Reproductive Health and HIV Medicine: Prevention and Treatment
What you must know
Family planning: effectiveness, medical eligibility criteria and contraindications, and emergency contraception timing. HIV: natural history, counselling and testing, antiretroviral regimens, adherence support, viral load monitoring, prevention of mother-to-child transmission, post-exposure prophylaxis, cotrimoxazole prophylaxis for opportunistic infections, and syndromic management of sexually transmitted infections.
Classic traps
- Post-exposure prophylaxis must start as soon as possible and within 72 hours, continues for 28 days, and requires testing of both source and exposed person.
- Viral load is the best measure of treatment success; CD4 count is used mainly to decide prophylaxis for opportunistic infections.
- Rifampicin reduces levels of efavirenz and dolutegravir, so doses must be adjusted in tuberculosis co-treatment.
- In prevention of mother-to-child transmission, all pregnant and breastfeeding women with HIV start lifelong antiretroviral therapy regardless of CD4 count.
- Emergency contraception: levonorgestrel works best within 72 hours, ulipristal within 120 hours, and a copper intrauterine device can be used later.
Rule of thumb
When a patient on antiretroviral therapy develops fever or a new infection, consider immune reconstitution inflammatory syndrome, treatment failure and drug interactions before assuming a new opportunistic infection. For sexually transmitted infection syndromes, treat the likely pathogens, treat partners and offer HIV testing.