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Infectious Disease > 1: HIV > Flashcards

1: HIV Flashcards

1
Q

What is HIV

A

Retrovirus that replicates in CD4 cells and macrophages causing progressive immune dysfunction

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2
Q

Define AIDS

A

CD4 count less than 200 or presence of AIDS defining illness

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3
Q

How is HIV transmitted

A
  • Sexual (80%)
  • Parental
  • Vertical (Childbirth, Breastfeeding)
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4
Q

At what viral load should a C-section be performed to deliver baby to HIV mother

A

Viral load is greater-than 50 a women should have a c-section

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5
Q

Can HIV mothers breastfeed

A

NO

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6
Q

What are 5 RF for HIV

A

MSM
Multiple Sexual partners
Unprotected Sex

Needle-sharing
Unsterilised procedures
IVDU

Viral load: undetectable means untransmissable

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7
Q

What is the risk of obtaining HIV through needle-stick injury

A

less than 1 in 300

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8
Q

What is the risk of transmitting Hep C via needlestick

A

2 in 100

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9
Q

In what % of individuals is seroconversion (primary HIV) symptomatic

A

80

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10
Q

when does primary conversion present

A

2-4W following infection

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11
Q

what are symptoms of primary HIV infection

A
  • Flu-like illness
  • Malaise
  • Sore-throat
  • Mucosal ulceration
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12
Q

What is a feature of chronic HIV

A

Persistent generalised lymphadenopathy

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13
Q

what is persistent generalised lymphadenopathy

A

Enlargement lymph nodes >1cm, in two or more contagious sites persisting beyond 3-months

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14
Q

what causes persistent generalised lymphadenopathy

A

follicular hyperplasia secondary to HIV

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15
Q

how does chronic HIV present

A

Asymptomatic - aside from opportunistic infections

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16
Q

What is a mnemonic to remember opportunistic infections that occur CD4 200-500

A

SHOK

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17
Q

What infections occur in HIV at CD4 200-500

A

Shingles

Hairy leukoplakia

Oral candidiasis

Kaposi’s sarcoma

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18
Q

What causes shingles

A

VZV

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19
Q

How does shingles present

A

Rash in dermatomal position

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20
Q

What causes hairy leukoplakia

A

EBV

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21
Q

What causes oral thrush

A

Candida albicans

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22
Q

What causes kaposi’s sarcoma

A

HHV8

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23
Q

How does Kaposi’s sarcoma present clinically

A

Purple macules-papules over trunk that can ulcerate

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24
Q

Aside from skin lesions, what can happen in Kaposi’s sarcoma

A

Involvement of respiratory tract can cause pleural effusion and haemoptysis

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25
Q

How is Kaposi’s sarcoma managed

A

Radiotherapy and resection of lesions

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26
Q

What is a mnemonic to remember infections that occur at CD4 count 100-200

A

CCPPH

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27
Q

What infections may occur at CD4 100-200

A 
Cerebral toxoplasmosis
Cryptosporidium 
Progressive multifocal leucoencephalopathy 
PCP
HIV dementia
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28
Q

What does cryptosporidium cause

A

Diarrhoea

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29
Q

What causes cerebral toxoplasmosis

A

Toxoplasmosis Gondii

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30
Q

Where is toxoplasmosis gondii acquired from

A

Cat faeces

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31
Q

How does toxoplasmosis gondii present

A
  • Asymptomatic

- Can present with malaise and headache

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32
Q

What investigation is ordered in cerebral toxoplasmosis

A

CT

Sabin-Feldman Dye Test

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33
Q

What will be seen on CT scan

A

Multiple ring-enhancing lesions

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34
Q

How can ring-enhancing lesions in cerebral toxplasmosis be differentiated from those of cerebral abscess

A

Toxoplasmosis = adjacent to basal ganglia

Cerebral abscess = periphery

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35
Q

How is cerebral toxoplasmosis managed

A

6W of pyrimethamine and sulphadiazine

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36
Q

What causes PML

A

JC virus

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37
Q

What does PML cause

A

Multi-focal demyelination

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38
Q

How is PML investigated

A

CT - single or multiple enhancing lesions

MRI - demyelinating white matter lesions

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39
Q

What causes PCP

A

Pneumocystitis Jirovecci

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40
Q

What is the most common HIV opportunistic infection

A

PCP

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41
Q

How does PCP present clinically

A
  • Dyspneoa
  • Dry cough
  • Exercise induced desaturations
  • Fever
  • Few chest signs
42
Q

What is a common complication of PCP

A

Pneumothorax

43
Q

How does a CXR of PCP present

A

Bilateral interstitial pulmonary infiltrates

44
Q

What investigation is required in PCP and why

A

Bronchoalveolar lavage - as CXR usually negative

45
Q

Explain prophylaxis for PCP

A

All individuals with CD4 under 200 are given prophylaxis with co-trimoxazole

46
Q

How are severe cases of PCP managed

A

Pentamidine

47
Q

If a patient with PCP has hypoxia, how are they managed

A

Steroids

48
Q

What will be seen on CT in HIV dementia

A

Cortical or subcortical atrophy

49
Q

How can cryptosporidium diarrhoea be detected

A

Red cysts on Ziehl-Neelsen stain

50
Q

What is a mnemonic to remember opportunistic infections CD4 count 50-100

A

COPA

51
Q

what are opportunistic infections 50-100

A

Cryptococcus meningitis
Oesophageal candiasis
Primary CNS lymphoma
Asperigillosis

52
Q

what is the most common CNS fungal infection

A

cryptococcus

53
Q

how does cryptococcus present

A

Headache
Fever
N+V
Focal Neurological Deficit

54
Q

what test is used to detect cryptococcus

A

LP = high opening pressure

India ink stain

55
Q

what causes oesophageal candiasis

A

Candida albicans

56
Q

how does oesophageal candiasis present

A

dysphagia

odynophagia

57
Q

how is oesophageal candiasis managed

A

fluconazole or itraconazole

58
Q

what causes primary CNS lymphoma

A

EBV

59
Q

how does primary CNS lymphoma present on CT

A

single homogenous enhancing lesion

60
Q

what is positive in CNS lymphoma

A

Thallium SPECT positive

61
Q

how is primary CNS lymphoma managed

A

steroids
radiation
chemotherapy

62
Q

what two infections can occur at a CD4 of less than 50

A

CMV encephalitis

Mycobacterium avium intracellulare

63
Q

how does mycobacterium avium intracellulare present

A

Diarrhoea
Abdominal pain
Deranged LFTs
Hepatomegaly

64
Q

what molecule does HIV bind to on CD4 cells

A

gp120

65
Q

what does HIV use gp120 to do

A

uses gp120 to bind to co-receptors CXCR4 and CCR5

66
Q

what does HIV require to enter cells

A

gp120, CCR5 and CXCR4

67
Q

what type of virus is HIV

A

viral RNA

68
Q

what does HIV require to replicate

A

reverse transcriptase to convert to DNA virus

69
Q

explain CD4-HIV ratio

A

HIV initially replicates, there is a decrease in CD4 cells. These cells then launch a counter-attack and HIV decreases. Reaches steady state where HIV gradually increases

70
Q

what is the first-line test for HIV

A

rapid point of care testing

71
Q

what is rapid point of care testing

A

immunoassay kit that gives rapid result from finger prick or swab

72
Q

what is the gold-standard test for HIV

A

4th generation testing

73
Q

what does the 4th-generation HIV test detect

A

HIV antibodies and p24 antigen

74
Q

what is the window period of fourth-generation HIV test

A

10-days

75
Q

what is the window period

A

false negative - time between infection and positive antibody/antigen test

76
Q

what is viral load

A

qualification of HIV RNA

77
Q

what is viral load used for

A

measure response to anti-retroviral antibodies

78
Q

why is HIV RNA not diagnostic

A

high false negative rate

79
Q

what is nucleic acid testing

A

viral PCR

80
Q

what test is used to detect vertical transfer of HIV

A

nucleic acid testing

81
Q

why can the 4th generation testing not be used in cases of suspected vertical transfer

A

maternal autoantibodies can alter ELISA results up to 18-months of age

82
Q

explain role of CD4 count

A

not used to diagnose HIV - but used to define AIDS and monitor disease progression

83
Q

what is current HIV anti-retroviral therapy

A

individual requires two NRTIs and one of:

  • NNRTI
  • Protease Inhibitor
  • Integrase Inhibitors
84
Q

what are nucleoside reverse transcriptase inhibitors (NRTIs)

A

inhibit reverse transcriptase convening HIV RNA to DNA

85
Q

what NRTI is given in the UK

A

Truvada: tenofovir and emtricitabine

86
Q

what is an integrase inhibitor

A

inhibits HIV DNA entering nucleus of CD4 cells

87
Q

what is the suffix of integrase inhibitors

A

‘gravir’

88
Q

what is the MOA of protease inhibitors

A

Inhibit protease - required for maturation of particles

89
Q

what is the role of NNRTIs

A

Inhibit reverse transcriptase

90
Q

what is maraviroc

A

binds CCR5 preventing interaction with gp41

91
Q

what is enfuvirtide

A

inhibits gp41

92
Q

what is PREP

A

given to individuals who do not have HIV, but are at a high-risk of HIV

93
Q

what is licensed for PREP

A

Truvada

94
Q

what is Truvada

A

tenofovir and ematricibine

95
Q

what is PEP

A

post-exposure prophylaxis

96
Q

when must PEP be started by

A

Within 72h of exposure

97
Q

how long is PEP taken

A

28-days

98
Q

what is given as PEP in the UK

A

Truvada and raltegravir

99
Q

when should all pregnant women with HIV have commenced ART by

A

24W

100
Q

what viral load does a women need a C-section

A

> 50 copies

101
Q

explain neonatal PEP

A

given from birth until 4W - if born to HIV mum

Infectious Disease (8 decks)

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