HIV Flashcards
What is primary HIV?
The period immediately after exposure to virus
When does primary HIV occur?
Usually occurs within 3-12 weeks of exposure
How does HIV progress to AIDs?
If it occurs longer than 2 weeks or involves the CNS
How does HIV present?
- Fever
- Lymphadenopathy
- Maculopapular rash
- Mucosal ulcers.
- Sore throat
Where would you get a maculopapular rash?
Upper chest
How is HIV diagnosed?
Test for HIV antibody with Elisa
Confirm with western blot
What would you use to confirm the diagnosis?
HIV PCR and P24 antigen
What is a CD4 count used to diagnose?
AIDs
When should you test asymptomatic patients?
4 weeks after exposure
What is the management of HIV?
Anti-Retroviral therapy
What does antiretroviral therapy involve?
- Two nucleoside reverse transcriptase inhibitors (NRTI)- Zidovudine, abacavir, tenofovir
- A protease inhibitor (PI) (-navir)
- or a non-nucleoside reverse transcriptase inhibitor (NNRTI)
What are examples of 2 nucleoside reverse transcriptase inhibitors?
Zidovudine
Abacavir
Tenofovir
What are examples of protease inhibitors?
Saquinavir
Indinavir,
What is an example of a non-nucleoside reverse transcriptase inhibitor (NNRTI)?
Nevirapine
When do you start treatment for HIV?
At the time of diagnosis- don’t wait for symptoms
What is AID’s?
Advanced stage of HIV
Why does AIDs develop?
cART has not stopped the spread of infection.
How is AID’s defined?
Evidence of an AIDS defining illness
Alongside a CD4 count of less than 200. (Normal 500-1200 cells/mm3)
What is the most common opportunistic infection?
Pneumocystis Jiroveci Pneumonia
How does Pneumocystis Jiroveci Pneumonia present?
Dyspnoea
Cough
Fever
Chest signs
What is a common complication of Pneumocystis Jiroveci Pneumonia?
Pneumothorax
How does Pneumocystis Jiroveci Pneumonia stain?
With silver stain
What is the main investigation for Pneumocystis Jiroveci Pneumonia?
Chest x-ray
Bilateral pulmonary interstitial filtrates
What is the management for Pneumocystis Jiroveci Pneumonia
Co-trimoxazole
Who is prophylaxis co-trimoxazole given to?
To patients with a CD4 under 200/mm3 to protect against pneumocystis jirovecii pneumonia (PCP).
What is the cause of 50% of cerebral lesions in someone with HIV?
Toxoplasmosis
How does toxoplasmosis present?
Constitutional symptoms
Headache
Confusion
Drowsiness
How is toxoplasmosis diagnosed?
CT scan
What would you see on a CT scan on someone with toxoplasmosis?
Multiple ring or nodular enhancing lesions, mass effect may be seen
Will a thallium SPECT be positive or negative in someone with toxoplasmosis?
Negative
What is the management of toxoplasmosis?
Sulfadiazine
Pyrimethamine
What is the cause of 30% of cerebral lesions in HIV?
Primary CNS lymphoma
How does Primary CNS lymphoma present?
Poorly-defined symptoms of headache and drowsiness
What is Primary CNS lymphoma associated with?
Epstein- Barr virus
How is Primary CNS lymphoma diagnosed?
CT head
What would you see on a CT scan of someone with Primary CNS lymphoma?
Single homogenous enhancing lesions
Will a thallium SPECT be positive or negative with HIV?
Positive
What is the management of Primary CNS lymphoma?
Steroids
Chemotherapy (e.g. methotrexate) + possible brain irradiation
Surgical may be considered for lower grade tumours
Commence cART and whole brain irradiation
What is the function of steroids in Primary CNA lymphoma?
Reduce tumour size
What is Kaposi’s sarcoma caused by?
HHV-8 (human herpes virus 8)
How does Kaposi’s sarcoma present?
Purple papules or plaques on the skin or mucosa
Where in the body does Kaposi’s sarcoma affect?
Gastrointestinal and respiratory tract
What might happen to the skin lesions caused by Kaposi’s sarcoma?
Ulcerate
What might respiratory involvement in Kaposi’s sarcoma cause?
May cause massive haemoptysis and pleural effusion
What is the management of Kaposi’s sarcoma?
Radiotherapy and resection
What is less common than Primary CNS lymphoma or Toxoplasmosis?
Tuberculosis
How is tuberculosis diagnosed?
CT scan
What would you find on a CT scan of Tuberculosis?
Single enhancing lesion
What is Progressive multifocal leukoencephalopathy (PML)?
Widespread demyelination
What is Progressive multifocal leukoencephalopathy (PML) due to?
Due to infection of oligodendrocytes by JC virus (a polyoma DNA virus)
How does Progressive multifocal leukoencephalopathy (PML) present?
Behavioural changes
Speech
Motor
Visual impairment
How is Progressive multifocal leukoencephalopathy (PML) diagnosed?
CT
MRI
What is the best method of diagnosis for Progressive multifocal leukoencephalopathy (PML)?
MRI
What would you find on a CT scan if someone has Progressive multifocal leukoencephalopathy (PML)?
Single or multiple lesions
What would you find on an MRI if that person has Progressive multifocal leukoencephalopathy (PML)?
Demyelinating white matter lesions are seen
What is the JC virus and what does it cause?
A polyoma DNA virus
Causes Progressive multifocal leukoencephalopathy (PML)
When would a pregnant woman be offered a c-section with HIV?
If her viral load is above 50