Page 633 - TNFlipTest

Toronto Notes 2019 Fungal Infections Types of Testing
1. Nominal/Name-Based HIV Testing
• personorderingthetestknowstheidentityofthepersonbeingtestedforHIV
• HIV test is ordered using the name of the person being tested
• personorderingthetestislegallyobligatedtonotifyPublicHealthofficialsiftestresultsarepositivefor
HIV
• testresultisrecordedinthehealthcarerecordofthepersonbeingtested
2. Non-Nominal/Non-Identifying HIV Testing
• similartonominal/name-basedtestingonallpointsexcept:
■ HIV test is ordered using a code or the initials of the person being tested
3. Anonymous Testing
• availableatspecializedclinics
• personorderingtheHIVtestdoesnotknowtheidentityofthepersonbeingtested
• HIVtestiscarriedoutusingauniquenon-identifyingcodethatonlythepersonbeingtestedforHIVknows • test results are not recorded on the health care record of the person being tested
• patient identification and notification of Public Health required to gain access to ART
HIV Pre- and Post-Test Counselling
• adiagnosisofHIVcanbeoverwhelmingandisoftenassociatedwithstigmaanddiscrimination
• consider pre- and post-test counselling, regardless of the results
• goals include: assessing risk, making informed decision to be tested, education to protect themselves
and others from virus exposure, where to go for more information and support • HIV+patientsshouldbeconnectedwithlocalsupportservices
Fungal Infections
Skin and Subcutaneous Infections
Superficial Fungal Infections
• seeDermatology,D5 Dermatophytes
• seeDermatology,D26
Subcutaneous Fungal Infection
Etiology
• subcutaneousinoculationbyfungithatnaturallyresideinthesoil,includingSporothrixschenckii,which usually occurs in gardeners injured by a rose thorn or splinter
Clinical Presentation
• causessubcutaneousnodulesatthepointofentry,maydevelopintoanulcer
• fungimaymigrateuplymphaticvesselscreatingnodulesalongtheway–“nodularlymphangitis”
Treatment
• oralazole
• IVamphotericinBforsevereordisseminatedinfection
Endemic Mycoses
Etiology
• fungalinfectionthatoccursthroughtheinhalationofspores(fromsoil,birddroppings,vegetation)or inoculation injury
• thermallydimorphicorganisms:mouldincoldtemperature(e.g.soil)andyeastathighertemperature (e.g. tissue)
• inNorthAmerica,thethreemajorendemicmycosesare:histoplasmosis,blastomycosis,and coccidioidmycosis
Infectious Diseases ID33
Early identification of HIV is essential for patients to receive the maximal benefit from ART
Efficacy, Safety, and Effect on Sexual Behaviour of On-Demand Pre-Exposure Prophylaxis for HIV in Men Who Have Sex With Men: An Observational Cohort Study
Lancet HIV 2017;4(9):e402-10.
Objective: Assess the efficacy, safety, and effect
of on-demand pre-exposure prophylaxis (PrEP) on sexual behaviour.
Methods: Men and transgender women who
have sex with men, previously enrolled in the placebo-controlled ANRS IPERGAU trial. On demand tenofovir disoproxil fumarate (300 mg)
and emtricitabine (200 mg) to be taken before and after sexual intercourse and participants assessed for incidence of HIV, PrEP adherence, safety, and sexual behaviour.
Results: HIV incidence was 0.19/100 person-yrs (95% CI 0.01-1.08) vs. 6.60/100 person-yrs (95%
CI 3.60-11.05) in the placebo group, relative risk reduction of 97%. Drug-related GI events were reported in 14% of participants, but were self- limiting. Participants reporting condomless sex at their last receptive anal intercourse increased from 77 to 86% at 18 mos follow up.
Conclusions: On-demand oral PrEP is highly effective at preventing HIV infection among high-risk men who have sex with men. This
represents an alternative to daily PrEP.
Use of a Vaginal Ring Containing Dapivirine for HIV-1 Prevention in Women
NEJM 2016;375:2121-32.
Objectives: To evaluate whether longer-acting methods of anti-retroviral therapy (i.e. vaginal rings) may simplify use of medications and provide HIV-1 protection.
Methods: Phase 3, randomized, double-blind, placebo-controlled trial of monthly vaginal ring containing dapivirine in women (aged 18-45) in Malawi, South Africa, Uganda, and Zimbabwe. Results: Among 2629 women enrolled, the incidence of HIV-1 infection was 3.3/100 person-yrs in dapivirine group and 4.5/100-yrs in placebo group. Post hoc analysis identified higher rates of HIV-1 protection in women >21 yrs (56%, 95% CI 31-71) but not among those 21 yrs (-27%, 95% CI -133-31), which correlated with reduced adherence. Conclusions: Monthly vaginal ring containing dapivirine reduced risk of HIV-1 infection among African women.
Histoplasmosis is commonly associated with exposure to chicken coops, bird roosts, and bat caves