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Reproduction and Sexual Health > HIV > Flashcards

HIV Flashcards

1
Q

HIV consists of 2 strands of what molecule?

A
  • single stranded RNA in an envelope
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2
Q

what are main 2 types of surface antigens on HIV molecule?

A
  • GP120
  • GP41

-> important in allowing virus to bind to host cell

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3
Q

host cell of interest in HIV is?

A
  • T helper cell or CD4 cell
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4
Q

what receptors are on CD4 cell?

A
  • CD4 receptor
  • CCR5 co-receptor
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5
Q

binding of CD4 cell and HIV receptors allows for what?

A
  • enables the viral envelope to fuse with the cell surface membrane (fusion)
  • allowing single stranded RNA to enter the cell
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6
Q

after single stranded DNA is in the cell what is the next process to occur?

A
  • reverse transcriptase
  • RNA is converted to DNA
    -> now have a DNA copy of viruses RNA
    -> this can then be incorporated into the host’s own genome
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7
Q

what is the term used to describe when virus RNA is incorporated into a host’s genome

A
  • integration
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8
Q

what can occur once RNA is part of host’s genome?

A
  • transcription
  • translation
    thus creating viral proteins which can be packaged together to form another virus through a process called budding (when RNA comes off membrane of the host cell)
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9
Q

final part of the process creates what cell?

A
  • mature virion
  • another virus
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10
Q

what is HIV?

A
  • single stranded RNA retrovirus that infects and replicates within the human immune system using host CD4 cells
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11
Q

what kind of virus is HIV?

A
  • RNA retrovirus
  • MSM is the risk group for the majority of prevalent infections and new infections in the UK
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12
Q

how is HIV transmitted?

A
  • sexual transmission accounts for 79% of the new infections in the UK
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13
Q

what are some factors increasing transmission risk?

A
  • anoreceptive
  • trauma
  • genital ulceration
  • concurrent STI
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14
Q

what is parental transmission?

A
  • process of acquiring an infectious agent into ones body through something other than GI (enteral route)
  • ie injection drug use, infected blood products, iatrogenic
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15
Q

mother-to-child infection can be transmitted through which ways?

A
  • in utero/trans-placental
  • delivery
  • breastfeeding
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16
Q

what is the pathophysiology behind HIV infection?

A
  • firstly infection of mucosal CD4+ cell
  • transport to regional lymph nodes
  • infection established within 3 days of entry
  • dissemination of virus
17
Q

what is CD4?

A
  • glycoprotein found on the surface of a range of cells, including T helper lymphocytes (CD4+ cells), dendritic cells, macrophages, and microglial cells
  • they are essential for induction of adaptive immune response
18
Q

what do CD4+ Th lymphocytes do?

A
  • recognise MHC2 antigen-presenting cell
  • activation of B-cells
  • activation of cytotoxic T cells (CD8+ cells)
  • cytokine release
19
Q

what effects do HIV infections have on the immune response?

A
  • reduced circulating CD4+ cells
  • reduced proliferation of CD4+ cells
  • reduction in CD8+ T cell activation -> dysregulated expression of cytokines
  • reduction in antibody class switching -> reduced affinity of antibodies produced
  • chronic immune activation

this will increase susceptibility to viral infections, fungal infections, mycobacterial infections and infection-induced cancers

20
Q

how does primary HIV infection present?

A
  • up to 80% present w sympoms
  • onset 2-4 weeks after initial infection
  • fever
  • rash (maculopapular)
  • myalgia
  • pharyngitis
  • headache/asceptic meningitis
  • v high risk of transmission at this stage
21
Q

what is an opportunistic infection?

A
  • infection by an individual that does not normally produce disease in a healthy individual
  • but will in those with weakened immune systems i.e. in people living w HIV
22
Q

those with HIV can go on to develop?

A
  • AIDS
23
Q

what kind of opportunistic infections are those living with HIV at risk of?

A

bacterial infection
- mycobacterium tuberculosis
- recurrent pneumonia

viral infection
- CMV
- herpes simplex
- bronchitis/pneumonitis
- progressive multifocal leukoencephalopathy (PML)

parasitic infection
- cerebral toxoplasmosis

fungal infection
- pneumocystis jiroveci pneumonia (PCP)
- candidiasis - oesophageal, bronchial/tracheal/pulmonary

24
Q

what are some symptoms and signs of PCP?

A
  • insidious onset SOB and dry cough
  • will see exercise oxygen desaturation
  • CXR may be normal, interstitial infiltrates, reticulonodular markings
  • Dx: BAL and immunofluorescence +/- PCR
  • Mx: high dose co-trimoxazole
25
Q

what is the prophylaxis for patients with PCP and a CD4+ <200

A
  • low dose co-trimoxazole - also offers some protection against cerebral toxoplasmosis
26
Q

what kind of TB can patients w HIV get?

A
  • more likely to have symptomatic primary infection, reactivation of latent TB, miliary TB, extrapulmonary TB
27
Q

what is cerebral toxoplasmosis?

A
  • infection of the brain or spinal cord caused by a single-celled parasite called toxoplasma gondii
  • reactivation of latent infection - multiple cerebral abscess, chorioretinitis
  • CD4+ <150
28
Q

how does cerebral toxoplasmosis present?

A
  • headache, fever, focal neurology, seizures, reduced consciousness, raised ICP
29
Q

what can be CD4 count be in those w HIV and CMV?

A
  • <50
  • people with CD4+ <50 should have ophthalmic screening
30
Q

reactivation of CMV can cause what kind of complications?

A
  • retinitis
  • colitis
  • oesophagitis
31
Q

how does CMV present?

A
  • reduced visual acuity, floaters, abdominal pain, diarrhoea, PR bleeding
32
Q

what is progressive multifocal leukoencephalopathy?

A
  • JC virus (reactivation)
  • CD4 <100
  • presents w rapidly progressing, focal neurology, confusion, personality change
33
Q

what are some skin infections that can affect those w HIV?

A
  • herpes zoster - multidermatomal, recurrent
  • herpes simplex - extensive, hypertrophic, aciclovir resistant
  • HPV - extensive, recalcitrant, dysplastic
34
Q

what is ‘slims disease’?

A
  • HIV associated wasting
  • it has multiple causes -> metabolic, anorexia, malabsorption/diarrhoea, hypogonadism
35
Q

Name 3 types of cancers related to AIDS

A
  • Kaposi’s sarcoma
  • non-hodgkin’s lymphoma
  • cervical cancer
36
Q

what is Kaposi’s sarcoma?

A
  • vascular tumour caused by HHV8
  • presents: cutaneous, mucosal, visceral (pulmonary, GI)
37
Q

mx for kaposis sarcoma?

A
  • anti-retrovirals, local therapies, systemic chemo

Reproduction and Sexual Health (29 decks)

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