Clinical Aspects of HIV Flashcards
Describe HIV transmission?
Blood- IVDU, transfussion, needlesick injury
sexual transmission
mother to babay- birth, breast feeding
what is the HIv transmisison ratios of common methods of transmission?
needlestick injiury- 1:300
Mucuous membrane 1:1111
Vaginal receptive 1:500
vaginal insertive 1:1111- 1:3333
less risk to men who are cirumcside- lack langerhans cells in forekin which bind HIV
Anal recptive trnamsision higher than insertive
avergaes depemnd on the virla load of person
what factors increase the risk of HIV transmission in pregnnacy to baby?
high virla load
advanced immunodeficincy
IVDU
malnutrtion
complicated labour
how does HIV transmision occur in pregnancy
third trimester
during birth process
breat feeding
what factor has the largets impact on HIV transmission
HIv viral load, if undetectable no risk
if viral laod >200 copies/ml high risk
if less than 100 strugeel to pass on
increase risk with concomitnatn STI
Decribe HIv primary infection
- Drop in CD4 cells
- HIV viral laod si very high after infection 2-10 weeks falls after this rapidly
- acute HIV syndrom- non specific flu like symptoms, fever, swollen glands, sore throat
describe the clinical latency phase of HIV
takes around qo years between primary ifnection and AIDs defining illness
very few symptoms
graudl fall in Cd4 cells over the years- slow increase in HIV
what happens after Clinical latency phase of HIV
constituional symptoms
oppoutbisitc disase and
death
fall in Cd4 and large increase in HIV viral load
what is HIV seroconversion?
- HIv estblaish itself in the body- immune ssytem recognises- Antibodies
- 2-6 weeks after ecpsoure
- asymptomatic 20%
- symptomatci 80% of the time
what are the symptoms of HIV seroconversion
Symptomatric 80%
- rash (maculopapular)
- lymphadenopathy
- fever
- sore throat
- headache
- diarrhoeas
important to diagnose to prevent trnamsisison and prevnt AIDs
Rare neurlogical- Encephalitis, mononueritis
what 2 factros do we measure to determine the progression of HIV
- Viral load and CD4 counts
- 40% of patients have high Viral load and high CD4 >200 at diagnosis
- if you have high viral laof above >55x103 even with good CD4 counts chance of developoing AIDs defining illness woithin 3years is higher
Mainly cviral load which determines the probabilioty of AIds rather than CD4
what % of people are living with HIV and are undiagnosed
15%
what is Clinical stage 1 HIV infection
- asymptomatic
- generalised lymphadenopathy
- performance scale 1- asymptomatic normal activity
what is clinical stage 2 HIv infection
- weight loss <10% of body weight
- minor mucocutaneosu manifestations
- seborrheic dermatitis, fungal nail infection, reucrrent oral ulcerations
- herpes zoster within last 5 years (shinles)
- especially multidermatome
- recurrent URTI (bacterial sinusitis)
- and or performance casle 2- symptomatic normal acitivty

Describe CLinical stage III infection
- weight loss >10%
- unexplained chronic diarrhoeas >1 month
- unecplained prolonged fever (intermittiend or constant), 1 month
- Oral candidiasi
- oral hair leuoplakia
- Pulmonary tuberculossi
- severe bacterial infections
what is Oesophageal candidiaise
AIDs deifning event
oral candidiasis would also be much mroe severe in clcinial stage III (AIDS),

what is this?

1/3 of patients who present with it AIDs defining illness- oral hairy leucoplakia (EBV) trigger
cannot be scraped away - unlike candida
disappears when immune system improivng on treatment
what is CLinal stage IV HIV infection?
AIDs
combination of immune system degradation and CD4 count below 200
Defined by AIDs event- infectio
what are some AIDs defining illness
HIv wasting syndrome (20% of body weight in 6 months)
pneumocystic carinii pneumonia (xray)
kaposis sarcoma
candidiais of oesophagus, trachea, bronchi
oral hairy leucoplakia
cryptospridiosis with diarrhoa >1 month
when would be begin to see aids defining illness with regards to CD4 count
400 CD4/ul- kapsoi sarcoma
3000- hairy leukoplakia, tuberculosis
200- PCP pneumocycsitis penuomia, fever freuqnrt fungal ifnection, crytococcis, toxoplasmsosi
100- CMv lymphoma

what drives tumours in HIV
mostly viral driven
- kapsosi sarcoma - Human herpes virus 8
- lymphomas- epstein barr virus
- cervical carcinoma- HPV
- anal caricnoma - HPV
overall increase to risk of many other cancers.
describe kaposis sarcoma.
- induced by human herpes virus 8
- in usa and northenr europe 95% in gay men
- rates of hiv similiar to Ks reflect seroprevalence in population
- apearance
- vascular tumours, reddish purple riased- check for organ infvovlemt (lung liuver)
- diffiuclt to treat
- can disseminated in the skin

what is this? and how might we treat

lymphoma in the liver
chemotherpay alsonide anti-retrovirals
descrie Penumocystic Carini penumon ia (and PJP)
occurs when CD4<200
the most common AIDs defining illness
caused by fungus
- subacute clinical presnetation- dry cough, night sweats, and increasing SOB- over 4-8 weeks
- Desaturation on exercise specific
- rapid drop off on oxygen saturations of exercise
- chest signs may bne minimal/ xray normal

describe the treatment and prevention of PCP
- Treatment
- first line- cotrimoxazole 120mg/kg in 3 divided doses
- Prvention
- cotrimoxazole 960mg three times a week
- primary prophylaics when CD4<250
- secondary prophalysi after PCP
- cotrimoxazole 960mg three times a week
what is the rationale behind mass HIV testing
large number of undiagnosed
patient being diagnosed late in disease process
late diagnosis increasing cost and motaltiy
reduced onward trnamsisison
triple ARV very efective
what is tuberuclosis associated with in developing word, how does it present
HIV- up to 65%
fevr, swetsm weight loss, repsiratory symptoms, lcoalsied symtposm on roganaffected
describe CMV disease in hiv infections
occurs in advanced immunodeficiency- CD4 less than 50
viraemai precits osnet of lincial disease
eye most commonest site of localsied CMv disease- rpaid onset of visual loss
haemhorage in the arteries in eye and around optic disc- can lead to blindness

Describe CNS disease in AIDs
opportunistic infections- cyrptooccus, CMV, AMC, PML, toxoplasmsosi
primary cerebral lymhpoma
HIV dementia complex
what is this?

toxoplamsis ring enchancing lesions in absla ganlia- AIDS