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MRCP Infectious Diseases > HIV > Flashcards

HIV Flashcards

1
Q

Factors which reduce vertical HIV transmission in pregnancy

A
  • maternal antiretroviral therapy (zidovudine)
  • caesarean section
  • neonatal antiretroviral therapy (zidovudine)
  • bottle feeding
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2
Q

CMV retinitis affects HIV patients with a CD4 count below what level?

A

< 50

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3
Q

Clinical features of CMV retinitis

A

‘blurred vision’
retinal haemorrhages/ necrosis on fundoscopy

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4
Q

Management of CMV retinitis in HIV

A

IV ganciclovir

alternative: IV foscarnet or cidofovir

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5
Q

Causes of diarrhoea in HIV

A
  • HIV enteritis

Opportunistic infections:
- Cryptosporidium + other protozoa
- CMV
- Mycobacterium avium intracellulare
- Giardia

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6
Q

Below what CD4 count in HIV does Mycobacterium avium intracellulare cause infection?

A

< 50.

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7
Q

Clinical features of Mycobacterium avium intracellulare in HIV

A

fever
sweats
abdominal pain
diarrhoea

may be hepatomegaly and deranged LFTs

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8
Q

Diagnostic investigations for mycobacterium avium intracellulare

A
  • blood cultures
  • bone marrow examination
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9
Q

Management of mycobacterium avium intracellulare

A

Rifabutin
ethambutol
clarithromycin

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10
Q

Vaccines given to ALL HIV infected adults

A

Hepatitis A
Hepatitis B
Haemophilus influenzae B (Hib)
Influenza-parenteral
Japanese encephalitis
Meningococcus-MenC
Meningococcus-ACWY I
Pneumococcus-PPV23
Poliomyelitis-parenteral (IPV)
Rabies
Tetanus-Diphtheria (Td)

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11
Q

Vaccines given to HIV patients with CD4 counts <200

A

Measles, Mumps, Rubella (MMR)
Varicella
Yellow Fever

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12
Q

Vaccines which are contraindicated in HIV

A

Cholera CVD103-HgR
Influenza-intranasal
Poliomyelitis-oral (OPV)
Tuberculosis (BCG)

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13
Q

What viral infection causes Kaposi’s sarcoma in HIV patients?

A

HHV-8 (human herpes virus 8)

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14
Q

purple papules or plaques on the skin or mucosa (e.g. GI and respiratory tract)

Respiratory involvement may cause massive haemoptysis and pleural effusion

A

Kaposi’s sarcoma

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15
Q

Management of Kaposi’s sarcoma

A

radiotherapy + resection

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16
Q

Typical combination of drugs used in anti-retroviral therapy

A

3 drug combo

2 nucleoside reverse transcriptase inhibitors (NRTI)

+ protease inhibitor (PI)
OR
+ non-nucleoside reverse transcriptase inhibitor (NNRTI)

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17
Q

These agents prevent HIV-1 from entering and infecting immune cells

A

Entry inhibitors

maraviroc
enfuvirtide

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18
Q

Examples include:
- zidovudine
- zalcitabine
- tenofovir

A

Nucleoside analogue reverse transcriptase inhibitors (NRTI)

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19
Q

nevirapine, efavirenz

A

Non-nucleoside reverse transcriptase inhibitors (NNRTI)

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20
Q

Examples include:
- indinavir
- nelfinavir
- ritonavir

A

Protease inhibitors (PI)

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21
Q

These antivirals blocks the insertion of the viral genome into the DNA of the host cell

A

Integrase inhibitors

e.g. raltegravir, elvitegravir, dolutegravir

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22
Q

NRTI side effects

A

Peripheral neuropathy

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23
Q

NNRTI side effects

A

P450 enzyme interaction
Rash

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24
Q

Protease inhibitor side effects

A

diabetes
hyperlipidaemia
buffalo hump
central obesity
P450 enzyme inhibition

25
Q

Common cause for cerebral lesions in HIV

A

Toxoplasmosis

26
Q

Presentation of toxoplasmosis in HIV

A

Constitutional symptoms
- headache
- confusion
- drowsiness

27
Q

Appearance of Toxoplasmosis on CT

A

single or multiple ring enhancing lesions

+/- mass effect

28
Q

Management of Toxoplasmosis in HIV

A

sulfadiazine and pyrimethamine

29
Q

Causes of viral encephalitis in HIV?

A

CMV
HIV itself
HSV (rare)

30
Q

Viral encephalitis appearance on CT?

A

oedematous brain

31
Q

Most common fungal infection of CNS in HIV

A

Cryptococcus

CSF
high opening pressure
elevated protein
reduced glucose
normally a lymphocyte predominance but in HIV white cell count many be normal
India ink test positive
CT: meningeal enhancement, cerebral oedema
meningitis is typical presentation but may occasionally cause a space-occupying lesion

32
Q

Clinical features of cryptococcus infection

A

headache
fever
malaise
nausea/vomiting
seizures
focal neurological deficit

33
Q

CSF findings in cryptococcus infection in HIV

A

high opening pressure
high protein
low glucose
lymphocyte predominance
India ink test positive

34
Q

CT findings in cryptococcus infection

A

meningeal enhancement
cerebral oedema

35
Q

Viral cause of Progressive multifocal leukoencephalopathy (PML)

A

JC virus (a polyoma DNA virus)

36
Q

Pathopysiology of Progressive multifocal leukoencephalopathy

A

infection of oligodendrocytes

=> widespread demyelination

37
Q

Symptoms of Progressive multifocal leukoencephalopathy

A

behavioural changes
speech/motor/visual impairment

38
Q

CT / MRI findings in Progressive multifocal leukoencephalopathy

A

CT:
- single or multiple lesions
- no mass effect
- lesions don’t enhance.

MRI
- high-signal where demyelinating white matter lesions are seen

39
Q

CT appearances in AIDS dementia complex

A

cortical and subcortical atrophy

40
Q

Common infections in HIV if CD4 count 200-500 cells

A

Thrush (Candida)
Shingles (herpes zoster)
Hairy leukoplakia (EBV)
Kaposi sarcoma (HHV-8)

41
Q

Common infections in HIV if CD4 count 100-200 cells

A

Cryptosporidiosis
Toxoplasmosis
Progressive multifocal leukoencephalopathy (JC virus)
Pneumocystis jirovecii pneumonia (PJP)

42
Q

Common infections in HIV if CD4 count 50-100 cells

A

Aspergillosis
Oesophageal candidiasis
Cryptococcal meningitis
Primary CNS lymphoma (EBV)

43
Q

Common infections in HIV if CD4 count <50

A

CMV retinitis
Mycobacterium avium-intracellulare

44
Q

What type of organism is PJP?

A

unicellular eukaryote

  • classified as a fungus but some consider it a protozoa
45
Q

Features of PJP infection

A

dyspnoea
dry cough
fever
very few chest signs

46
Q

Common complication of PJP which causes dyspnoea and acute chest pain

A

Pneumothorax

47
Q

Extrapulmonary manifestations of PJP

A

hepatosplenomegaly
lymphadenopathy
choroid lesions

48
Q

CXR findings in PJP

A
  • bilateral interstitial pulmonary infiltrates
  • lobar consolidation
  • May be normal
49
Q

Diagnostic investigation for PJP

A
  • bronchoalveolar lavage
    (silver stain shows characteristic cysts)
50
Q

Management of PJP

A

co-trimoxazole

IV pentamidine in severe cases

steroids if hypoxic (reduce risk of respiratory failure)

51
Q

How does HIV seroconversion typically present?

A

glandular fever-type illness
- sore throat
- lymphadenopathy
- malaise, myalgia, arthralgia
- maculopapular rash
- mouth ulcers

52
Q

When does HIV seroconversion usually occur?

A

3-12 weeks after infection

52
Q

Tests used to diagnose HIV

A

HIV antibody and HIV antigen
- most develop antibodies at 4-6 weeks but 99% do by 3 months

HIV RNA (qualitative or quantitative)
- useful for diagnosis of neonatal HIV infection and screening blood donors

53
Q

What type of virus is HIV?

A

RNA retrovirus of the lentivirus genus (long incubation period)

54
Q

Which subtype of HIV has a lower transmission rate anf slower progression to AIDS?

A

HIV-2
(more common in west Africa)

55
Q

What types of white cells can HIV infect?

A

CD4 T cells
macrophages
dendritic cells

56
Q

How does HIV replicate in the host?

A

reverse transcriptase creates dsDNA from the RNA for integration into the host cell’s genome

57
Q
A

MRCP Infectious Diseases (73 decks)

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