HIV

Question 1

ART (antiretroviral therapy) consists of

Answer 1

2 NRTIs nucleoside reverse transcriptase inhibitors

AND 1 (PI protease inhibitor OR NNRTI non-nucleoside reverse transcriptase inhibitors)

Question 2

When does seroconversion occur

Answer 2

3-12 weeks after infection

Question 3

Diagnosis

Answer 3

combination tests (HIV p24 antigen and HIV antibody)

If positive –> repeat

Question 4

When should HIV testing be done in asymptomatic patients after potential exposure?

Is it repeated?

Answer 4

testing for HIV in asymptomatic patients should be done at 4 weeks after possible exposure

Yes, at 12 weeks

Question 5

Neurological complications (focal)
1. Ring-enhancing lesions, Thallium SPECT negative
2. Single/multiple homogenous enhancing lesions, Thallium SPECT positive
3. TB

Answer 5

1. Toxoplasmosis - sulfadiazine and pyrimethamine
2. Primary CNS lymphoma - associated with EBV - steroids + methotrexate

Question 6

Neurological complications (generalised)
1. CT shows oedematous brain
2. High opening pressure CSF, India ink stain positive
3. MRI - high-signal demyelinating white matter lesions are seen

Answer 6

1. Encephalitis
2. Cryptococcus neoformans - amphotericin B
3. Progressive multifocal leukoencephalopathy - widespread demyelination 2ndary to JC virus infection

Question 7

HIV diarrhoea

1. 7 days incubation, modified Ziehl-Neelsen stain (acid-fast stain) reveal intracellular red cysts
2. Diarrhoea and visual problems
3. CD4 count is below 50, fever, sweats, abdominal pain and diarrhoea + hepatomegaly and deranged LFTs
4. stool microscopy shows trophozoite and cysts:

Answer 7

1. Cryptosporidium
2. CMV
3. Mycobacterium avium intracellulare
4. Giardia lamblia - treat with metronidazole

Question 8

CD4 count 200 - 500 cells/mm³

Answer 8

Oral thrush Secondary to Candida albicans
Shingles Secondary to herpes zoster
Hairy leukoplakia Secondary to EBV
Kaposi sarcoma Secondary to HHV

Question 9

CD4 count 100 - 200 cells/mm³

Answer 9

Cryptosporidiosis
- Whilst patients with a CD4 count of 200-500 may develop cryptosporidiosis the disease is usually self-limiting and similar to that in immunocompetent hosts

Cerebral toxoplasmosis
Progressive multifocal leukoencephalopathy Secondary to the JC virus
Pneumocystis jirovecii pneumonia
HIV dementia

Question 10

CD4 count 50 - 100 cells/mm³

Answer 10

Aspergillosis Secondary to Aspergillus fumigatus
Oesophageal candidiasis Secondary to Candida albicans
Cryptococcal meningitis
Primary CNS lymphoma Secondary to EBV

Question 11

CD4 count < 50 cells/mm³

Answer 11

Cytomegalovirus retinitis
- Affects around 30-40% of patients with CD4 < 50 cells/mm³

Mycobacterium avium-intracellulare infection

Question 12

AIDS defining malignancies

Answer 12

Kaposi’s sarcoma
High grade B cell non-Hodgkin’s lymphoma
Invasive cervical cancer.

Question 13

Post-exposure prophylaxis

Answer 13

Check viral load
Combination of oral ART within 1-2hrs, up to 72hrs
Take them for 4 weeks
HIV test 12 weeks after finishing PEP
80% reduction

Question 14

Chance of getting HIV from a needlestick

Answer 14

0.3%

Question 15

PEP combination of drugs

Answer 15

Truvada (emtricitabine and tenofovir ) + Raltegravir

Question 16

PrEP combination of drugs

Answer 16

Truvada (emtricitabine and tenofovir )
Take before sex and 2 days after