HIV

Question 1

HIV = AIDS. True/False?

Answer 1

False

HIV does not mean you have AIDS but it increases the risk of getting AIDS

Question 2

What type of virus is HIV?

Answer 2

Retrovirus

Question 3

Which immune receptors are the target of HIV infection?

Answer 3

CD4+ receptors

Question 4

What effect does HIV attacking CD4 receptors have on the immune system?

Answer 4

Reduced circulating CD4
Reduced CD8 activation
Reduced antibody class switching
Chronic immune activation
Basically, increases susceptibility to infection!

Question 5

What is the normal range of CD4 cells?

Answer 5

500-1600 cells/mm3

Question 6

What is meant by opportunistic infection?

Answer 6

Infection that would not normally occur in a healthy individual

Question 7

At what points of infection does HIV rapidly replicate?

Answer 7

Early and late points

Question 8

When do clinical presentations of HIV typically occur?

Answer 8

2-4 weeks after onset of infection

Question 9

List some clinical features of HIV infection

Answer 9

Fever
Maculopapular rash
Myalgia
Pharyngitis
Headache
Meningism

Question 10

Is there a high risk of transmission of HIV?

Answer 10

Very high risk through normal routes (i.e. not airborne)

Question 11

Asymptomatic HIV infection involves a latent/dormant virus. True/False?

Answer 11

False!

Infection is ongoing even though person is asymptomatic; still risk of transmission

Question 12

What cause of pneumonia is a common opportunistic infection occurring in HIV/AIDS patients?

Answer 12

Pneumocystis jirovecii

Question 13

How is pneumocystis jirovecii pneumonia diagnosed?

Answer 13

Bronchoalveolar lavage and immunofluorescence

+/- PCR

Question 14

What is the treatment for pneumocystis jirovecii?

Answer 14

Co-trimoxazole

Question 15

Cerebral toxoplasmosis is another opportunistic infection. What organism causes it?

Answer 15

Toxoplasma gondii

Question 16

What happens pathologically in cerebral toxoplasmosis?

Answer 16

Chorioretinitis - multiple cerebral abscesses

Question 17

Which animal/pet is particularly infamous for transferring toxoplasma to humans?

Answer 17

Cats

Question 18

What is the CD4 threshold for cerebral toxoplasmosis?

Answer 18

CD4 less than 150

Question 19

CMV is another opportunistic infection. What is the CD4 threshold for this?

Answer 19

CD4 less than 50

Question 20

How does CMV usually present?

Answer 20

Reduced visual acuity
Floaters
Abdo pain, diarrhoea

Question 21

List some opportunistic skin infections that may occur with HIV

Answer 21

Herpes zoster
Herpes simplex
Human papilloma virus
Weird ones - histoplasmosis, molluscum contagiosum

Question 22

Which HIV strain is associated with neurocognitive impairment?

Answer 22

HIV-1

Question 23

Which condition is caused by JC virus as an opportunistic inffection?

Answer 23

Progressive multifocal leukoencephalopathy

Question 24

What is “Slim’s disease” in association with HIV?

Answer 24

HIV-associated wasting due to metabolic disorder, anorexia, malabsorption and/or hypogonadism

Question 25

What is the most common AIDS-related cancer?

Answer 25

Kaposi's sarcoma

Question 26

Which organism causes Kaposi's sarcoma?

Answer 26

Human herpes virus 8

Question 27

How is Kaposi's sarcoma treated?

Answer 27

HA anti-retroviral therapy Local therapy Systemic chemotherapy

Question 28

Which AIDS-related cancer is caused by EBV?

Answer 28

Non-Hodgkins lymphoma

Question 29

Which AIDS-related cancer is caused by HPV?

Answer 29

Cervical cancer

Question 30

What are the 3 main modes of transmission of HIV?

Answer 30

Sexual Parenteral Mother-to-child

Question 31

Is HIV more common in men who have sex with men or women who have sex with men who have sex with men?

Answer 31

Men who have sex with men

Question 32

What sexual factors increase the risk of getting HIV?

Answer 32

Anoreceptive Trauma Genital ulceration Concurrent STI

Question 33

How might HIV be acquired parenterally?

Answer 33

Injection drug use Infected blood products Iatrogenic

Question 34

Who should be tested for HIV?

Answer 34

Those in high prevalence areas Screening of high-risk groups Those with clinical indicators

Question 35

What are high-risk groups for HIV?

Answer 35

``` Men who have sex with men Women who have sex with men who have sex with men Injecting drug users People living with people who have HIV Endemic areas ```

Question 36

What markers of HIV are used to detect infection?

Answer 36

Antibody Antigen (p24) Viral RNA

Question 37

List markers of HIV in order of first appearance

Answer 37

Viral load Antigen Antibody

Question 38

What is the window period of 3rd generation antibody tests for HIV compared to 4th generation antibody tests?

Answer 38

20-25 days (3rd gen) | 14-28 days (4th gen)

Question 39

How do 4th gen antibody tests differ from 3rd gen antibody tests for HIV?

Answer 39

3rd gen: antibody only | 4th gen: antibody + antigen

Question 40

What is the BASHH guidance on a negative 4th gen antibody test with regards to HIV?

Answer 40

Negative antibody test performed 4 weeks after exposure is highly likely to exclude HIV infection

Question 41

What rapid HIV tests can be done?

Answer 41

Fingerprick Recent infection testing algorithm Home sampling Home testing

Question 42

Which drug class has in vitro activity against HIV? Give an example of a drug under this class

Answer 42

Nucleoside analogues reverse transcriptase inhibitors (NRTI) | Zidovudine

Question 43

What is highly-active anti-retroviral therapy (HAART)?

Answer 43

Combination of 3 drugs from at least 2 drug classes to which the virus is susceptible

Question 44

Partner notification of HIV is a voluntary process. True/False?

Answer 44

True

Question 45

There is no risk of HIV transmission with casual/household contact. True/False?

Answer 45

True