Clinical Features of HIV Flashcards
What are the two markers used to monitor HIV infection
- CD4 count
2. HIV viral load
What is the following:
Normal throat Mouth Ulcers Mild Lymphadenopathy Diffuse Rash Fever Headache
Acute HIV syndrome
What is distinguishable about the rash in HIV
The rash is symmetrical that involves the whole body
What can the rash seen in acute HIV be mistaken for
Secondary Syphilis
What is Maculopapular symptom
Raised red lumps
When does Acute HIV syndrome occur
2-4 weeks after infection
HIV replicates rapidly causing CD4 count to rapidly increase and then rapidly drops during this time
What can Acute HIV syndrome be mistaken for
Glandular fever
Flu
What is the significance of the degree of severity of symptoms in Acute HIV syndrome
Progression is more rapid when severity is greater
Why can some patients present with aseptic meningitis
Direct effect of HIV on CNS
Recap: Symptoms of Acute HIV Syndrome
- Fever
- Sore throat
- Myalgia
- Rash
- Headache
- Weight loss
- Lymphadenopathy
- Vomiting
What do you ask following a patient with fever, rash and non-specific symptoms
- Ask about sexual history
2. Think of HIV conversion
What is clinical latency
- HIV viral load rapidly decreases due to activation of CD4
- During clinical latency the CD4 population slowly declines causing a very slow increase in HIV viral load (become rapid after clinical latency period)
What are the symptoms during clinical latency
- NONE
2. May see enlarged lymph nodes
What is Lymphadenopathy
Persistant generalised lymph node enlargement (2 areas of the body for atlas 3 months)
How long can clinical latency last for
8 years
How do we distinguish shingles from HIV
Shingles tends to appear in elderly NOT the young!
What is shingles
Reactivation of chickenpox
Shingles vs HIV
HIV affects many dermatological areas
Shingles effects one
Later on in clinical latency once CD4 levels are extremely low, what indications are there for HIV
- Minor infections become very common (thrush) or difficult to treat
- . Thrush may appear in the mouth without another explanation
Difference between Oral hairy leukoplakia vs thrush
Thrush can be scraped off but oral can’t
What is Oral hair leukoplakia caused by
Glandular fever (EBV virus)
If you can scrape it, could be recurrent thrush associated with HIV
What is Kerion
A scalp condition caused by ringworm (can become common in HIV)
When do we diagnose AIDS
CD4 < 200 or AIDS defining illness symptoms present (PCP)
If a patient presents with Thinness, oral thrush and SpO2 has dropped to 79% on walking, what do they have
Pneumocystis Pneumonia (associated with HIV patients)
Difference between PCP and common pneumonia
Common pneumonia only effects one area of the lung whilst PCP affects every alveoli
What is the PCP caused by
Fungal
Signs of PCP
- Fever
- Dry cough
- Drop in SpO2
How dow e diagnose PCP
- Chest x-ray
- Arterial blood gas to assess for hypoxia
- Induced septum for PCR
What is Induced Septum
Squirt saline into the lung and extracted to acquire sputum
What is PCP commonly treated with
Antibiotic: Cotrimoxazole with Prednisolone is hypoxic
What drug is prednisolone
Steroid
Three issues with late diagnoses
- Increased transmission
- Increased morbidity
- Increased mortality
How is HIV TB caused
Acid fast bacilli
Symptoms of HIV TB
Night sweats
Weight Loss
Productive Cough
When does HIV TB cause issues
At any CD4 count - this is AIDS defining
What requirements do all patients with TB have
To do a HIV test
How do we test for acid fast bacilli at a microscopic level
Diehl-Neilson staining
How does HIV effect the CNS (AIDS defining symptoms involving mass lesions)
- Mass lesions leads to primary CNS lymphoma
- Single mass with surrounding oedema - lymphocytic CSF
- Toxoplasmosis (lesions on MRI)
If a patient has HIV and a headache, what do we do
Undergo a lumbar puncture (low threshold = HIV)
How does HIV effect the risk of cancer
Any cancer associated with a virus can increase in risk
What virus is caused by EBV
Lymphomas in HIV (common)
What virus is caused by Human papillomavirus
Cervical, anal and penile carcinoma (HIV)
What virus is caused in individuals with HIV by hepatitis BC
Hepatocellular carcinoma
What cancer is most commonly seen in HV
Kaposi’s sarcoma
What is Kapok’s sarcoma caused by
Human Herpesvirus 8
Symptoms of Karposi’s sarcoma
Single to multiple lesions on skin
How is Kapok’s sarcoma treated
with HAART and chemotherapy
Is Kaposi’s sarcoma genetic
No
How can HIV be managed
HAART (highly active anti-retroviral therapy)
3 ART drugs
What are the three ART drugs used in HAART
NRTI
NRTI
One other
What does HAART do
Surpasses viruses to undetectable levels (CD4 count high)
Pharmacology of ART
ART stops active CD4 cells with HIv making anymore viruses causing load to drop by 90% in first few days
How long does it take for an individual with a viral count of 100,00 to fall to undetectable levels
three months
How common is mutation in HIV
1 in every 2 produced
How do we inhibit HIv from binding to CD4 receptor
- ENF and MRC Fusion inhibitors
What is the most common drug used to treat against HIV
Reverse Transcriptase Inhibitors (NRTIs)
What are the two subcategories of NRTIs
Pyrimidine and Purine analogues
What is an NRTI
Nucleotide reverse transcriptase inhibitors: Placing a dummy nucleotide in the genome so no more can be active
What is an NNRTI
Occupy the active site of reverse transcriptase and stop it from working
What are integrate inhibitors
They stop Viral DNA from integrating to genome
What are protease inhibitors
Prevents budding and releasing of HIV
What is the problem of protease inhibitors
Can effect host proteases too
How do HIV develop drug resistance
Non-adherence - Missing one or two doses
Drug-drug interactions
What happens if I give lansoprazole to a patient on rilpvirine
Decreases rilpvirine conc. due to increased gastric acid pH levels
What is lansoprazole used for
proton pump inhibitor
Should we co-administer Nevirpine and Itraconazole
No
Should we co-administer Darunavir/Ritonavir and Clindamycin
No
Should we co-administer Abacavir and Amoxicillin
Yes
