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3rd Year - Infection > 3. HIV > Flashcards

3. HIV Flashcards

1
Q

How is HIV Spread?

A
  1. Sexual Transmission
  2. Injection Drug Misuse
  3. Blood Products
  4. Vertical Transmission
  5. Organ Transplant
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2
Q

Can you test unconscious patients for HIV?

A

Yes, if you think it is in the patient’s best interest

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3
Q

What does the HIV infection do to the immune system?

A

It infects and destroys cells of the immune system, especially the T-Helper cells that are CD4+

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4
Q

What does a T-Helper Cell, that is CD4+ mean?

A

The T-Helper Cell has a CD4 receptor on its surface

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5
Q

Are CD4 receptors exclusive to lymphocytes?

A 
No, they are also present on the surface of:
1. Macrophages and Monocytes
2. Cells in the Brain
3. Cells in the Skin
and many other sites
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6
Q

Over the course of the HIV infection, what happens to the

  1. CD4 count?
  2. HIV Viral load?
A
  1. The CD4 count declines

2. The HIV Viral load increases

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7
Q

Over the course of the HIV infection, what happens to the risk of developing infections / tumours?

A

They increase

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8
Q

How does the severity of the illness relate to the CD4 count?

A

The severity of the illness is greater, the lower the CD4 count

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9
Q

At what CD4 count do most AIDS diagnoses occur at?

A

Less than 200

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10
Q

What does a low CD4 count, allow for?

A

Opportunistic infection

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11
Q

What are Opportunistic infections?

A

Pathogens which are capable of causing infection only when the host defences are compromised

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12
Q

In HIV, what are the 2 categories of Opportunistic infections?

A
  1. New infections (e.g. PCP, cryptosporidiosis)

2. Re-activation of existing infection (e.g. toxoplasmosis CMV)

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13
Q

What are the most common New Opportunistic Infections, in HIV?

A
  1. Pneumocystis Jiroveci Pneumonia
  2. Candidiasis
  3. Mycobacterium Avium Complex
  4. Cryptosporidiosis
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14
Q

What are the most common Re-Activated Opportunistic Infections, in HIV?

A
  1. Cerebral Toxoplasmosis
  2. Tuberculosis
  3. CMV disease
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15
Q

What is the natural history of HIV infection?

A
  1. Acute infection - seroconversion
  2. Asymptomatic HIV
  3. HIV related illness
  4. AIDS defining illness
  5. Death
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16
Q

What is the CD4 count between in Asymptomatic HIV?

A

400+

Note - Normal is 1000-1500

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17
Q

What happens as the CD4 count drops below 350?

A
  1. Thrust is likely

2. Skin changes

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18
Q

What happens as the CD4 count drops below 200?

A

Other opportunistic infections can arise:

  1. PCP
  2. TB
  3. Cryptospondiosis
  4. Kaposis Lymphoma
  5. Toxicoplasmosis
  6. Cryptococcal Meningitis
  7. CMV, MAC
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19
Q

What is a Seroconversion Illness?

A

When HIV antibodies first develop

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20
Q

What are the symptoms of Primary HIV (Seroconversion Illness)?

A

Like Glandular Fever, but EBV Serology is not in keeping:

  1. Flu-like illness
  2. Fever
  3. Malaise / Lethargy
  4. Pharyngitis
  5. Lymphadenopathy
  6. Toxic Exanthema
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21
Q

How is the length of duration of this illness calculated?

A
  1. If had a seroconversion illness then date is from then
  2. Test stored samples of blood (if available)
  3. Considering when the patient was at most risk
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22
Q

Is stage of the illness at presentation helpful in estimating duration of infection?

A

No

23
Q

What is an AIDS illness?

A

Infections and Tumours which develop due to a weakened immune system

24
Q

If there are no symptoms, does the patient have HIV or an AIDS illness?

A

HIV infection only

25
Q

Do most people with an AIDS illness (HIV + infection / tumour) recover?

A

Yes

26
Q

What are Respiratory AIDS-defining conditions?

A
  1. Tuberculosis

2. Pneumocystis

27
Q

What are Neurology AIDS-defining conditions?

A
  1. Cerebral Toxoplasmosis
  2. Primary Cerebral Lymphoma
  3. Cryptococcal Meningitis
  4. Progressive Multifocal Leucoencephalopathy
28
Q

What are Dermatology AIDS-defining conditions?

A

Kaposi’s sarcoma

29
Q

What are Gastroenterology AIDS-defining conditions?

A

Persistent Cryptosporidiosis

30
Q

What are Oncology AIDS-defining conditions?

A

Non-Hodgkin’s Lymphoma

31
Q

What are Gynaecology AIDS-defining conditions?

A

Cervical Cancer

32
Q

What are Ophthalmology AIDS-defining conditions?

A

Cytomegalovirus Retinitis

33
Q

How is HIV infection monitored?

A
  1. CD4 Lymphocyte Count
  2. HIV Viral Load
  3. Clinical Features
34
Q

What do the different classes of drugs, used to treat HIV infection, act on?

A

Different stages of the HIV life-cycle

35
Q
  1. What is the treatment used to treat HIV infection?

2. What does this mean?

A
  1. Combination Antiretroviral Therapy (cART)

2. 3 Drugs from at least 2 Groups

36
Q

What percentage adherence does there need to be to support the patient?

A

90%

Note - this will lead to a normal life but side effects may be significant (e.g. metabolic, lipodystrophy etc.)

37
Q
  1. When should cART be started?

2. Should the drug combination be changed?

A
  1. If the CD4 Count falls below 350 cells/mm3 or rapidly falling
  2. Yes, if the Viral Load is not adequately suppressed after 4-6 weeks
38
Q

What is the life expectancy according to according to CD4 count of:

  1. < 100?
  2. 100-200?
  3. > 200?
A
  1. 52 years old
  2. 62 years old
  3. 70+
39
Q

How long will you need to be on treatment for a HIV infection?

A

For life

40
Q

Will the treatment for HIV infection remain constant throughout the rest of the patients life?

A

No, it may need to be changed from time to time but some form of medication will also be included
Note - this is the same as treating any other chronic condition

41
Q

Why do treatments fail?

A

Poor adherence leads to Viral Mutation and Resistance

42
Q

What are the 3 main types (groups) of drugs used to treat HIV infection?

A
  1. Reverse Transcriptase Inhibitors
  2. Integrase Inhibitors
  3. Protease Inhibitors
43
Q

What are the 4 main types of anti-viral drugs (used in cART)?

A
  1. Nucleoside Reverse Transcriptase Inhibitors
  2. Non-Nucleoside Reverse Transcriptase Inhibitors
  3. Protease Inhibitors
  4. Integrase Inhibitors
44
Q

Where doe Reverse Transcriptase Inhibitors act?

A

During the “Reverse Transcription” Stage - As the Viral DNA tries to manipulate the host DNA

45
Q

Where doe Integrase Inhibitors act?

A

During the “Intergration” Stage - The integration of the Viral DNA into the Host DNA

46
Q

Where doe Protease Inhibitors act?

A

During the “Release and Protease” Stage - preventing exit from the host

47
Q

What are the side effects of Nucleoside Reverse Transcriptase Inhibitors?

A
  1. Marrow Toxicity
  2. Neuropathy
  3. Lipodystrophy
48
Q

What are the side effects of Non-Nucleoside Reverse Transcriptase Inhibitors?

A
  1. Skin rashes
  2. Hypersensitivity
  3. Drug Interactions
49
Q

What are the side effects of Protease Inhibitors?

A
  1. Drug Interactions
  2. Diarrhoea
  3. Lipodystrophy
  4. Hyperlipidaemia
50
Q

What are the side effects of Integrase Inhibitors?

A

Rashes

51
Q

What can be done to reverse the Lipodystrophy (side effect of some HIV medication)?

A
  1. Change drugs
  2. Facelift
  3. Liposuction
  4. Fillers
52
Q

What is the relationship between Cardiovascular Disease and HIV?

A
  1. Increased incidence of M.I. (through unknown mechanism)
  2. Hyperlipidaemias
  3. Insulin Resistance
53
Q

What are the main challenges of HIV care in modern times?

A
  1. Osteoporosis
  2. Cerebrovascular Disease
  3. Cognitive Impairment
  4. Ischemic Heart Disease
  5. Renal Disease
  6. Malignancy
  7. Diabetes Mellitus
54
Q

What is the best method of HIV prevention?

A
  1. Behaviour change and condoms
  2. Circumcision (50% reduction)
  3. Treatment as prevention
    Note - if the Viral Load is undetectable, transmission risk is 1 in 100,000
  4. Pre-exposure Prophylaxis (PrEP)
  5. Post-exposure Prophylaxis for Sexual Exposure (PEPSE)

3rd Year - Infection (29 decks)

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