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Year 3 Infection > 3. HIV > Flashcards

3. HIV Flashcards

1
Q

How does HIV spread?

A 
Sexual transmission
Injection and drug misuse
Blood products
Vertical transmission
Organ transplant
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2
Q

How does HIV cause damage?

A

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.

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3
Q

What is the difference between HIV and AIDS?

A

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

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4
Q

What are the different clinical stages of HIV infection?

A

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

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5
Q

What is HIV wasting syndrome?

A

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

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6
Q

What infections are more likely over time?

A

Asymptomatic- normal CD4
Thrush, skin changes- 350 and above
TB, PJP, toxoplasmosis, Crypotospofidosis- 200 and below

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7
Q

Can you recover from AIDS?

A

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

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8
Q

What respiratory diseases indicate a HIV test?

A

TB, pnuemocystis, bacterial pneumonia, aspergillosis

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9
Q

What Neuro diseases indicate a HIV test?

A 
Progressive multifocal leucoencephalopathy
Cerebral toxoplasmosis
Primary cerebral lymphoma
Cryptococcal meningitis
Aseptic meningitis
Gullain Barre
Space occupying legion of unknown cause
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10
Q

What cancers indicate HIV testing?

A

Cervical cancer, non-hodgkin’s lymphoma, Castleman’s disease

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11
Q

What haemoatological conditions indicate HIV testing

A

Thrombocytopenia
Neutropenia
Lymphopenia

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12
Q

What GI conditions indicate HIV testing?

A

Persistent cryptosporidosis
Oral candidiasis
Chronic diarrhoea
Weight loss

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13
Q

Describe the course of HIV

A 
Acute infection
Asymptomatc- Can last for 2 -30 years
HIV related illness
AIDS defining illness
Death- 50% dead in 12 years without treatment
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14
Q

What is seroconversion

A 
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
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15
Q

What is PJP?

A

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

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16
Q

What is the general guidance for antiretroviral therapy?

A

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

17
Q

What are the side effects to HIV care?

A 
Osteoporosis
Cognitive impairment
Malignancy
Cerebrovascular disease
Renal disease
Ischaemic heart disease
Diabetes mellitus
Lipodystrophy- big one! less likely with newer agents
18
Q

When do you start HIV therapy?

A

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

19
Q

What is outcome like for HIV and AIDS

A

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+

20
Q

What are the HIV drugs?

A

Nuceloside reverse transcriptase
Non-nucleoside reverse transcriptase
Protease inhibitors
Intergrase inhibitors

21
Q

Discuss nucleoside reverse transcriptase inhibitors

A

Type of reverse transcriptase inhibtors, prevents the viral DNA being transcripted

  • narrow toxicity
  • Neuropathy
  • Lipodystrophy
22
Q

Discuss non-nucleoside reverse transcriptase inhibitors

A

Type of reverse transcriptase inhibtors, prevents the viral DNA being transcripted

-skin rashes
Hypersensitivty
Drug interactions
Neuropschiatric effects

23
Q

Discuss protease inhibitors

A

Inhibit the viral proteins from being formed in the cells

Drug interactions
diarrhoea
Hyperlipidaemia

24
Q

Discuss integrase inhibitors

A

Prevents the viral DNA being integrated into the cell DNA

Rashes
Disturbed sleep

25
Q

How do you prevent HIV?

A 
Behaviour change and condoms
Circumcision
Treatment as prevention
Pre-exposre prophylaxis (PrEP)
Post exposure prophylaxis for sexual exposure (PEPSE)
26
Q

How can you be resistant to HIV?

A

If you have antibodies to GP120 (a rector protein ont eh HIV virus)

27
Q

What testing can be done to manage the HIV infection.

A 
Viral load
HIV resistance testing
Avidity testing
Subtype determination
Tropism testing
Drug levels
Resistance
28
Q

After which point do markers of HIV become detectable?

A

Seroconversion

29
Q

When do people with HIV have to inform their work?

A

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

30
Q

What are the modes of transmission for healthcare worker contracting HIV?

A

Sharps penetrating the skin

Blood or other bodily fluids splashes into the eyes , nose or mouth or into broken skin

31
Q

What should you do if suspected HIV infection

A

Wash of splashes with soap and runnign water
Encourage bleeding if skin has been broken
Wash out splashes in the eye nose or mouth

32
Q

What determines the risk of a healthcare worker contracting HIV?

A

Source of contamination
Extent of injury and type of sharp causing it
The likelihood of B/C/HIV in the source

33
Q

What do you do if someone has been exposed to HIV

A

Truvade and kaletra within 48-72 hours of exposure, continued for 28 days

34
Q

What are the treatments for PJP?

A

Treat with Cotrimoxazole and pentamidine until CD4 returns to normal

Year 3 Infection (15 decks)

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