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3 Reproduction > HIV 1- pathophysiology and presentation > Flashcards

HIV 1- pathophysiology and presentation Flashcards

1
Q

What is HIV

A

Human Immunodeficiency Virus

a retrovirus which can cause Acquired Immunodeficiency Syndrome (AIDS)

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2
Q

how is AIDS prevented in HIV positive people

A

early diagnosis and treatment

those with treated HIV have a ‘near normal’ life expectancy

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3
Q

what does AIDS cause

A

opportunistic infections

AIDS related cancers

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4
Q

what is the target site for HIV

A

CD4+ receptors

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5
Q

what is CD4

A

a glycoprotein sound on the surface of a range of immune cells:

  • T helper lymphocytes (CD4+ cells)
  • Dendritic cells
  • Macrophages
  • Microglial cells
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6
Q

what to T helper cells (CD4+ Th cells) do

A

essential for induction of the adaptive immune response

Recognise MHC2 antigen presenting cells

Activate B-cells

Activate cytotoxic T cells (CD8+)

Cytokine release

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7
Q

what does HIV do to the immune response

A

Reduces circulating CD4+ cells

Reduced proliferation of CD4 cells

Reduction in CD8+ T cell activation

Reduction in antibody class switching

Chronic immune activation

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8
Q

what is a normal CD4+ sound

A

500-1600 cells/mm3

risk of opportunistic infection if <200 cells/mm3

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9
Q

how does the HIV virus replicate

A

rapid replication in very early and very late stage

new generation every 6-12 hours

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10
Q

how does the HIV infection spread around the body

A

Infection of mucosal CD4 cell

transport to regional lymph node

Infection established within 3 days of entry

Dissemination of virus

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11
Q

how does a primary HIV infection present

A

80% present with symptoms

onset is 2-4 weeks after infection

fever
rash 
myalgia 
pharyngitis 
headache/aseptic meningitis

v high risk of transmission

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12
Q

what happens to the virus during asymptomatic infection

A

ongoing viral replication

ongoing CD4 count depletion

ongoing immune activation

still risk of transmutation

just no symptoms

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13
Q

what are opportunistic infections

A

infection caused by a pathogen that does not normally produce disease in a healthy individual

uses the ‘opportunity’ given by a weakened immune system

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14
Q

what organism often causes an opportunistic pneumonia in those with HIV

A

Pneumocystitis Jiroveci

in people who’s CD4 count is <200

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15
Q

how do you treat pneumoncystitis Jiroveci pneumonia

A

High dose co-trimoxazole (+/- steroid)

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16
Q

what bacterial infection is much more common in HIV+ve individuals than HIV-ve

A

TB

Symptomatic primary infection 
Reactivation of latent TB
Lymphadenopathies 
Miliary TB
Extrapulmonary TB 
Multi-drug resistant TB 
Immune reconstitution syndrome
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17
Q

what are the characteristics of cerebral toxoplasmosis in those with HIV

A

Toxoplasma gondii infection
CD4 <150

headache 
fever 
focal neurology 
seizures
reduced consciousness
raised intracranial pressure
18
Q

what are the characteristics of cytomegalovirus in HIV

A

CMV
CD4 threshold <50
causes retinitis, colitis, oesophagi’s

presentation:

  • reduced visual acuity
  • floaters
  • abdo pain, diarrhoea, PR bleeding

ophthalmic screening given for all those CD4 <50

19
Q

what skin infections are more common in HIV

A 
Herpes Zoster
Herpes Simplex
Human Papilloma Virus 
Weird/wonderful 
-penicilliosis 
-histoplasmosis
20
Q

what are some important HIV associated neurological problems

A

HIV associated Neurocognitive impairment (HIV-1)
-reduced short term memory +/- motor dysfunction

Progressive multifocal leukoencephalopathy (JC virus)

  • rapidly progressing
  • focal neurology
  • confusion
  • personality change
21
Q

what is ‘slim’s disease’

A

HIV-associated muscle wasting

caused by:

  • metabolic (chronic immune activation)
  • Anorecia
  • Malabsorpiton/diarrhoea
  • hypogonadism
22
Q

what are some AIDS related cancers

A

Kaposi’s sarcoma
Non-hodgkins lymphoma
Cervical cancer

23
Q

what is Kaposi’s sarcoma

A

Sarcoma caused by the Human Herpes Virus 8 (HHV8)

vascular tumour

cutaneous
mucosal
visceral (pulmonary, GI)

treat with HAART( highly active antiretroviral therapy) local therapy or systemic chemo

24
Q

what is non-hodgkin’s lymphoma

A

caused by EBV

cancer of B cells

presents with: 
B symptoms 
Bone marrow involvement 
Extranodal disease 
Increase CNS involvement

Tx- HAART

25
Q

what is cervical cancer

A

cancer of the cervix caused by HPV

rapid progression to severe dyplasias and invasive disease

HIV testing should be offered for all complicated HPV presentations

26
Q

What non-opportunistic infections are also symptomatic of HIV

A 
Mucosal Candidiasis 
Seborrhoeic Dermatitis 
Diarrhoea 
Fatigue 
Worsening psoriasis 
Lymphadenopathy 
Parotitis 
Epidemioloigcally linked conditions eg. STIs, Hep B, Hep C
27
Q

what haematological conditions are caused by HIV

A

Anaemia (effects up to 90%)

Thrombocytopenia (CD4 300-600)

28
Q

how is HIV transmitted

A

Sexual transmission
Parenteral transmission
Mother to child

29
Q

what factors increase HIV sexual transmission risk

A

Anoreceptive sex
Trauma
Genital ulceration
Concurrent STI

30
Q

what is parenteral transmission

A

transmission from injection drug use

infected blood products

iatrogenic

31
Q

how can HIV be passed from mother to child

A

In utero/trans-placental

During delivery

Breast feeding

32
Q

what group of people are at the highest risk of HIV in the uk

A

Men who have sex with men (MSM)

effects 1:17
1:7 in London

33
Q

who should be tested for HIV

A

Everyone in high prevalence areas

Opt-pout testing in certain clinical settings

Screening of high risk groups

Testing in the presence of clinical indicators

34
Q

when is there opt-out HIV testing offered

A 
Termination of Pregnancy 
Genitourinary Clinics 
Drug Dependency Services
Antenatal services 
Assisted conception services
35
Q

when should you test on clinical groups

A

if HIV is in the differentials - any chance there is HIV

36
Q

how do you take an HIV test

A

Document consent
Obtain venous sample for serology
Request via ICE
Ensure pathway is in place for retrieving and communicating result

37
Q

what markers are used by labs to detect HIV infection

A

Viral RNA

Antigen

Antibody

38
Q

what do 3rd generation HIV antibody tests identify

A

if HIV-1 or HIV2
IgM and IgG
v sensitive/specific in established infection

Average 20-25 days window periods

39
Q

what can 4th generation HIV antibody tests do

A

Identify combined antibody and antigen

shortens window period

window 14-28 days

negative 4th generation test at 4 weeks = v likely to exclude HIV infection

40
Q

what is a rapid HIV test (POCT)

A

Fingerprick blood specimen or saliva

Results within 20-30 mins

3rd generation (Ab only)

4th generation (Ab/Ag)

41
Q

advantages of POCT

A 
simple to use 
no lab needed 
no venopuncture needed 
no anxious wait 
reduced follow up 
good sensitivity
42
Q

disadvantages of POCT

A 
expensive £10
quality control 
poor positive predictive value in low prevalence settings 
not suitable for high volume 
cant be relied on in early infection

3 Reproduction (49 decks)

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