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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
Q

What two things are needed for HIV diagnosis?

A
  1. IgG, IgM

2. RNA > 100,000 copies/mL

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26
Q

How long does it take for IgG and IgM to be positive?

A

15-45 days until +ve

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27
Q

What do antibodies show?

A

body’s RESPONSE to HIV

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28
Q

What does the antigen show?

A

direct confirmation of VIRUS particles

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29
Q

What does RNA/DNA show?

A

direct confirmation of viral genetic material

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30
Q

What is antibdoisy-antigen test?

A

BEST for early infection

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31
Q

What can also be used for diagnosis for HIV?

A

can also use CD4 count + CD4:CD8 ratio (<1)

32
Q

What is HAART therapy?

A

combination therapy to reduce chance of resistance

33
Q

What is 1st line treatment?

A

Protease inhibitor

34
Q

What are examples of Nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs)?

A
  1. Tenofovir
  2. abacavir,
  3. zidovudine
  4. stavudine,
  5. Lamivudine
  6. Emtricitabine
35
Q

What are examples of Non-nucleoside reverse transcriptase inhibitors (NNRTIs)?

A
  1. Efavirenz
  2. nevirapine
  3. etravirine
36
Q

What are examples of integrase inhbitors?

A

Raltegravir

37
Q

What are examples of protease inhibitors?

A
  1. Fosamprenavir
  2. Atazanavir
  3. Darunavir
  4. lopinavir
  5. saquinavir (ritonavir)
38
Q

What is an examples of CCR5 inhibtors?

A

maraviroc

39
Q

What is an example of fusion inhibtiors?

A

enfuviritide

40
Q

What do you start everyone on?

A

ART regardless of CD4 count and viral load

41
Q

What is PEP?

A

daily tenofovir, reduce chance of transmission

42
Q

What is the indication for PEP?

A

‘high risk’ sexual behaviour, drug use

43
Q

How is monitoring done for HIV?

A
  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
Q

Which type of HIV is more common?

A

HIV-1 more common and HIV-2 less common as less infectious

45
Q

Does HIV change?

A

HIV rapidly acquire mutations so various HIV strain and develop resistance

46
Q

What type of gene is HIV?

A

Diploid genome: 2 copies of positive ssRNA

47
Q

How long does the acute phase last?

A

peaks week 6

48
Q

What is oral hairy leukoplakia?

A

unescapable white plaque in mouth caused by EBV

49
Q

What is the first line investigation for HIV?

A
  1. Serum HIV enzyme-linked immunosorbent assay (ELISA)

2. Serum HIV rapid test

50
Q

What are AIDs defining illness?

A
  1. Histoplasmosis caused by histoplasma capsulatum
  2. Pneumocystis pneumonia: pneumocystis jirvoecii
  3. Progressive multifocal leukocencephalopathy
  4. HIV associated dementia and cerebral atrophy
51
Q

What are symptoms of Histoplasmosis caused by histoplasma capsulatum?

A
  1. Fever
  2. Weight loss
  3. Fatigue
  4. Cough
52
Q

How do you get a diagnosis of Histoplasmosis?

A

oval yeast cell within macrophages

53
Q

What do you see on CXR with Pneumocystis pneumonia?

A

ground glass opacities

54
Q

What is Progressive multifocal leukoencephalopathy caused by?

A
  • caused by JC virus

- demyleinating disease

55
Q

How do you get a diagnosis of Progressive multifocal leukoencephalopathy?

A

MRI, non enahcing areas

56
Q

How can you tell Kaposi’s sarcoma?

A

on punch biopsy find lymphocytic inflammation

57
Q

What are examples of opporutinstic infections in AIDS?

A
  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
Q

What are symptoms of Aspergillosis caused by aspergillus fumigatus?

A
  1. Haemoptysis
  2. Pleuritic chest pain
  3. Dyspnoea
  4. Cough
59
Q

What does chest imaging show on Aspergillosis caused by aspergillus fumigatus?

A

show pulmonary infiltraes and cavitation

60
Q

What can Cryptococcosis: cryptooccouc neoformans cause?

A

crytoccoccal meningitis

61
Q

How do you diagnose Cryptococcosis: cryptooccouc neoformans?

A
  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
Q

How do you get Toxoplasmosis

caused by parasite toxoplasma gondii?

A
  • Cat feaces, undercooked meat

- Can cause cerebral toxoplasmosis

63
Q

What do you get on imaging for Toxoplasmosis caused by parasite toxoplasma gondii?

A

CT scan or MRI would show multiple ring -enhacing lesions with central necrosis

64
Q

How do you diagnose Crytosprodisosis: Cryptosporirium spp?

A
  1. Chronic watery diarrhoea

2. Stool sample show oocysts upon acid fast staining

65
Q

When do you get candidia albicans in AIDS?

A
  1. T cell count <100

2. Esophagitis

66
Q

How do you diagnose candidia albicans?

A
  1. Upper endoscopy: white plaques surrounded by erythema

2. Confirm with biopsy which would show psuedohypahe

67
Q

What can CMV cause in AIDS?

A
  • esophagitis and reintiis

- can also present with colitis, encephalitis and pneumonia

68
Q

How do you diagnose CMV?

A
  1. Upper endoscopy show: linear ulcers
  2. Fundocscopy show: cotton wool spots
  3. Biopsy show Owle’s eye includion bodies within their nuceli
69
Q

What can EBV cause?

A
  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
Q

How do you diagnosis bascillary angiomatyosis?

A
  • Bartonella Henselae

- Biopsy shows neutrophilic inflammation

71
Q

How do you diagnose mycobacterium avium complex?

A

-Non TB
-T cell count <50
Disseminated infection
-No specific symptoms: FLAWS and focal lymphadenitis
-Blood culture needed

72
Q

What are the 5 different classes of HIV drugs?

A
  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
Q

What is PrEP?

A

combo of two antiretroviral drugs taken before and after sex

74
Q

What is PEP?

A

post exposure prophylaxis

75
Q

What drugs can you not use in HIV-2?

A

NNRTIs and Entery inhibitor Enfuvirtide are no effective against HIV-2

76
Q

What is the most common ART?

A

3 drugs: 2 NRTIs and 1 of another class mostly integrase

Z Year3 Infectious Diseases (5 decks)

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