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Tropical Viruses > HIV > Flashcards

HIV Flashcards

1
Q

In 2019 how many people were living with HIV?

A

38million

  1. 8 children
  2. 7 new infections

68000 AIDS related deaths

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2
Q

In 2019 what were the stats on the 95-95-95 HIV figures?

A

81% know status
67% on ART
59% suppressed VL

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3
Q

What are the UNAIDS 10-10-10 goals?

A

Less than 10% countries have punitive legal systems
<10% PLHIV and key pops should experience stigma
<10% women should report inequality

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4
Q

What are the 2 HIV viruses?.

A

HIV 1- main one, divided into M,N,O and P. M is main one

HIV2- West Africa, usually co-infected. Intrinsically resistant to NNRTIs

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5
Q

Describe the features of seroconversion syndrome.

A

Occurs in 50%
2-5wks post infection
Non specific, flu like, macpap rash over arms and trunk
Potential for significant Immunosuppression and therefore present with OI but negative HIV test

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6
Q

Without ART how long does it take to get AIDS?

A

9yrs

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7
Q

What are signs of HIV if CD4>500?

A 
Candida vaginitis
Generalised LN
GBS
Aseptic meningitis 
TB
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8
Q

What are the signs of HIV if CD4 200-500?

A 
Bacterial pneumonia 
Pulmonary TB
Shingles
Oral thrush
Oral hairy leukoplakia 
Cryptosporidiosis 
Kaposi
Lymphomas
Cervical Ca
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9
Q

What are the signs of HIV if CD4 <200?

A 
PCP
Disseminated histoplasmosis or coccidioidomycosis
Extrapulm TB
PML
Wasting syndrome
Dementia 
Non Hodgkin Lymphoma
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10
Q

What are the signs of HIV when CD4 <100?

A 
Disseminated herpes
Toxoplasmosis 
Cryptococcus 
Chronic cryptosporidiosis 
Oesophageal thrush
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11
Q

What are the signs if HIV if CD4<50?

A

Disseminated CMV
Disseminated MAC
PCNSL

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12
Q

What is HIV wasting syndrome?

A

Weight loss >10% plus

  • unexplained diarrhoea over 1month or
  • chronic weakness + unexplained fever over 1 month
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13
Q

What are the WHO’s 5 Cs of HIV testing?

A 
Consent
Confidentiality 
Counselling
Correct test results 
Connection to care
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14
Q

What tests are available to diagnose HIV?

A

HIV viral DNA/RNA PCR- mainly for early infant

ELISA/RDTs of p24antigen and antibodies

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15
Q

When should you retest following a negative HIV result?

A

If inconclusive -retest after 14d
Pregnant and breastfeeding- if in high incidence setting then at labour and every 3months
Key populations
This using PrEP

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16
Q

When should you test fit HIV VL?

A

3-6months after ART start and then annually

17
Q

When should you test for CD4 count in HIV?

A

At ART start p, if interruption to ART and if new WHO stage 3 or 4 or OIs

18
Q

What investigations should be done when starting ART?

A 
CD4 count
CrCl
HBsAg
HCV antibodies
Hb
Clinical screening for TB, OIs and NCDs
19
Q

When do you delay ART start?

A

TB- start ART within 2weeks
TBM- delay by 4-8wks
Cryptococcal meningitis- delay 4-6wks

20
Q

When do you give cotrimoxazole prevention in PLIHIV?

A

Lifelong for all in high prevalence of malaria and severe bacterial infections
WHO stage 3/4 or CD4 <351

21
Q

When do you give TB preventative treatment in PLHIV?

A

All with no clinical evidence of active TB
Isoniazid with pyridoxine for 6 months or
Rifapentine plus isoniazid for 3 months

22
Q

When do you give cryptococcal prevention therapy in PLHIV?

A

Treat if serum CrAg positive

If no CrAg and CD4 <100 then fluconazole prophylaxis

23
Q

Name the NRTIs and their SEs

A 
Tenofovir- renal failure, active against HepB
Abacavir- hypersensitivity 
Zidovudine- BM suppression
Emtricitabine- active against HepB
Lamivudine- active against HepB
24
Q

Name the NNRTIs and their SEs

A

Nevirapine- rash and Hepatitis

Efavirenz- rash and Hepatitis, psychiatric Sx

25
Q

Name the protease inhibitors and their SEs

A

Lopinavir/ritonavir- GI Sx, lipid abnormalities
Atazanavir/ritonavir- lipid abnormalities
Darunavir/ritonavir- GI Sx

26
Q

Name the integrate inhibitors and their SEs

A

Dolutegravir- insomnia, diarrhoea, Hepatitis

Raltegravir- diarrhoea

27
Q

What us the first line HIV treatment?

A

Tenofovir+emtricitabine/lamivudine+dolutegravir

28
Q

If you can’t use dolutegravir what should to replace it with?

A

Efavirenz

29
Q

What should you do if VL>1000 after starting on ART?

A

Ensure on NRTI+DTG regime

Repeat in 3months

30
Q

What should you do if VL 50-1000 on ART?

A

Enhanced adherence counselling

Repeat in 3 months

31
Q

Who should be prioritised for POC VL testing?

A 
Pregnant and breastfeeding women
Children
Repeat VLs after previous high
Suspected Tx failure
Sick Pts
32
Q

When should you test VL in pregnant women?

A

At 34-36 wks
If on ART prepregnancy- at booking
If starting ART -3months after ART start

If VL>1000- enhanced post natal infant prophylaxis and NAT testing at birth

If breastfeeding- 3months post birth and every 6months

33
Q

What is the criteria for advanced HIV?

A

WHO stage 3 or 4 or CD4 <200

34
Q

What is the package of care for Pts with advanced HIV?

A 
CD4 count
BGL
Hb
Malaria
Syphilis
HepB
If CD4<200- serum CrAg
If CD4<100- TB-LAM
35
Q

What are the WHOs signs of serious illness in HIV?

A 
RR >30
Sats <90%
Temp >39
HR >120
Inability to walk unaided
36
Q

What causes Kaposis sarcoma?

A

HHV8 leading to malignancy of lymphatic endothelial cells

37
Q

How does Kaposis sarcoma present?

A 
Purple/black/brown lesions
Lymphoedema
Oral lesions
Bloody pleural effusion
GI bleeding/malabsorption 
Constitutional Sx
38
Q

Ho do you diagnose Kaposis sarcoma?

A

Biopsy

Clinical diagnosis

39
Q

How do you treat Kaposis sarcoma?

A

ART alone may Tx minor skin lesions

Chemotherapy if extensive skin lesions or visceral involvement

Tropical Viruses (19 decks)

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