HIV

Question 1

what is HIV

Answer 1

RNA retrovirus

Question 2

how quickly does HIV replicate

Answer 2

fast - new generation every 6-12 hours

Question 3

what are the target sites for HIV

Answer 3

CD4+ receptors

Question 4

what effect does HIV infection have on the immune response

Answer 4

Reduced circulating CD4+ cells

Reduced proliferation of CD4+ cells

Reduction CD8+ (cytotoxic) T cell activation
-Dysregulated expression of cytokines

Reduction in antibody class switching
-Reduced affinity of antibodies produced

Chronic Immune Activation (microbial translocation)

Question 5

what are normal CD4+ levels

Answer 5

500-1600 cells/mm3

Question 6

how long does HIV take from exposure to establish itself as an infection

Answer 6

up to 72h

Question 7

what percentage of patients with primary HIV infection present with symptoms?

Answer 7

80%

Question 8

primary HIV infection symptoms

Answer 8

Fever
Rash (maculopapular)
Myalgia
Pharyngitis
Headache/aseptic meningitis

Question 9

when is average symptom onset in primary HIV infection

Answer 9

2-4 weeks after infection (up to 3mths)

Question 10

what does AIDS stand for

Answer 10

acquired immunodeficiency syndrome

Question 11

opportunistic infections definition

Answer 11

an infection caused by a pathogen that does not normally produce disease in a healthy individual

Question 12

pneumocystis pneumonia treatment

Answer 12

high dose co-trimoxazole (+/- steroid)

Question 13

cerebral toxoplasmosis CD4 threshold

Answer 13

<150

Question 14

cytomegalovirus CD4 threshold

Answer 14

<50

Question 15

ophthalmic screening for patients with CD4 under ___?

Answer 15

50

Question 16

HIV-associated neurocognitive organism

Answer 16

HIV-1

Question 17

progressive multifocal leukoencephalopathy (PML) organism

Answer 17

JC virus (reactivation)

Question 18

skin infections in HIV

Answer 18

herpes zoster
herpes simplex
HPV

Question 19

HIV muscle wasting aetiology

Answer 19

chronic immune activation
anorexia
diarrhoea
hypogonadism

Question 20

AIDS related cancer

Answer 20

Kaposi’s sarcoma
Non-Hodgkins lymphoma
Cervical cancer

Question 21

cervical cancer organism

Answer 21

HPV

Question 22

Non-AIDS symptomatic HIV symptoms

Answer 22

Mucosal candidiasis
Seborrhoeic dermatitis
Diarrhoea
Fatigue
Worsening psoriasis
Lymphadenopathy
Parotitis
Epidemiologically linked conditions
-STIs
-Hepatitis B
-Hepatitis C

Question 23

most common mode of transmission of people living with HIV (PLWHIV) in UK

Answer 23

sexual

Question 24

factors increasing HIV transmission risk

Answer 24

Anoreceptive sex
Trauma
Genital ulceration
Concurrent STI

Question 25

mother to child HIV transmission

Answer 25

0.5% of new diagnoses in England In utero/trans-placental Delivery Breastfeeding

Question 26

what % of all new HIV diagnoses in UK are diagnosed late (CD4<350 cells/mm3)

Answer 26

40%

Question 27

who should be tested for HIV?

Answer 27

Universal testing in high prevalence areas Opt-out testing in certain clinical settings Screening of high risk groups Testing in the presence of “clinical indicators”

Question 28

where is opt out HIV testing used

Answer 28

termination of pregnancy services sexual health services addiction and substance misuse services

Question 29

HIV screening of high risk groups

Answer 29

- men who have sex with men - female partners of MSM - people from endemic areas - incarcerated people - trans women - people who inject (have injected) drugs - partners of people living with HIV

Question 30

Which markers of HIV can be used by labs to detect infection?

Answer 30

- antibody (only positive after 3mths) - antigen (p24) - viral RNA (first one of the tests to pick up HIV)

Question 31

rapid HIV tests

Answer 31

fingerprick blood specimen or saliva results within 20-30 mins

Question 32

HIV clinical care

Answer 32

medical care anti-retroviral treatment holistic care

Question 33

does a mum with HIV need a c section

Answer 33

yes if detected viral load. If undetected then can have vaginal delivery