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Z Year3 Infectious Diseases > HIV > Flashcards

HIV Flashcards

1
Q

Where is HIV-1 endemic?

A

USA, UK and worldwide

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2
Q

Where is HIV-2 endemic?

A

West africa and south asia

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3
Q

How can HIV be transmitted?

A
  1. Sexual intercourse (75%)
  2. IVDU
  3. Vertical (mother to baby)
  4. Needlestick, blood transfusion
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4
Q

How is HIV sexually transmitted?

A
  • M – M USA/UK
  • M – F GLOBALLY
  • F – M
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5
Q

How is HIV vertically transmitted?

A
  • Placenta
  • Breastmilk
  • Birth canal
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6
Q

What is the patho of HIV?

A
  1. HIV socks to the CD4 receptor on the host cell via glycoprotein gp120
  2. Conformation changes in gp120 permit binding to co-receptor chemokines e.g. CCR5 or CXCR4
  3. Further changes to the gp41 transmembrane protein allow for fusion with the cell membrane
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7
Q

What cells are attacked by HIV?

A

Macrophages, T helper cell, dendritic cells

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8
Q

What cell is the CXCR4 co-receptor found on?

A

T cells (late infection)

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9
Q

What cell is the CCR5 co-receptor found on?

A

T cells, macrophages, monocytes, dendritic cells

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10
Q

What does mutation in these receptors confer?

A
  1. immunity to HIV (homozygous)

2. OR halt progression of the disease once acquired (heterozygous).

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11
Q

What type of virus is HIV?

A

single-stranded, positive-sense, enveloped RNA retrovirus

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12
Q

What does a retovirus mean?

A

has to use reverse transcriptase enzyme to transcribe a complementary double-stranded piece of “proviral” DNA

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13
Q

What is the viral load in acute HIV?

A

INCREASE then DECLINE (but still detectable)

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14
Q

What are the symptoms in acute HIV?

A

Flu-like (fever, myalgia, sore throat)

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15
Q

What is the viral load in chronic/latent HIV?

A

STABLE then STEADY INCREASE

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16
Q

What are the symptoms like in chronic/latent HIV?

A
  1. Asymptomatic OR
  2. Oral/vaginal candidiasis
  3. Herpes zoster
  4. TB
  5. oral hairy leukoplakia (EBV
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17
Q

What is the viral load like AIDs?

A

May INCREASE significantly

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18
Q

What are symptoms like in AIDs?

A

severe immune compromise

  1. fever, weight loss, darrhoea, lymphadenopathy
  2. ‘AIDS-defining’ illnesses
  3. Neuropsychiatric disease
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19
Q

When does HIV become AIDs?

A
  • when T cell count drops to between 200-500 cells/mm3, patient develop persistent symptoms
  • ‘AIDS’ defining infections/neoplasms is when below 200
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20
Q

What are examples of neuropsychiatric diseases in HIV?

A
  1. Delirium
  2. Major depression
  3. Mania
  4. Schizophrenia
  5. PTSD
  6. Substance abuse
  7. Addiction (also a RF for infection in first place)
  8. Dementia
  9. CMV encephalitis
  10. Progressive multifocal leukoencephalopathy
  11. Cerebral toxoplasmosis
  12. Cryptococcal meningitis
  13. CNS lymphoma
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21
Q

What are some AIDs defining illness?

A
  1. Pneumocystis pneumonia (PCP) / Pneumocystis jiroveci
  2. Oesophageal canditidiase
  3. Kapsoi Sarcom
  4. Mycobacterium avium complex
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22
Q

What are signs of PCP?

A
  1. Pneumonia
  2. Disseminated infection
  3. Reduced exercise tolerance
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23
Q

What is Kaposi’s sarcoma?

A
  1. Human herpes virus 8
  2. Widespread
  3. Tumours of skiun, mucous membranes, GI tract, lymph nodes, lungs
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24
Q

What is myobacterium avium complex?

A

extra pulmonary or disseminated disease

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25
What two things are needed for HIV diagnosis?
1. IgG, IgM | 2. RNA > 100,000 copies/mL
26
How long does it take for IgG and IgM to be positive?
15-45 days until +ve
27
What do antibodies show?
body’s RESPONSE to HIV
28
What does the antigen show?
direct confirmation of VIRUS particles
29
What does RNA/DNA show?
direct confirmation of viral genetic material
30
What is antibdoisy-antigen test?
BEST for early infection
31
What can also be used for diagnosis for HIV?
can also use CD4 count + CD4:CD8 ratio (<1)
32
What is HAART therapy?
combination therapy to reduce chance of resistance
33
What is 1st line treatment?
Protease inhibitor
34
What are examples of Nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs)?
1. Tenofovir 2. abacavir, 3. zidovudine 4. stavudine, 5. Lamivudine 6. Emtricitabine
35
What are examples of Non-nucleoside reverse transcriptase inhibitors (NNRTIs)?
1. Efavirenz 2. nevirapine 3. etravirine
36
What are examples of integrase inhbitors?
Raltegravir
37
What are examples of protease inhibitors?
1. Fosamprenavir 2. Atazanavir 3. Darunavir 4. lopinavir 5. saquinavir (ritonavir)
38
What is an examples of CCR5 inhibtors?
maraviroc
39
What is an example of fusion inhibtiors?
enfuviritide
40
What do you start everyone on?
ART regardless of CD4 count and viral load
41
What is PEP?
daily tenofovir, reduce chance of transmission
42
What is the indication for PEP?
'high risk’ sexual behaviour, drug use
43
How is monitoring done for HIV?
1. HIV RNA at 2, 4, 8 weeks after starting Tx THEN every 2 weeks until below detection 2. Drug resistance testing at 24 weeks if increasing (or not decreasing) RNA 3. Once suppressed, repeat testing every 3-6 months
44
Which type of HIV is more common?
HIV-1 more common and HIV-2 less common as less infectious
45
Does HIV change?
HIV rapidly acquire mutations so various HIV strain and develop resistance
46
What type of gene is HIV?
Diploid genome: 2 copies of positive ssRNA
47
How long does the acute phase last?
peaks week 6
48
What is oral hairy leukoplakia?
unescapable white plaque in mouth caused by EBV
49
What is the first line investigation for HIV?
1. Serum HIV enzyme-linked immunosorbent assay (ELISA) | 2. Serum HIV rapid test
50
What are AIDs defining illness?
1. Histoplasmosis caused by histoplasma capsulatum 2. Pneumocystis pneumonia: pneumocystis jirvoecii 3. Progressive multifocal leukocencephalopathy 4. HIV associated dementia and cerebral atrophy
51
What are symptoms of Histoplasmosis caused by histoplasma capsulatum?
1. Fever 2. Weight loss 3. Fatigue 4. Cough
52
How do you get a diagnosis of Histoplasmosis?
oval yeast cell within macrophages
53
What do you see on CXR with Pneumocystis pneumonia?
ground glass opacities
54
What is Progressive multifocal leukoencephalopathy caused by?
- caused by JC virus | - demyleinating disease
55
How do you get a diagnosis of Progressive multifocal leukoencephalopathy?
MRI, non enahcing areas
56
How can you tell Kaposi's sarcoma?
on punch biopsy find lymphocytic inflammation
57
What are examples of opporutinstic infections in AIDS?
1. Aspergillosis caused by aspergillus fumigatus 2. Cryptococcosis: cryptooccouc neoformans 3. Toxoplasmosis caused by parasite toxoplasma gondii 4. Crytosprodisosis: Cryptosporirium spp 5. Candidia albicans 6. CMV 7. EBC 8. Bacillary Angioamtyosis 9. Myobacterium Avium complex
58
What are symptoms of Aspergillosis caused by aspergillus fumigatus?
1. Haemoptysis 2. Pleuritic chest pain 3. Dyspnoea 4. Cough
59
What does chest imaging show on Aspergillosis caused by aspergillus fumigatus?
show pulmonary infiltraes and cavitation
60
What can Cryptococcosis: cryptooccouc neoformans cause?
crytoccoccal meningitis
61
How do you diagnose Cryptococcosis: cryptooccouc neoformans?
1. India ink stain: it is an encapsulated yeast so would see a clear halo 2. Latex agglutination test can be used to find polysaccjardie capsular antigen
62
How do you get Toxoplasmosis | caused by parasite toxoplasma gondii?
- Cat feaces, undercooked meat | - Can cause cerebral toxoplasmosis
63
What do you get on imaging for Toxoplasmosis caused by parasite toxoplasma gondii?
CT scan or MRI would show multiple ring -enhacing lesions with central necrosis
64
How do you diagnose Crytosprodisosis: Cryptosporirium spp?
1. Chronic watery diarrhoea | 2. Stool sample show oocysts upon acid fast staining
65
When do you get candidia albicans in AIDS?
1. T cell count <100 | 2. Esophagitis
66
How do you diagnose candidia albicans?
1. Upper endoscopy: white plaques surrounded by erythema | 2. Confirm with biopsy which would show psuedohypahe
67
What can CMV cause in AIDS?
- esophagitis and reintiis | - can also present with colitis, encephalitis and pneumonia
68
How do you diagnose CMV?
1. Upper endoscopy show: linear ulcers 2. Fundocscopy show: cotton wool spots 3. Biopsy show Owle’s eye includion bodies within their nuceli
69
What can EBV cause?
1. B cell lymphoma (HL + NHL + Burkitt and CNS lymphoma) | 2. CT scan or MRI can show solitary or single ring enhancing lesion in CNS lymphoma
70
How do you diagnosis bascillary angiomatyosis?
- Bartonella Henselae | - Biopsy shows neutrophilic inflammation
71
How do you diagnose mycobacterium avium complex?
-Non TB -T cell count <50 Disseminated infection -No specific symptoms: FLAWS and focal lymphadenitis -Blood culture needed
72
What are the 5 different classes of HIV drugs?
1. Nucleoside/tide reverse transcriptase inhibitors (NRTIs). 2. Non-nucleoside reverse transcriptase inhibitors (NNRTIs). 3. Protease inhibitors (PIs). 4. Integrase inhibitors (IIs). 5. Entry inhibitors (EIs)
73
What is PrEP?
combo of two antiretroviral drugs taken before and after sex
74
What is PEP?
post exposure prophylaxis
75
What drugs can you not use in HIV-2?
NNRTIs and Entery inhibitor Enfuvirtide are no effective against HIV-2
76
What is the most common ART?
3 drugs: 2 NRTIs and 1 of another class mostly integrase

Z Year3 Infectious Diseases (5 decks)

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