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infection > 7.2 HIV > Flashcards

7.2 HIV Flashcards

1
Q

define HIV ?

A

human immunodeficiency virus

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2
Q

define AIDS?

A

acquired immunodeficiency syndrome

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3
Q

define viral tropism?

A

ability of different viruses to infect different cellular types

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4
Q

define ART?

A

antiretroviral therapy

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5
Q

define MSM?

A

men who have sex with men

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6
Q

define POCT ?

A

point of care test

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7
Q

define PWID?

A

people who inject drugs

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8
Q

define STI?

A

sexually transmitted infection

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9
Q

define TasP?

A

treatment as prevention

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10
Q

HIV
1. type of RNA virus ?
2. tyupe of virus ?
3. …. kb genome
4. … genes encoding ….. viral proteins

A
  1. enveloped single-stranded
  2. retrovirus
  3. 9
  4. 9 , 15
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11
Q

what is HIV capsid ?

A

HIV’s core that contains HIV RNA

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12
Q

what is HIV envelope?

A

outer surface of HIV

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13
Q

what is HIV enzymes ?

A

proteins that carry out steps in the HIV life cycle

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14
Q

what is HIV glycoproteins ?

A

protein ‘spikes’ embedded in the HIV envelope

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15
Q

what is HIV RNA ?

A

HIV’s genetic material

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16
Q

Examples of variety of body fluids that can be exchanged from infected people to transmist HIV ?

A
  • blood
  • breast milk
  • semen
  • vaginal fluids, including menstrual blood
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17
Q

How can a HIV be transmitted from mother to child ?

A
  • during pregnancy
  • delivery
  • breastfeeding
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18
Q

What substances don’t have sufficient viral loads to cause infection ?

A
  • saliva
  • sweat
  • urine
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19
Q

Individuals on …1…. with an undetectable viral load do not transmit HIV

A
  1. ART = antiretroviral therapy
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20
Q

How is HIV not passed on ?

A
  • spitting
  • kissing
  • biting
  • contact with unbroken, health skin
  • sneezing
  • sharing baths, towels or cutlery
  • using the same toilets or swimming pools
  • mouth-to-mouth resuscitation
  • contact with animals or insects like mosquitoes
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21
Q

Transmission of HIV includes what ?

A
  • unprotected anal or vaginal sex
  • sharing contaminating needles, syringes, other injecting equipment and drug solutions when injecting drugs
  • receiving unsafe injections, blood transfusions , tissue transplanation and medical procedures that involve unsterile cutting or piercing
  • experiencing accidental needle stick injuries, including among health workers
  • vertically from mother to child
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22
Q

Stages of HIV infection ?

A
  1. primary HIV infection
  2. asymptomatic stage
  3. advanced HIV infection
  4. AIDS
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23
Q

Symptoms that are common to primary HIV (PHV) infection

A
  • fevers
  • sore throat
  • maculopapular rash
  • malaise
  • lethargy
  • arthralgia
  • myalgia
  • lymphadenopathy
  • oral, genital, perianal ulcers
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24
Q

Less common symptoms of primary HIV infection

A
  • headache
  • meningitis
  • cranial nerve palsies
  • diarrhoea
  • weight loss
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25
Q

What’s the name of the illness involved in primary HIV infection ?

& explain what the illness is

A

HIV seroconversion illness = ‘flu like’ illness for first few weeks following infection can be mild or severe

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26
Q

7 stages of viral replication

A
  1. Binding

2.Fusion

3.Reverse transcription
HIV reverse transcriptase copies viral RNA as proviral DNA

4.Integration
HIV integrase facilitates the proviral DNA’s integration into the host’s DNA.

  1. Replication
    the host cell then produces HIV RNA and HIV proteins.

6.Assembly
HIV proteins are assembled into HIV virions and budded from the cell surface.

  1. Budding
    HIV protease cleaves viral proteins, converting the immature virion to a mature, infectious virus.
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27
Q

Which cells does HIV primarily infect ?

A

CD+4 T cells (T helper cells), monocytes/ macrophages and dendritic cells

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28
Q

3 functions of CD4+ T helper cells:

A
  • help B cells generate stronger longer-lived antibody responses
  • maximise CD8+ T cytotoxic cell expansion, and facilitate generation of memory CD8+ T cells
  • secrete cytokines and attract macrophages to the site of infection
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29
Q

Name 2 cells that are important reservoir for viral replication, persistence and disease progression

A

DCs and macrophages

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30
Q

Cell-mediated immunity = activation of…

A

cytotoxic T cells that induce apoptosis of infected cells (intracellular bacteria/ fungi, viruses, tumour cells)

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31
Q

How do macrophages and NK cells destroy pathogens ?

A

phagocytosis or cytotoxic granules

32
Q

Where is cell-mediated immunity directed at ?

A

pathogens that either survive against phagocytosis (& opsonisation) or pathogens that infect cells directly

33
Q

which cytokine response does cell-mediated immunity involve ?

A

pro-inflammatory (IFN-gamma, TNF)

34
Q

Difference between development of asymptomatic stage once symptoms resove to AIDS in people ?

A
  • some people progress rapidly to advanced HIV infection or AIDS within 1-2 years, while others may remain imunocompetent more than 10 years later
35
Q

When does advanced HIV infection / AIDS occur ?

A
  • number of CD4 cells < 200 cells per microlitre
  • certain opportunistic infections (‘AIDS defining illness’)
  • malignancies develop
36
Q

what is an indicator condition ?

A

any medical condition associated with an undiagnosed HIV seroprevalence ≥1 per 1000

37
Q

2 categories of indicator conditions ?

A
  • Conditions that would be AIDS defining in an individual living with
    HIV.
  • Non-AIDS-defining conditions associated with an undiagnosed HIV seroprevalence >1 per 1000
38
Q

what are AIDS defining illnesses ?

A

serious and life threatening conditions that occur in HIV positive patients

39
Q

List 4 AIDS defining illnesses

note. these are examples from ppt there are lots more examples online

A
  • pneumocystis pneumonia
  • kaposi’s sarcoma
  • histoplasmosis
  • cryptococcosis
40
Q

Cause of pneumocystis pneumonia (PCP) ?

A

fungus - Pneumocytstis jirovecii (formerly P. carinii)

41
Q

PCP is extremely rare in …

A

non-immunocompromised patients

42
Q

presentation of PCP ?

A

non specific : dyspnoea (SOB) , non-productive cough (dry, no phlegm)

43
Q

Kaposi’s sarcoma :
1. tumour ?
2. associated with … ?
3. presentation ? (can form lesions on …)

A
  1. mesenchymal
  2. human herpes virus type 8 (HHV8)
  3. skin, mouth, lymph nodes and other organs
44
Q

Histoplasmosis caused by ?

A

histoplasma capsulatum

45
Q

histoplasmosis affects ?

A

primarily the lungs but when disseminated can affect other organs

46
Q

what can histoplasmosis start with ?

A

non-specific respiratory infection

47
Q

Histoplasmosis :
1. often have normal …
2. more common in the …
3. skin involvement in up to … % of those with AIDS and PDH

A
  1. CXR
  2. US
  3. 25
48
Q

CNS cyrptococcosis results from infection of CNS with what pathogenic microorganism ?

A

yeast-like fungus Cryptococcus neoformans

49
Q

signs & symptoms of cryptococcosis ?

A

Are of meningitis e.g. headache, seizure, blurred vision (raised ICP)

50
Q

CD4+ count of cryptococcosis ?

A

< 100 cells per microlitre

51
Q

Possibility of HIV infection should be considered whenever a person presents with one or more of the alerting features which are what ?

A
  • Common symptoms or infections that are unusually severe, prolonged, recurrent, or unexplained.
  • Persistent enlarged lymph nodes other than in the inguinal area.
  • Conditions related to immunosuppression.
  • Glandular fever-like illness.
  • Lifestyle and social risk factors for contracting HIV, such as high prevalence area, MSM and IVDU
  • Weight loss of more than 10 kg
52
Q

Infants with HIV often present with what ?

A
  • Failure to thrive, and/or
  • Pneumocystis pneumonia, or
  • Cytomegalovirus disease, or
  • HIV encephalopathy.
53
Q

After first year of lige, consider HIV infection in children presenting with what ?

A
  • Recurrent infections such as URTI, LRTI
  • Parotid gland swelling
  • Severe presentations of common
    childhood infections.
  • Chronic diarrhoea.
  • Herpes zoster.
  • Severe pneumonia.
  • Tuberculosis.
  • Lymphadenopathy.
  • Any AIDS-defining condition.
54
Q

Situations when HIV testing should be offered in primary care?

A
  • As part of routine antenatal care
  • If person requests a test, has HIV risk factor, has another STI
  • people newly registering at a practice or having a blood test
  • people presenting with symptoms of PHI or longstanding HIV infection
55
Q

HIV testing should be offered in primary care to people newly registered at a practice or having a blood test in what 2 situations ?

A
  • not had an HIV test in past 12 months
  • areas where prevalence of diagnosed HIV is greater than 2 in 1000
56
Q

Some HIV-related conditions such as ..1… or ..2.. can be life threatening and require ..3… to …4… care

A
  1. pneumocystis pneumonia
  2. cryptococcal meningitis
  3. urgent admission or referral
  4. secondary
57
Q

what are the 2 methods for routine HIV testing ?

A
  • laboratory-based tests performed on samples obtained through venepuncture
  • self-sampling, self-testing and rapid POCTs which can be performed in the clinic, in the community setting or as a home test
58
Q

Steps for blood test for HIV testing ?

A
  • small sample of blood is taken from arm in clinic
  • sample sent to lab
  • results available within several days
59
Q

Steps for POCT (rapid point of care) test for HIV testing ?

A
  • small spot of blood is taken from finger
  • no need to send to lab
  • results available within minutes
60
Q

Steps for home sampling kit for HIV testing ?

A
  • collect a small sample of blood yourself
  • send sample to lab
  • results available within several days
61
Q

Steps for home testing kit for HIV testing ?

A
  • you collect a small sample of blood and test it at home
  • no need to send to the lab
  • results available within minutes
62
Q

1st generation HIV test ?
based on …. to detect ….

A

based on viral lysate antigens to detect HIV antibodies e.g. western blot

63
Q

2nd generation HIV test ?
(antigens, with or without…, detect… )

A
  • utilise synthetic peptide or recombinant protein antigens
  • with / without viral lysates
  • detect HIV immunoglobulin (Ig) G antibodies
64
Q

3rd generation HIV test:
1. ….. based tests
2. detect …. antibodies
3. increased sensitivity during …

A
  1. synthetic peptide or recombinant protein antigen
  2. IgM or IgG
  3. early seroconversion
65
Q

4th generation HIV test is what ?

A

combination 3rd generation assays to detect IgM and IgG antibodies, and monoclonal antibodies to detect p24 antigen

66
Q

What do the consensus guidelines recommend for HIV testing ?

A

4th generation HIV lab tests with venous sampling as 1st line choice, with POCTs also available (which are largely 3rd gen tests)

67
Q

According to who and which testing should be undertaken with HIV testing ?

A
  1. according to locally determined pathways in liaison with local virology teams
  2. confirmatory testing
68
Q

what’s the window period of a test ?

A

time interval between exposure to infection and accurate detection of that infection

69
Q
  1. What may occur if a HIV test is taken in the ‘window period’ after infection ?
  2. which days can this happen on depending on the test used ?
A
  1. false negatives
  2. 45 days to 90 days
70
Q

Why should patients be aware of the likelihood of a negative test ?

A

They may be asked to return to test again, if HIV test taken in window period after infeciton false negative may occur (can be 45 days to 90 days) depending on the test used

71
Q

What is used for early detection of HIV ?

A

P24 antigen

72
Q

What can blunt the HIV antibody response, yielding atypical HIV serology ? [this means what change Q]

A

post-exposure prophylaxis, PrEP

73
Q

Diagnosis of AIDS vs HIV difference in what is present ?

A

HIV = HIV antibodies

AIDS = HIV positive, CD4+ count below 200 cells/microlitre (or CD4+ % of lymphocytes < 14%) or AIDS defining illness

74
Q

7 barriers to testing & some ideas why

A
  1. access to services - geographical distance, waiting time
  2. testing environment - lack of cultural sensitivity, trans patients
  3. service capacity - insufficient time, staff and training
  4. cost - lack of funding
  5. lack of knowledge by clinicians - may be unaware of who to test
  6. lack of awareness by the individual - perception of being low risk, assumption of on-going negative status
  7. fear of a positive result - immigration, dying, lack of knowledge
75
Q

slide 45

A

infection (33 decks)

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