GUM Flashcards
What is HIV and AIDS?
HIV - virus that damages the immune cells and weakens ability to fight infections /illnesses.
AIDS - (acquired immune deficiency syndrome ) - collection of infections/illness or malignancies that happen due to HIV infections destroying immune cells. (these are potentially life threatening)
What is HIV infection?
HIV - retrovirus that damages the immune cells (CD4 T cells) over many years and cumulatively weakens ability to fight infections /illnesses.
(puts body at increased risk of opportunistic and other infections , malignancies )
SIGNS AND SYMPTOMS
- Generlaised lymphanopathy
- unexplained fever and night sweats
- weight loss ( could be due to TB , malnutrition , HIV muscle wasting syndrome)
- Rashes (most common sign of stage 2)
- Diarrhoae
- wasting syndrome
- TB infection (risk increases with worsening immunosuppression)
- Chronic herpes infection ( painful genital or anal ulceration) - GENITAL STIs
- chronic vaginal candidiasis
- shingles
- oral ulcers , angula chelitis , oral thrush . oral ahiry leukoplakia
- Karposi sarcoma (usually occurs in oral or face - highly vasculised)
RISK FACTORS
(can be transmitted through sex , mother to child - childbirth, breastfeeding , Inoculation)
- Unprotected receptive anal intercourse & penile - vaginal sexual intercourse.
(so unprotected & receptive) - Mother with high viral load
- Needle stick injury
- Needle sharing - IV drug use.
WHO clinical stages for HIV /AIDS?
STAGE 1 - Asymptomatic or persistent generalized lymphadenopathy (at 2 sites excluding inguinal ) for 6 months.
(REMAIN HERE FOR MANY YEARS)
STAGE 2 - mildly symptomatic stage - unexplained weight loss (less than 10%) - Recurrent respiratory infection 0 Sinusitis 0 Bronchitis 0 Otis media 0 Pharyngitis - Dermatological conditions 0 Herpes zoster flares 0 angular cheilitis 0 recurrent oral ulcerations 0 papular pruritic eruptions 0 Seborrhoeic dermatitis 0 Fungal nail infections
STAGE 3 - moderately symptomatic stage
- unexplained weight loss (greater than 10%)
- prolonged unexplained diarrhea (more than 1 month)
- Primary TB
- Systemic bacterial infections
0 pneumonia, pyelonephritis, empyema (pockets of pus), pyomyositis (infection of skeletal muscle), meningitis, bone and joint infections, and bacteremia.
0 Mucocutaneous conditions, including recurrent oral candidiasis, oral hairy leukoplakia, and acute necrotizing ulcerative stomatitis, gingivitis, or periodontitis, may also occur at this stage
- Unexpalin anameia
- cHronic thrombocytopenia
STAGE 4 - Severely symptomatic stage
-
HIV muscle wasting syndrome
- Pneumocystis pneumonia (PCP), recurrent severe or radiological bacterial pneumonia,
- extrapulmonary tuberculosis, - HIV encephalopathy,
- CNS toxoplasmosis,
- chronic orolabial herpes simplex infection (more than 1 month).
- esophgeal candidiasis
Kaposi’s sarcoma (advanced HIV disease cancer cells are found in membranes taht line GI tract - may look like purple patches or nodules on skin/mucous membranes)
- Cytomegalovirus infection (retinitis or infection of other organs)
- Central nervous system toxoplasmosis
- HIV encephalopathy
- Extrapulmonary cryptococcosis (FUNGAL) including meningitis
- Disseminated non-tuberculous mycobacterial infection
- Progressive multifocal leukoencephalopathy
- Chronic cryptosporidiosis (with diarrhoed)
- Chronic isosporiasis
- Disseminated mycosis (coccidiomycosis or histoplasmosis) - FUNGAL
- Recurrent non-typhoidal Salmonella bacteraemia
- Lymphoma (cerebral or B-cell non-Hodgkin) or other solid - HIV-associated tumours
Invasive cervical carcinoma
Atypical disseminated leishmaniasis
Symptomatic HIV-associated nephropathy or symptomatic HIV-associated cardiomyopathy
Presence of these conditions unaccompanied by the AIDS-defining illnesses, however, should prompt confirmatory testing.
Investigation of HIV infection ?
Serum HIV enzyme linked immunosorbent assay (ELISA)
Serum HIV rapid test
(both should be positive)
CD4 count - reflects degree of immunosuppression
- normal levels - 500 cells per microlitre (can be naturally lower tho)
- < 200 cells /ml - high risk of opportunistic infections & cancers
(the earlier you recover this , the better the prognosis )
* if viral load is suppressed , CD4 levels can recover.
Viral load - measures rates of viral replication (using PCR test)
- Undectable (20 -50 copies of viral genome / ml of blood or millions copies/ml.)
- if high inidcates - non - adherence to ART , resistance to one or more anti-viral drug
TO FIND POSSIBLE CAUSE
TB skin test
Test done when on antiviral therapy
( FBC - may show anaemia or thrombocytopenia)
- Serum electrolytes
- serum electrolytes creatinine
- LFTs
- lipid profile
- Hep A serology - if negative all should be vaccinated if not done so already.
- Toxoplasma serology (if positive + CD4 count <50 - prophylatic therapy.
- pregnancy TEST SHOULD BE DONE IN ALL WOMEN OF CHILDBEARING AGE STARTING THERAPY.
Serum Hepatitis C & B serology - in patients at risk.
- Treponema pallidum haemagglutination test
- Serum venereal disease research laboratory test
(tets for syphillis) - Rapid plasma reagin ( follow up test for syphillis)
CONSIDER :
CXR - signs of TB , pneumonia , etc.
- Gonorrhoea & Chlamydia testing.
Treatment of HIV infection ?
aim for an undetectable viral load. if tested HIV positive given ART regardless of viral load.
Supportive care ( vaccination s, anti- biotic prophylaxis , micronutrientsetc) + ART - anti - viral therapy (has may interactions - so be careful) 2 NRTIs (nucleoside reverse transcriptase ) 0 abacavir (ABC); 0 emtricitabine (FTC)*, 0 lamivudine (3TC); 0 tenofovir alafenamide fumarate (TAF), 0 tenofovir disoproxil fumarate (TDF)*, 0 zidovudine (AZT). (Vudines, fovirs, cavir) * stars are used most
\+ One of the following: Intergrase inhibitors (IGI) - Raltegravir - Dolutergravir - elvitegravir - bictegravir
(Gravirs)
or
Non - nucleoside reverse transcriptase inhibitor :
0 nevirapine , delavirdine , efavirenz
or
Ritonavir Boosted Protease inhibitor (PI):
atazanavir, darunavir, fosamprenavir, lopinavir, saquinavir, and tipranavir.
(navirs)
If both HIV positive & chronic hepatitis B
Regimens of choice are tenofovir disoproxil and emtricitabine, or tenofovir alafenamide and emtricitabine.
ART has failed if viral load is <200 copies/ml - reassessment.
