HIV Flashcards
T/F: AIDS is now mostly referred to as late-stage HIV
true
HIV is a(n) RNA/DNA retrovirus
RNA retrovirus
HIV enters and destroys which cells of the immune system
CD4 T-helper cells
presentation of HIV?
3-12 weeks post infection: glandular fever-like infection. Sore throat, lymphadenopathy, malaise, myalgia, diarrhoea, rash, mouth ulcers
how is HIV transmitted?
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)
T/F: HIV is a treatable condition
true (most are fit and healthy on treatment)
repeat testing is necessary if an initial test is negative within ___ ___ of exposure to the virus
3 months
as that’s how long Abs to the virus can take to develop
T/F: written consent is needed prior to HIV testing
false- verbal is fine
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?
1) Ab test
2) p24 Ag test
3) PCR test for HIV RNA
2 tests which can be used for monitoring?
CD4 count
viral load (number of copies of HIV RNA)
what CD4 count indicates end-stage HIV (AIDS)
<200 (high risk of opportunistic infection)
T/F: ART is offered to everyone with HIV irrespective of viral load or CD4 count
true
starting regime for treating HIV?
generally 2x NRTIs (e.g. tenofovir and emtricitabine) plus a third agent
aim of treatment?
undetectable viral load plus normal CD4 count
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
true
Pneumocystis jirovecii pneumonia (PCP)
1) tends to develop with what CD4 count
2) treatment?
1) <200
2) co-trimoxazole (also given prophylactically if CD4< 200 to prevent PCP)
what additional monitoring do women with HIV require?
annual cervical smear (increased risk of HPV and cervical cancer)
T/F: HIV patients should avoid live vaccines
true
T/F: barrier protection is still advised if both partners are HIV positive
true
mode of delivery in HIV + mother?
viral load <50: can SVD
viral load> 50: c/s advised, start zidovudine infusion 4 hours prior
T/F: prophylaxis is given post-delivery to the baby of a HIV + mother
true
viral load<50: zidovudine for 4 weeks
viral load>50: zidovudine, lamivudine and nevirapine for 4 weeks
Can HIV be transmitted during breastfeeding?
yes even at undetectable viral loads, therefore not recommended in any HIV + women in UK
PEP must be commenced within what timeframe?
<72hr (sooner the better)
following HIV exposure, tests are done immediately and also a minimum of __ __ post-exposure to confirm a negative status
3 months
what does PEP consist of?
combination of ART therapy
currently Truvada + Raltegravir for 28 days
testing for HIV in asymptomatic patients should be done how long after possible exposure?
1 month
offer repeat test at 3 months if negative
the HIV antibody test usually consists of both a screening ____ test and a confirmatory ___ ___ Assay
ELISA
western blot
what accounts for 50% of cerebral lesions in HIV?
cerebral toxoplasmosis
Toxoplasmosis
1) presentation
2) appearance on CT?
3) Management?
1) constitutional symptoms: HA, confusion, drowsy
2) multiple ring enhancing lesions
3) pyrimethamine and sulfadiazine (toxoPlaSmosis)
Primary CNS lymphoma
1) associated with what virus
2) appearance on CT?
3) will be positive on which scan?
1) EBV
2) single homogenous enhancing lesion
3) thallium SPECT
Encephalitis in HIV
1) due to?
2) CT?
1) CMV or HIV
2) oedematous brain
most common fungal CNS infection?
cryptococcus
Cryptococcus infection
1) presentation?
2) CSF?
3) CT?
1) HA, fever, malaise, nausea/vomiting, seizures, focal neurological deficit (think meningism)
2) high opening pressure, India ink
3) meningeal enhancement
Progressive multifocal leukoencephalopathy (PML)
1) causes widespread ____
2) caused by infection of ____ by what virus?
3) symptoms?
4) preferrred imaging?
1) demyelination
2) Oligodendrocytes with John cunningham (JC)
3) behaviour, speech, motor, visual impairment (multifocal indeed)
4) MRI (demyelinating white matter lesions seen)
AIDS dementia complex
1) pathogen?
2) symptoms?
3) CT?
1) HIV
2) behaviour changes, motor impairment
3) cortical and subcortical atrophy
T/F: NICE recommend offering HIV screening to all pregnant women
true
T/F: pregnant women should should not be commenced on antiretroviral therapy if they were not taking it previously
false- all should be offered regardless of whether they were taking it previously
Kaposi’s sarcoma
1) caused by which pathogen
2) presentation?
3) treatment?
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
hairy leukoplakia can occur secondary to infection with what?
EBV
what opportunistic infection can occur with CD4<50?
cytomegalovirus retinitis
most common opportunistic infection in AIDS?
PCP
Pneumocystis jiroveci pneumonia
1) features?
2) common pulmonary complication?
3) T/F: CXR may be normal
4) treatment?
1) dyspnoea, dry cough, fever, few chest signs, exercise-induced desaturation
2) pneumothorax
3) true
4) co-trimoxazole
commonest cause of oesophagitis (dysphagia, odynophagia) in HIV patients?
treatment?
oesophageal candidiasis
Fluconazole and itraconzaole first line
commonest infective cause of diarrhoea in HIV patients?
Cryptosporidium
ART involves a combination of at least ___ drugs
Typically two ____ and either a ____ or a ____
3
NRTI
PI
NNRTI
NRTIs
1) examples
2) side effect
1) zidovudine (AZT), abacavir, emtricitabine, tenofovir
2) peripheral neuropathy
NNRTI
1) examples
2) side effect
1) nevirapine
2) P450 enzyme inducer, rash
PI
1) examples
2) side effect
1) ‘VIR’ e.g. indinavir
2) diabetes, hypelipidaemia, central obesity
