vertical: Mother to Child
    2. Intravenous drug use
    3. Prophylaxis - PrEP (microbicides, ARV), circumcision
    4. Prophylaxis - PrEP - occupational/non-occupational
  2. HIV Transmission and Prevention in Specific Populations
    1. IVDU
    2. Adolescents
    3. MSM/other sexual minorities (GLTBQ)
    4. Incorporating HIV prevention