AIDs,Viral Hepatitis And STIs Flashcards
What is HIV,AIDS,? What are the types of HIV? What are STIs
How is HIV transmitted?
Which two diseases can HIV patient be coinfected with easily?
Why can’t individuals get HIV through kissing,hugging,food and water?
Acquire Immune Deficiency Syndrome (AIDS) is a late stage infection with Human Immuno Deficiency Virus
•HIV is an RNA virus which is an evolved Human
organism from the ancient simian origin and it belongs to the
Retroviridae family of viruses.
There are two types of HIV’s and they are:
HIV 1 and HIV 2
Sexually transmitted infections are diseases which are
mainly transmitted through body fluids during sexual
activities and HIV remains the largest.
Transmission of these viruses are through:
1.Exchange of a variety of body fluids from infected people such as blood (transfusions ), breast milk, semen and vaginal secretions.
2. From a mother to her child during pregnancy and delivery
NB: Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water.
Co- infections with Tuberculosis and Hepatitis B are particularly
the most frequent and hence these diseases must be screened in all
HIV patients
Cuz HIV is gotten through the blood,breast milk,semen and vaginal secretions not through sweat or saliva
Name five risk factors for getting HIV
Behaviours and conditions that put individuals at greater risk
of contracting HIV include:
•having unprotected anal or vaginal sex;
•having another sexually transmitted infection (STI) such as syphilis, herpes, Chlamydia, gonorrhoea and bacterial vaginosis
•sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs
•receiving unsafe injections, blood transfusions and tissue transplantation, and medical procedures that involve unsterile cutting or piercing
•experiencing accidental needle stick injuries among health workers
What is the pathophysiology of HIV
What leads to the majority of signs and symptoms observed in HIV patients
NB: blood infection and host with weak immune system lead to a quicker infection, progression and early symptoms than other routes.
True or false
What is budding?
The interrelationship between HIV and the host
immune system is the basis of the pathogenesis of HIV
disease
•After this section you must be able to
- understand the infection mechanism of Human Immune Viruses type 1 & 2 and the replication process of these viruses
- Correlate how the replication process leads to the late stage infection ‘AIDS’ and the observe clinical signs and symptoms with time
Pathophysiology cont…
After a successful entry of HIV 1 or 2 organisms through already stated routes , the following activities occurs :
A. Recognition of the virus
the virus surface antigen is detected by dendritic and Fc receptors and this leads to
Inflammatory response.
B. this first inflammatory response which starts after few minutes of infection is called the
ACUTE INFLAMMATION but this initial response involving Polymorphonuclear
leukocytes often fails to remove Viruses (foreign body) due to the presence of the capsules
and as a results this response is prolonged by chronic inflammation where Lymphocytes
and macrophages begin to get involve.
C. Unfortunately the virus antigens( gp 120 ) target molecules on the surface of T-
lymphocytes specifically sub-type CD4 (these receptors are CCXR4 and CCR5 ) and this
leads to binding and fusion of the virus into the cytoplasm of the CD4 molecules and this
leads to reverse transcription mechanism initiated by viral reverse transcriptase enzyme
and formation of the viruses DNA.
D. After replication viruses bud out of CD4 molecules in large numbers
leading to death of CD4 molecules. This again leads to viremia which is
followed by a latency period and a heavy reinfection if not well controlled
Depletion of CD4 cells leads to reduce immunity of the host
and susceptibility to co- infections such as infection by normal flora,
Tuberculosis, Hepatitis B and Candidiasis .
E. Lastly,CD8 molecules are released to control viremia as the population
of CD4 molecules decreases gradually.
•Co-infections leads to majority of the signs and symptoms observed after the immune defence is impacted by HIV
Budding:when the HIV virus is getting out
What are the complications of HIV and how many stages of HIV infection are there?
What happens in these stages ?(name at least theee)
Name four important signs you’ll see in early HIV in infected patients
According to WHO staging of HIV/AIDS we have 4 stages of HIV infection and they contribute to the complications that constitutes almost all the body systems
Stage1:Asymptomatic,persistent generalised lymphadenopathy,recurrent infections especially yeast infections
Stage2: Moderate unexplained weight loss (<10% of presumed or measured body weight)
•Recurrent respiratory tract infections (sinusitis, bronchitis, otitis media, pharyngitis)
•Herpes zoster
•Angular cheilitis/Recurrent oral ulcerations
•Papular pruritic eruptions
•Seborrhoeic dermatitis
•Fungal nail infections or fingers
Stage 3: Severe unexplained weight loss (<10% of presumed or measured body weight)
•Unexplained chronic diarrhoea for longer than 1 month
•Persistent oral candidiasis
•Oral hairy leukoplakia
•Severe bacterial infections (emphyema,pneumonia , pyomyositis, bone or joint infection, bacteremia , severe pelvic inflammation)
Stage4:
•HIV wasting syndrome
•Pneumocytis Jiroveci pneumonia
Recurrent severe bacterial pneumonia
•Oesophageal candidiasis ( 0r Candidiasis of the trachea or bronchi or lungs
•Extrapulmonary tuberclosis
•Kaposi sarcoma
•Cytomegalovirus infection( retinitis or infection of other organs)
•Central nervous system toxoplasmosis
•HIV encephalopathy
•Extrapulmonaary Cryptococcis including meningitis
•Progressive multifocal leukoencephalopathy
•Symptomatic HIV associated neuropathy
•Cocydiomycosis
•Isoporiasis
•lymphoma
•Cardiomyopathy
- Chronic diarrhea
- recurrent infections
- Hodgkins and non Hodgkin’s lymphoma
- Persistent generalised lymphadenopathy in an adult due to chronic infection
Name three non specific signs and symbols in HIV AIDS presentation
State five differentials for It
SYMPTOMS
These are non-specific during clinical presentation
•Fever
•Pharyngitis with cervical lymphadenopathy
•Myalgia/arthralgia
•Headache
SIGNS •rash •Mucosal ulceration • Chronic diarrhoea •Xeroderma •Oral hairy leucoplakia •Oropharyngeal candidiasis
Differential diagnosis •Tuberculosis •Syphilis •Gonorrhoea •Cytomegalovirus infection •Toxoplasmosis •Herpes infection
How is AIDS diagnosed
Where is viral load checked?
Which two diseases are dangerous for HIV patients
AIDS is defined by serologic evidence of HIV infection with the presence of a variety of indicator diseases associated with clinical immunodefi ciency
From the lymph nodes
Toxoplasmosis and Cytomegalovirus
What is the primary investigation for HIV and name four other investigations
Why is it that a person can have HIV but will test negative for the rapid diagnostic test
VCT (voluntary counseling and testing) or HIV rapid diagnostic test OraQuick for detecting antibodies against HIV •OTHER INVESTIGATIONS ●CD4 count ●Viral load ●Hepatitis B (HBV) status ●Hepatitis C (HCV) antibody ●Hepatitis A (HAV) IgG antibody ●Toxoplasma and cytomegalovirus (CMV) IgG antibody ●Lipid profile and urinalysis ● Cervical smear in women ● STI screen ● FBC
This is because the test shows positive if the person has been infected for 6-12 weeks
If the person tests before 6-12weeks and is infected,the person will test negative
What are the five objectives of treatment in an HIV patient?
What is the non pharmacological treatment and pharmacological treatment?
Objectives
To reduce viral proliferation
To increase CD4 count
To prevent spread of infection
To reduce co-morbidities
Prophylaxis against later infections
•Pharmacological
Anti –Retroviral/Highly active anti-retroviral medications(Haart)
Antibiotic prophylaxis
Treating co-morbidities
- Non- pharmacological
- Safe sexual practices
- Emotion and psychological counselling
State the classes of anti retroviral drugs and state examples,doses and significant side effects
1.Nucleotide Reverse Transcription Inhibitors: Zidovudine (AZT)-300mg 12hrly Lamivudine-150mg 12hrly Anemia Generally safe
- Nucleotide Reverse Transciptase Inhibitors:
Tenofovir-300mg 24hrly
Renal impairment - Non-Nucleoside Reverse Transcription Inhibitors
Nevirapine-200mg 12hrly
Efavirenz-600mg nocte
Skin rashes from mild to steven johnson syndrome and hepatoxicity - Protease Inhibitors
Lopinavir/Ritonavir-400/100 mg 12hrly
Dysglycemia
How is HIV prevented
Individuals can reduce the risk of HIV infection by limiting exposure to risk factors.
Key approaches for HIV prevention, which are often used in combination, include:
•male and female condom use
•testing and counselling for HIV and STIs
•testing and counselling for linkages to tuberculosis (TB) care
•voluntary medical male circumcision (VMMC)
•use of antiretroviral drugs (ARVs) to reduce spread and also as prophylaxis for harm reduction for people who inject and use drugs
•Lastly preventing mother-to-child transmission (MTCT) of HIV through timely intervention with Antiretroviral drugs
What is the mechanism of action of each type of Anti retroviral drugs
Ask
What is hepatitis
• It can be acute, when the symptoms last for less than 6 months or chronic when the symptoms persist for more than 6 months. True or false
State five causes of it
Hepatitis is simply the inflammation of the hepatocytes or the liver cells (liver parenchyma)
True
Viruses (hepatitis A, B, C, D and E, yellow fever etc.)
• Drugs (allopathic alternative and herbal preparations) e.g. Methyldopa, isoniazid, ketoconazole.
• Alcohol
• Autoimmune response
• Hereditary e.g. Wilson’s disease
• Inflammatory bowel diseases
State five signs and five symptoms of a patient w hepatitis
SYMPTOMS • Right hypochondrial pain • Fever (occurring 1 – 4 weeks before the jaundice appears) • Malaise • Anorexia • Nausea • Vomiting • Yellow or dark coloured urine • Pale stools • Itching • Fatigue • Confusion
SIGNS
CLINICAL PRESENTATIONS
• Right hypochondrial tenders
• Hepatomegaly
• Asterixis
• Jaundice
• Mild splenomegaly (uncommon except in Epstein-Barr virus (EBV) infection)
• Mild hepatomegaly (but rapid shrinkage occurs in severe hepatitis)
• Cervical lymphadenopathy (uncommon)
• Skin manifestations include spider naevi, scratch marks in the pruritic phase, and rarely urticarial rash
State the common and less common causes of hepatitis
Which of the causes of Hepatitis can be acute? Which can be chronic?
CAUSES (COMMON) 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D 5. Hepatitis E VIRAL HEPATITIS Less common 1. Cytomegalovirus 2. Epstein-Barr virus 3. Herpes virus 4. Yellow fever
They differ in their tendency to cause acute and chronic infections.
Hepatitis A, B, C, and E can all initiate and acute self-limited hepatitis. Only hepatitis b and c can cause chronic viral hepatitis
Hepatitis D co-infects patients infected with hepatitis B
How is Hep A and E transmitted?
How is B and C transmitted ?
Fecal-oral transmission
HAV is commonly acquired by travelers. HEV is commonly acquired from contaminated water or undercooked seafood.
Parenteral transmission (e.g., childbirth, unprotected intercourse, intravenous drug abuse [IVDA], and needle stick) (Note that B is transmitted through childbirth and not C making B ore dangerous)
C-Parenteral transmission (e.g., IVDA, unprotected intercourse); risk from transfusion is almost nonexistent due to screening of the blood supply
