HIV

Question 1

HIV

Answer 1

human immunodeficiency virus

Question 2

AIDS

Answer 2

acquired immunodeficiency syndrome

aka late-stage HIV

Question 3

type of virrus

Answer 3

RNA retrovirus

Question 4

what does virus do

Answer 4

enter and destroy CD4 T helper cells

Question 5

clinical course

Answer 5

1. initial seroconversion flu-like illness within few weeks infection
2. asymptomatic
3. progress until become immunocompromised
4. AIDS-defining illness

Question 6

transmission

Answer 6

unprotected sex
mother to child (vertical)
mucous membrane, blood, open wound exposure to infected blood/body fluids

Question 7

AIDS defining illness - examples

Answer 7

Kaposi's sarcoma 
pneumocystitis Jirovecii pneumonia (PCP)
CMV 
candidiasis - oesophageal, bronchial
lymphoma 
TB

Question 8

monitring

Answer 8

CD4 count

viral load

Question 9

monitoring - CD4 count

Answer 9

normal = 500-1200

< 200 = AIDS, high risk opportunistic infectoins

Question 10

monitoring - viral load

Answer 10

undetectable = 50-100

viral load can be 100,000s in untreated HIV

Question 11

who is offered antiretroviral therapy (ART)

Answer 11

everyone with HIV diagnosis

regardless of CD4 and viral load

Question 12

initial starting regime of ART

Answer 12

2 NTRIs (e.g. tenofovir + emtricitabine) 
plus another agent

Question 13

aims of ART

Answer 13

normal CD4 count

undetectable viral load

Question 14

classes of ART for HIV

Answer 14

protease inhibitiors
integrase inhibitors
nucleoside reverse transcriptase inhibitors
non-nucleoside reverse transcriptase inhibitors
entry inhibitors

Question 15

additional Mx - PCP prophylaxis

Answer 15

co-trimoxazole is given to all patients with CD4 < 200 to protect against PCP

Question 16

additional Mx - smear tests

Answer 16

yearly cervical smears needed

HIV predisposes to HPV infection + cervical cancer

Question 17

additional Mx - vaccinations

Answer 17

annual influenza
pneumococcal
Hep A 
Hep B 
tetanus
diptheria 
polia 

avoid live vaccines

Question 18

advice - sex

Answer 18

condom use even if both partners positive

regular HIV testing

Question 19

pregnancy and childbirth

Answer 19

CS used unless undetectable VL

consider vaginal birth if VL undetectable

Question 20

newborns to HIV + mums

Answer 20

ART for 4wks after birth to reduce vertical transmissino.

breastfeeding considered if VL undetectable although it is high risk

Question 21

Post exposure prophylaxis - when

Answer 21

< 72hrs post exposure

Question 22

Post exposure prophylaxis - regime

Answer 22

truvada + raltegravir for 28days

Question 23

serooconversion illness features

Answer 23

sore throat
lymphadenopathy
malaise, myalgia, arthralgia
diarrhoea
maculopapular rash
mouth ulcers
rarely meningoencephalitis