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Sexual health > Clinical presentation and diagnosis of HIV > Flashcards

Clinical presentation and diagnosis of HIV Flashcards

1
Q

Describe the HIV life cycle.

A
  1. Binding:
    - Surface viral protein (gp120) binds host glycoprotein CD4+ and co-receptors (CCR5 and CXCR4)
  2. Fusion:
    - Viral protein (gp41) penetrates cell membrane, leading to fusion of virus and cell
  3. Reverse transcription:
    - Viral reverse transcriptase converts HIV single-stranded RNA and double-stranded DNA
  4. Integration:
    - Viral integrase enzymes allow HIV DNA to insert into host DNA
  5. Replication:
    - Host machinery transcribes and translates new HIV RNA and polyproteins
  6. Assembly:
    - New HIV proteins and HIV RNA move the cell membrane and assemble to immature, non-infectious virion
  7. Budding:
    - New HIV virion exits the cell and viral protease cleaves the long HIV protein chains to form the mature, infectious virion
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2
Q

Which class of HIV drug targets the binding part of the HIV life-cycle?

A

CCR5 inhibitors

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3
Q

Which class of HIV drug targets the fusion part of the HIV life-cycle?

A

Cell fusion inhibitors

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4
Q

Which class of HIV drug targets the reverse transcription part of the HIV life-cycle?

A
  • Non-nucleoside reverse transcriptase inhibitors

- Nucleoside reverse transcriptase inhibitors

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5
Q

Which class of HIV drug targets the integration part of the HIV life-cycle?

A

Integrase inhibitors

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6
Q

Which class of HIV drug targets the budding part of the HIV life-cycle?

A

Protease inhibitors

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7
Q

What are the risk factors for contracting HIV?

A
  • MSM
  • Female sexual contacts of MSM
  • Those originating from areas with a high prevalence of HIV
  • Those in current or former serodiscordant relationships
  • IVDU
  • Occupation exposure (needlestick injury)
  • Sexual risk factors –> unprotected anal or vaginal sex with 1+ partners, having another STI such as hep B or hep C
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8
Q

What are the typical features associated with seroconversion illness?

A
  • Fever
  • Malaise
  • Arthralgia
  • Anorexia
  • Maculopapular rash/symmetrical erythematous rash
  • Myalgia
  • Pharyngitis
  • Oral ulcer
  • Weight loss >2.5kg
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9
Q

What symptoms warrant investigation for HIV?

A
  • Glandular fever-like symptoms
  • FUO
  • Lymphadenopathy
  • Unexplained weight loss
  • Unexplained neutropenia
  • Anaemia
  • Thrombocytopenia
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10
Q

What are the constitutional symptoms indicative of long-standing HIV infection?

A
  • Fever, sweating
  • Weight loss
  • Lymphadenopathy (>3 months, occurring in 2+ extra-inguinal sites)
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11
Q

What are the haematology features indicative of long-standing HIV infection?

A
  • Unexplained neutropenia
  • Unexplained anaemia
  • Unexplained thrombocytopenia
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12
Q

What are the respiratory symptoms indicative of long-standing HIV infection?

A
  • Cough
  • Breathlessness
  • Infection with pneumocystis jirovecii, TB, bacterial pneumonia
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13
Q

What are the neurological symptoms indicative of long-standing HIV infection?

A
  • Confusion
  • Personality change
  • Seizures
  • Focal neurological symptoms
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14
Q

What are the oral symptoms indicative of long-standing HIV infection?

A
  • Candidiasis
  • Hairy leukoplakia
  • Gingivitis
  • Dental abscess
  • Aphthous ulcers
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15
Q

What are the gastrointestinal features indicative of long-standing HIV infection?

A
  • Oesophageal candidiasis

- Diarrhoea

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16
Q

What are the dermatological features indicative of long-standing HIV infection?

A
  • Kaposi’s sarcoma
  • Fungal skin and nail infections
  • Pityriasis versicolor
  • Shingles
  • Warts
17
Q

What are the genitourinary features indicative of long-standing HIV infection?

A
  • Candidiasis
  • Herpes simplex
  • Warts
18
Q

List the AIDS-defining illnesses.

A
  • Pneumocystis jirovecii
  • Kaposi’s sarcoma
  • Cryptococcal meningitis
  • Cerebral toxoplasmosis
  • Cerebral lymphoma
  • CMV retinitis
  • Non-Hodgkin’s lymphoma
  • Oesophageal candidiasis
  • TB
  • Primary CNS lymphoma
19
Q

What are 4th generation HIV tests?

A
  • Most used assay
  • Uses serum to detect presence of HIV IgM and IgG antibodies, and viral p24 antigen
  • +ve result necessitates a 2nd sample for confirmation
  • -ve result 4 weeks after exposure may be reassuring, but still requires a repeat test at 12 weeks post-exposure to definitively exclude HIV infection
20
Q

What is the window period for 4th generation HIV tests?

A

4 weeks

21
Q

What are the 3rd

A
  • Employed in point-of-care testing and self-testing
  • Samples are taken from a finger prick or mouth swab
  • Detect HIV IgM and IgG antibodies
  • Increased sensitivity during early seroconversion
  • Higher rate of false +ve results
  • -ve results should be considered in the context of a 90-day window period –> for exposures within this period, a second test is required to exclude HIV

Sexual health (5 decks)

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