HIV

Question 1

T/F: AIDS is now mostly referred to as late-stage HIV

Answer 1

true

Question 2

HIV is a(n) RNA/DNA retrovirus

Answer 2

RNA retrovirus

Question 3

HIV enters and destroys which cells of the immune system

Answer 3

CD4 T-helper cells

Question 4

presentation of HIV?

Answer 4

3-12 weeks post infection: glandular fever-like infection. Sore throat, lymphadenopathy, malaise, myalgia, diarrhoea, rash, mouth ulcers

Question 5

how is HIV transmitted?

Answer 5

unprotected oral/anal/vaginal sex
vertical (mother>child) during pregnancy, birth or breastfeeding
Mucous membrane, blood or open wound exposure to infected blood or bodily fluids

(not through kissing)

Question 6

T/F: HIV is a treatable condition

Answer 6

true (most are fit and healthy on treatment)

Question 7

repeat testing is necessary if an initial test is negative within ___ ___ of exposure to the virus

Answer 7

3 months

as that’s how long Abs to the virus can take to develop

Question 8

T/F: written consent is needed prior to HIV testing

Answer 8

false- verbal is fine

Question 9

HIV testing

1) typical screening test?
2) what test can give a positive result earlier in infection compared with the antibody test?
3) what test gives the viral load?

Answer 9

1) Ab test
2) p24 Ag test
3) PCR test for HIV RNA

Question 10

2 tests which can be used for monitoring?

Answer 10

CD4 count

viral load (number of copies of HIV RNA)

Question 11

what CD4 count indicates end-stage HIV (AIDS)

Answer 11

<200 (high risk of opportunistic infection)

Question 12

T/F: ART is offered to everyone with HIV irrespective of viral load or CD4 count

Answer 12

true

Question 13

starting regime for treating HIV?

Answer 13

generally 2x NRTIs (e.g. tenofovir and emtricitabine) plus a third agent

Question 14

aim of treatment?

Answer 14

undetectable viral load plus normal CD4 count

Question 15

T/F: when a HIV patient has a normal CD4 and an undetectable viral load on ART, treat their physical health problems (e.g. routine chest infections) as you would an HIV negative patient

Answer 15

true

Question 16

Pneumocystis jirovecii pneumonia (PCP)

1) tends to develop with what CD4 count
2) treatment?

Answer 16

1) <200

2) co-trimoxazole (also given prophylactically if CD4< 200 to prevent PCP)

Question 17

what additional monitoring do women with HIV require?

Answer 17

annual cervical smear (increased risk of HPV and cervical cancer)

Question 18

T/F: HIV patients should avoid live vaccines

Answer 18

true

Question 19

T/F: barrier protection is still advised if both partners are HIV positive

Answer 19

true

Question 20

mode of delivery in HIV + mother?

Answer 20

viral load <50: can SVD

viral load> 50: c/s advised, start zidovudine infusion 4 hours prior

Question 21

T/F: prophylaxis is given post-delivery to the baby of a HIV + mother

Answer 21

true
viral load<50: zidovudine for 4 weeks
viral load>50: zidovudine, lamivudine and nevirapine for 4 weeks

Question 22

Can HIV be transmitted during breastfeeding?

Answer 22

yes even at undetectable viral loads, therefore not recommended in any HIV + women in UK

Question 23

PEP must be commenced within what timeframe?

Answer 23

<72hr (sooner the better)

Question 24

following HIV exposure, tests are done immediately and also a minimum of __ __ post-exposure to confirm a negative status

Answer 24

3 months

Question 25

what does PEP consist of?

Answer 25

combination of ART therapy currently Truvada + Raltegravir for 28 days

Question 26

testing for HIV in asymptomatic patients should be done how long after possible exposure?

Answer 26

1 month | offer repeat test at 3 months if negative

Question 27

the HIV antibody test usually consists of both a screening ____ test and a confirmatory ___ ___ Assay

Answer 27

ELISA | western blot

Question 28

what accounts for 50% of cerebral lesions in HIV?

Answer 28

cerebral toxoplasmosis

Question 29

Toxoplasmosis 1) presentation 2) appearance on CT? 3) Management?

Answer 29

1) constitutional symptoms: HA, confusion, drowsy 2) multiple ring enhancing lesions 3) pyrimethamine and sulfadiazine (toxoPlaSmosis)

Question 30

Primary CNS lymphoma 1) associated with what virus 2) appearance on CT? 3) will be positive on which scan?

Answer 30

1) EBV 2) single homogenous enhancing lesion 3) thallium SPECT

Question 31

Encephalitis in HIV 1) due to? 2) CT?

Answer 31

1) CMV or HIV | 2) oedematous brain

Question 32

most common fungal CNS infection?

Answer 32

cryptococcus

Question 33

Cryptococcus infection 1) presentation? 2) CSF? 3) CT?

Answer 33

1) HA, fever, malaise, nausea/vomiting, seizures, focal neurological deficit (think meningism) 2) high opening pressure, India ink 3) meningeal enhancement

Question 34

Progressive multifocal leukoencephalopathy (PML) 1) causes widespread ____ 2) caused by infection of ____ by what virus? 3) symptoms? 4) preferrred imaging?

Answer 34

1) demyelination 2) Oligodendrocytes with John cunningham (JC) 3) behaviour, speech, motor, visual impairment (multifocal indeed) 4) MRI (demyelinating white matter lesions seen)

Question 35

AIDS dementia complex 1) pathogen? 2) symptoms? 3) CT?

Answer 35

1) HIV 2) behaviour changes, motor impairment 3) cortical and subcortical atrophy

Question 36

T/F: NICE recommend offering HIV screening to all pregnant women

Answer 36

true

Question 37

T/F: pregnant women should should not be commenced on antiretroviral therapy if they were not taking it previously

Answer 37

false- all should be offered regardless of whether they were taking it previously

Question 38

Kaposi's sarcoma 1) caused by which pathogen 2) presentation? 3) treatment?

Answer 38

1) HHV-8 2) purple papules or plaques on the skin or mucosa (e.g. GI, resp) respiratory involvement > massive haemoptysis and pleural effusion 3) radiotherapy + resection

Question 39

hairy leukoplakia can occur secondary to infection with what?

Answer 39

EBV

Question 40

what opportunistic infection can occur with CD4<50?

Answer 40

cytomegalovirus retinitis

Question 41

most common opportunistic infection in AIDS?

Answer 41

PCP

Question 42

Pneumocystis jiroveci pneumonia 1) features? 2) common pulmonary complication? 3) T/F: CXR may be normal 4) treatment?

Answer 42

1) dyspnoea, dry cough, fever, few chest signs, exercise-induced desaturation 2) pneumothorax 3) true 4) co-trimoxazole

Question 43

commonest cause of oesophagitis (dysphagia, odynophagia) in HIV patients? treatment?

Answer 43

oesophageal candidiasis Fluconazole and itraconzaole first line

Question 44

commonest infective cause of diarrhoea in HIV patients?

Answer 44

Cryptosporidium

Question 45

ART involves a combination of at least ___ drugs Typically two ____ and either a ____ or a ____

Answer 45

3 NRTI PI NNRTI

Question 46

NRTIs 1) examples 2) side effect

Answer 46

1) zidovudine (AZT), abacavir, emtricitabine, tenofovir | 2) peripheral neuropathy

Question 47

NNRTI 1) examples 2) side effect

Answer 47

1) nevirapine | 2) P450 enzyme inducer, rash

Question 48

PI 1) examples 2) side effect

Answer 48

1) 'VIR' e.g. indinavir | 2) diabetes, hypelipidaemia, central obesity