CC Nov 2016 Gynecologic care for HIV infected women

echoecho's version from 2016-11-27 14:16


Question Answer
What % of women have HIV? What % are living with HIV infection?19%; 25%
Acquisition of the disease is primary through ________ contact (87%) with ______ use accounting for 13%?1) heterosexual contact 2) IV drug use
AA women account for a disproportionately high percent of cases, true or false?true
While new HIV diagnoses in women declined by ____% between 2005 and 2014, the number of AIDS diagnosis has tripled in women since 1985?40%
___% are linked to HIV care in the first 3 months after diagnosis (2013)?84%
____% are retained in continuous HIV care (2013)?55%
____% were receiving combined antiretroviral therapy (end of 2012)?39%
____% achieved viral suppression?30%
Providers are at the front line to do what?screen for HIV and ensure access to care and promote adherence to therapy
Health maintenance for HIV positive women is much as the same for no infected women, including what screening?breast cancer
Due to the increased risk of cervical cancer in HIV positive women, due to the oncogenes strains of _____, recommendations for cervical cancer differ, reflecting that higher risk, even at an early age?HPV
Following a total hysterectomy, Pap smears are not necessary if the reason for surgery was what?benign pathology (fibroids)
Pap smears of the vagina cuff are recommended for women with what history?high grade CIN (cervical intraepithelial neoplasia), carcinoma in situ or invasive cervical cancer
List the guidelines for cervical cancer screening recommendations for the HIV positive woman who is < 30 years?1) begin screening (pap smear) one year after onset of sexual activity for women < 21 years of age (no later than age 21 years) 2) screen at time of diagnosis for women 21-29 years of age. 3) if screen is negative, repeat Pap smear in one year (some say 6 months) 4) If 3 normal negative Pap smears, can increase interval to every 3 years 5) If ASCUS - colposcopy if reflex high risk HPV is positive or repeat pap in 6-12 months 6) colposcopy for other abnormalities
List the guidelines for cervical cancer screening recommendations for HIV positive woman who is > 30 years?1) screening should be continued indefinitely (lifetime) with Pap smear along or with HPV co-testing (ACOG preferred) 2) if Pap smear alone - every 12 months (some recommend second test at 6 months) until 3 normal smears and then every 3 years 3) if Pap smear with co-testing (repeat in 3 years if both are negative); pap negative but HPV positive (HPV positive but not 16/18 so repeat in 1 year; if repeat co-testing in 1 years is positive (either pap or HPV 16/18 = refer for colposcopy. If HPV positive, refer for colposcopy 4) if pap is abnormal, refer to colposcopy if ASCUS and positive HPV as well as any high-grade lesions
Discuss the type of contraceptives for category 1 (no restriction on use) in HIV positive women and women with AIDS?combined hormonal contraceptives, progesterone only pills, merrily progesterone injections and progesterone only implants
Discuss the type of contraceptives for category 2 (benefits outweigh risks) in HIV positive women and women with AIDS?copper IUDs and progesterone IUDs for initiation and continuation (these methods are considered category 3 (risks outweigh benefits) for initiation and category 2 for continuation in women with AIDS
*** SUMMARY = For women < 21 years of age, cervical cancer screening with a Pap smear should begin ___ year after the onset of sexual activity and no later than age ______ years?1; 21
*** SUMMARY = Women with positive HIV aged 21-29, should have pap when?at the time of diagnosis
*** SUMMARY = What is the screening guidelines for a women > 30 years of age should have a Pap smear annually until ____ normal smears or Pap smear with HPV co-testing every ____ years?3; 3
*** SUMMARY = True or false? Cervical cancer screening should continue for the lifetime of the women?true