3. HIV Flashcards
How does HIV spread?
Sexual transmission Injection and drug misuse Blood products Vertical transmission Organ transplant
How does HIV cause damage?
Infects and destroys the immune system, especially the T-helper cells that are CD4 positive
CD4 receptors are not exclusive to lymphocytes, they are also present on the surface of macropages and monocytes.
What is the difference between HIV and AIDS?
CD4 count declines and HIV viral load increases throughout the disease leading to an increasing risk of developing infections and tumours. Normal CD4 count is greater than 500. A diagnosis of AIDS (autoimmune deficiency syndrome) is CD4 below 200
What are the different clinical stages of HIV infection?
Stage 1- Asymptomatic, persistant lymphadenopathy
Stage 2- weight loss<10%, herpes, recurrent URTI,
Stage 3-weight loss >10%, severe infections, Oral thrush
Stage 4- HIV wasting syndrome
What is HIV wasting syndrome?
A range of different clinical presentations such as:
Toxoplasmosis of the brain
Cryptosporidosis and diarrhoea
Disease of organ other than liver,spleen or lymphs
Progressive multifocal leukoencephalopathy
candidiasis of the oesophagus, trachea, bronchi or lungs
Extrapulmonary TB
HIV encephalopathy
What infections are more likely over time?
Asymptomatic- normal CD4
Thrush, skin changes- 350 and above
TB, PJP, toxoplasmosis, Crypotospofidosis- 200 and below
Can you recover from AIDS?
Yes pretty much everyone from AIDS should recover from it once it is identified and adequate antivirals are started to keep them free of any future illness
What respiratory diseases indicate a HIV test?
TB, pnuemocystis, bacterial pneumonia, aspergillosis
What Neuro diseases indicate a HIV test?
Progressive multifocal leucoencephalopathy Cerebral toxoplasmosis Primary cerebral lymphoma Cryptococcal meningitis Aseptic meningitis Gullain Barre Space occupying legion of unknown cause
What cancers indicate HIV testing?
Cervical cancer, non-hodgkin’s lymphoma, Castleman’s disease
What haemoatological conditions indicate HIV testing
Thrombocytopenia
Neutropenia
Lymphopenia
What GI conditions indicate HIV testing?
Persistent cryptosporidosis
Oral candidiasis
Chronic diarrhoea
Weight loss
Describe the course of HIV
Acute infection Asymptomatc- Can last for 2 -30 years HIV related illness AIDS defining illness Death- 50% dead in 12 years without treatment
What is seroconversion
Approximately 30-60% of patients have a seroconversion illness. It is an abrupt onset 2-4 weeks post exposure. There is a varying presentation of symptoms such as Fever, fatigue, lethargy Pharyngitis Lymphadenopathy Toxic exanthema
What is PJP?
Pneumocystis jiroveci pneumonia
Classical history of dry cough and increasing breathlessness over several weeks
Chest x- ray-hazy peri hilar shadowing at costoprhenic angles
Induced sputum fro PCR
What is the general guidance for antiretroviral therapy?
Different classes of drugs acting on different stages in HIV lifestyle
Combination antiretroviral therapy (cART) means at least 3 drugs from at least 2 groups
Adherence must be over 90% or else patients develop resistance
What are the side effects to HIV care?
Osteoporosis Cognitive impairment Malignancy Cerebrovascular disease Renal disease Ischaemic heart disease Diabetes mellitus Lipodystrophy- big one! less likely with newer agents
When do you start HIV therapy?
All patients start regardless of CD4 and viral load
CD4<200 need to start as soon as possible
Any pregnant woman- start before third trimester
Three drug combinations with treatment adjustment if viral load not adequately suppressed after 4-6 weeks
What is outcome like for HIV and AIDS
Once you start treatment youre on it for the rest of your life. Treatment may need to be changed from time to time but always need to take antivirals.
CD4<100- 52 years
CD4 100-200- 62
CD4>200- 70+
What are the HIV drugs?
Nuceloside reverse transcriptase
Non-nucleoside reverse transcriptase
Protease inhibitors
Intergrase inhibitors
Discuss nucleoside reverse transcriptase inhibitors
Type of reverse transcriptase inhibtors, prevents the viral DNA being transcripted
- narrow toxicity
- Neuropathy
- Lipodystrophy
Discuss non-nucleoside reverse transcriptase inhibitors
Type of reverse transcriptase inhibtors, prevents the viral DNA being transcripted
-skin rashes
Hypersensitivty
Drug interactions
Neuropschiatric effects
Discuss protease inhibitors
Inhibit the viral proteins from being formed in the cells
Drug interactions
diarrhoea
Hyperlipidaemia
Discuss integrase inhibitors
Prevents the viral DNA being integrated into the cell DNA
Rashes
Disturbed sleep
How do you prevent HIV?
Behaviour change and condoms Circumcision Treatment as prevention Pre-exposre prophylaxis (PrEP) Post exposure prophylaxis for sexual exposure (PEPSE)
How can you be resistant to HIV?
If you have antibodies to GP120 (a rector protein ont eh HIV virus)
What testing can be done to manage the HIV infection.
Viral load HIV resistance testing Avidity testing Subtype determination Tropism testing Drug levels Resistance
After which point do markers of HIV become detectable?
Seroconversion
When do people with HIV have to inform their work?
If work doesn’t require HIV test then the answer is no
HIV test for a visa to work abroad
If involved in healthcare, avoid exposure prone procedures
What are the modes of transmission for healthcare worker contracting HIV?
Sharps penetrating the skin
Blood or other bodily fluids splashes into the eyes , nose or mouth or into broken skin
What should you do if suspected HIV infection
Wash of splashes with soap and runnign water
Encourage bleeding if skin has been broken
Wash out splashes in the eye nose or mouth
What determines the risk of a healthcare worker contracting HIV?
Source of contamination
Extent of injury and type of sharp causing it
The likelihood of B/C/HIV in the source
What do you do if someone has been exposed to HIV
Truvade and kaletra within 48-72 hours of exposure, continued for 28 days
What are the treatments for PJP?
Treat with Cotrimoxazole and pentamidine until CD4 returns to normal
