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Y4 - GOSH > HIV > Flashcards

HIV Flashcards

1
Q

What is the difference between HIV / AIDS?

A

HIV:

  • having contracted the human immunodeficiency virus

AIDS:

  • HIV progresses and the person becomes immunodeficient
  • they are susceptible to opportunistic infections
  • now referred to as late-stage HIV

(acquired immunodeficiency syndrome)

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2
Q

What is HIV and how does it cause illness?

A
  • it is a RNA retrovirus
  • the virus enters and destroys CD4 T-helper cells of the immune system
  • reverse transcriptase integrates HIV DNA into host DNA, which takes 3-5 days after exposure
  • HIV virions budding out will destroy the host T cell
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3
Q

How does HIV typically present?

A
  • there is an initial seroconversion flu-like illness within a few weeks of infection (primary HIV)
  • the person is then asymptomatic until the condition progresses to immunodeficiency
  • immunodeficient patients develop AIDS-defining illnesses** + **opportunistic infections
  • this progression can take several years
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4
Q

Why does it take several years for HIV to progress to immunodeficiency?

A
  • the CD4 cells are destroyed faster than they are being made
  • it takes time for the CD4 count to become so low that immunodeficiency results
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5
Q

How can HIV be transmitted?

A
  • unprotected anal, vaginal or oral sexual activity
  • mother to child at any stage of pregnancy, birth or breastfeeding (vertical transmission)
  • mucous membrane, blood or open wound exposure to infected blood or bodily fluids
    • e.g. sharing needles, blood splashed in an eye
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6
Q

What type of sex is associated with an increased risk of HIV transmission?

A
  • receptive anal intercourse is the highest risk, followed by:
  • receptive vaginal intercourse
  • insertive anal intercourse
  • insertive vaginal intercourse (lowest risk)
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7
Q

What other sexual factors can increase the risk of HIV transmission?

A
  • trauma (e.g. sexual assault / fisting) that damages the skin
  • presence of other STIs / genital infections
    • e.g. HSV, gonorrhoea, syphilis, BV
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8
Q

What is the risk of contracting HIV from oral sex?

A
  • the likelihood of transmission is rare, but it is possible
  • the person who is receiving is at greater risk
  • dental treatment / bleeding gums / ulcerative conditions increase the risk

!! HIV cannot be transmitted through saliva !!

(i.e. kissing / sharing cups)

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9
Q

What is involved in the natural history of HIV?

A
  • there is a sharp drop in CD4 count shortly after primary infection
    • opportunistic infections may arise at this point
  • CD4 count then comes back up and stays steady for some time
  • it then gradually declines as HIV viral load increases
    • this is when symptoms start to develop
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10
Q

What are the typical symptoms of primary HIV infection (seroconversion)?

A
  • symptoms begin 2-6 weeks** after infection and last for **5-10 days
  • fever
  • pharyngitis
  • lymphadenopathy
  • skin rash
  • myalgia
  • headache / malaise
  • N&V

!! a recent negative HIV test supports the diagnosis !!

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11
Q

Why would a HIV test be negative during primary infection?

A
  • it can take up to 3 months for antibodies against HIV to be made
  • p24 antigen may be positive at this stage, but antibodies will be negative
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12
Q

How can someone tell they are in the asymptomatic stage of HIV infection?

Why is it important to detect this?

A
  • the only way to tell is by doing a blood test for HIV
  • there is ongoing viral replication causing immune system damage during this stage
  • this chronic inflammatory state increases the risk of malignancy + cardiovascular disease
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13
Q

What symptoms may develop when someone enters the symptomatic stage of HIV infection?

A

skin lesions:

  • folliculitis
  • multi-site herpes zoster
  • seborrhoeic dermatitis

oral lesions:

  • candidiasis
  • oral hairy leukopenia

recurrent bacterial infections:

  • pneumonia
  • impetigo

abnormal blood results:

  • lymphopenia
  • thrombocytopenia

non-specific symptoms:

  • diarrhoea
  • fever
  • myalgia
  • persistent lymphadenopathy
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14
Q

When do AIDS-defining illnesses occur?

A
  • these are associated with end-stage HIV infection
  • the CD4 count has become so low that opportunistic infections / malignancies can occur
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15
Q

Why are there worse outcomes associated with diagnosis at a late stage?

A
  • the lower the CD4 count, the greater the damage to the immune system
  • there is less chance of immune system recovery
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16
Q

What are examples of AIDS-defining illnesses?

A
  1. Kaposi’s sarcoma
  2. pneumocystis jirovecii pneumonia
  3. cytomegalovirus infection
  4. candidiasis (oesophageal / bronchial)
  5. lymphomas
  6. tuberculosis
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17
Q

What is the drawback of HIV testing using HIV antibodies?

A
  • it can take up to 3 months to develop antibodies to the virus
  • HIV antibody tests can be negative for 3 months following exposure
  • a repeat test is required within 3 months if the initial test is negative
18
Q

What test can detect HIV earlier than the antibody test?

A

testing for the p24 antigen:

  • this is a antigen specific to HIV
  • it can given a positive result earlier in infection than the antibody blood test
19
Q

What 2 tests are used in the monitoring of HIV?

A
  • CD4 count
  • viral load (VL)
20
Q

What is the CD4 count and why is it monitored?

A
  • the number of CD4 cells in the blood
  • this is an indicator of the risk of opportunistic infections
  • CD4 count usually improves with treatment
21
Q

What is a normal CD4 count?

When is someone at greater risk of opportunistic infections?

A

normal range:

  • 500 - 1,200 cells / mm3
  • there is no need to monitor regularly if > 350 cells / mm3

end-stage HIV:

  • < 200 cells / mm3
  • the patient is at a high risk of opportunistic infections
22
Q

What does viral load measure?

A
  • it is the number of copies of HIV RNA per ml of blood
  • it is monitored to assess disease progression +/- treatment response
23
Q

What is a normal viral load?

A
  • “undetectable” refers to a viral load below the detectable range
  • this is usually 50 - 100 copies / ml
  • the aim of treatment is to get viral load < 50 copies / ml
24
Q

What is the typical treatment regime for HIV?

A
  • highly active antiretroviral therapy (HAART / ART) is used
  • this is usually 3 different drugs in combination
  • treatment is lifelong
  • compliance is essential as viral replication under partial pressure can result in drug resistance
25
Q

What is the aim of HIV treatment?

A

to achieve a normal CD4 count and undetectable viral load

26
Q

What additional prophylaxis is given to patients with a CD4 count < 200?

A

prophylactic co-trimoxazole

  • this is to protect against pneumocystis jirovecii pneumonia
27
Q

What is significant about HIV and cardiovascular risk?

A
  • HIV increases the risk of developing cardiovascular disease
  • close monitoring of blood lipids / risk factors is required
  • statins may be started to reduce CVD risk
28
Q

How is cervical screening different for patients with HIV?

A
  • they are offered yearly smear tests
  • HIV predisposes to HPV infection and cervical cancer
29
Q

What is important about vaccinations in a HIV positive patient?

A

ALL vaccinations should be up to date:

  1. influenza
  2. pneumococcal
  3. hepatitis A + B
  4. tetanus
  5. diphtheria
  6. polio

!! patients should AVOID live vaccines !!

30
Q

What advice is given around sexual intercourse and HIV?

A
  • condoms are advised for all acts of sexual intercourse
  • transmission is almost unheard of when the viral load is undetectable, but still possible
  • partners should have regular HIV tests
  • unprotected sex / pregnancy** are considered when **viral load is undetectable
31
Q

When is a normal vaginal delivery recommended?

A

for all women with a viral load < 50 copies / ml

32
Q

When is Caesarean section recommended?

What medication may be given during the procedure?

A
  • considered when viral load > 50 copies / ml
  • highly recommended when viral load > 400 copies / ml
  • IV zidovudine is given if viral load is unknown or there are > 10,000 copies per ml
33
Q

What prophylactic treatment is given to low-risk babies?

A
  • when mother’s viral load < 50 copies / ml
  • zidovudine** is given for **4 weeks
34
Q

What prophylactic treatment is given to high risk babies?

A
  • when mother’s viral load > 50 copies per ml
  • zidovudine, lamivudine + nevirapine are given for 4 weeks
35
Q

What is the recommendation for breastfeeding?

A
  • HIV can be transmitted during breastfeeding, even when the viral load is undetectable

!! breast feeding is not recommended !!

  • it is sometimes attempted with close monitoring if mother is very keen and viral load is undetectable
36
Q

What is the rapid point of care test for HIV?

A
  • self administered blood test with an immediate result
  • if the test is positive, a blood test is required for confirmation
37
Q

When sending a venous blood sample to the lab to test for HIV, what must always be done as follow-up?

A
  • a second confirmatory sample should be sent to ensure no labelling / lab process error
  • action is taken based on first result
38
Q

What are the guidelines around telling other people following a new HIV diagnosis?

A
  • encourage the patient to tell their contacts (but this cannot be enforced)
  • anonymous provider referral is available
  • failure to disclose can result in criminal proceedings if the transmission was preventable
39
Q

What is pre-exposure prophylaxis (PrEP) and who may used this?

A
  • taken by HIV-negative people before, during and after sex
  • 2 tablets are taken 2-24 hours before sexual activity
  • it can be taken daily or around sexual activities
  • it prevents HIV contraction but does not protect against other STIs
  • regular testing is required
40
Q

What is post-exposure prophylaxis (PEP)?

When is it taken?

A
  • HIV medications that are taken after high risk sex / exposure
  • medication taken for 28 days
  • should be started as soon as possible, but can be taken up to 72 hours after exposure
41
Q

What is the current PEP regime?

A
  • Truvada (emtricitabine + tenofovir)

AND

  • raltegavir

taken for 28 days

42
Q

When must HIV tests be performed in someone taking PEP?

A
  • perform a HIV test immediately and after 3 months to confirm a negative status
  • individuals should abstain from sexual activity for 3 months

Y4 - GOSH (62 decks)

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