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Infectious disease > HIV > Flashcards

HIV Flashcards

1
Q

What type of virus is HIV

A

Lentivirus- part of retrovirus family
Single stranded RNA
2 copies in nuclear capsid of p24 protein

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2
Q

What is classicla of retroviruses

A

Long incubation and latency

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3
Q

Targets of virus for serologic testing

A

p24 viral protein nucelar capsid
Lipid membrane evelope proteins

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4
Q

What are the only external genes on HIV

A

GP 120
3 x GP41 attachoing to lipid coat
Uses to attach to target cells

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5
Q

Major cellular targets of HIV

A

CD4 binds GP120
CD4 positive T lymphocytes, macrophages, glial cells

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6
Q

Why is reverse transcriptatse being unstable an adaptation of HIV

A

V quickly becomes drug resistant

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7
Q

3 enzymes of HIV

A

Reverse transcriptase
Integrase
Protease

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8
Q

When do antibodies to HIV become detectable in blood

A

> 2 weeks

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9
Q

ACute infection of HIV

A

Ranges in severity
Myalgia, sweats, fever
Lymphadenopathy generalised, may persist, widespread macular rash, pharyngitis
CNS - bells palsy, seizures
Diarrhoea
Mouth ulcers
After rapid reproduction in body - high levels of viraemia

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10
Q

What is seroconversion

A

Initial infection w HIV - serum becomes antibody positive
Viral load is depressed

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11
Q

Whats the median clinical latency of HIV

A

5 years

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12
Q

What does CD4 count <500 cause

A

Bacterial pneumonias egTB
Oral pharyngeal candidiaseis, OHL
Herpes zoster/shingles - recurrent, multidermatomal
Psoriasis
Diarrhoeal illness - parasitic infections eg kryptosporiasis

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13
Q

CD4 count <200 presentation

A

PMultifocal encephalopathy - JC virus
Karposis sarcoma
Pneumocystis pneumonia

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14
Q

CD4 <100 presentation

A

Cerbral toxoplasmosis
Retinitis or colitis - reactivated CMV
non TB - Mycobacterium complex eg MACC
Lyphoid malignancies eg primary CNS lymphomas

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15
Q

How predict developent of AIDS

A

CD4 count and viraemia level combined

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16
Q

What is PGL

A

Persistent generalised lympahdenopathy

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17
Q

What lesions see in karposis sarcoma

A

Highly vascular red lesions on skin and mucosal, rubbery appearnace

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18
Q

Karposis sarcoma treat

A

Retreats with antriretrovirals
If inviscera need chemo

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19
Q

What causes hairy leukoplakia

A

EBV
Immunocomp in general not just HIV
Regresses once immune system reovers

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20
Q

Staging of HIV

A

I - asymptomatic
II - minor symptoms
III - moderate dymptoms
IV - AIDS defining illness

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21
Q

Typical diseases of Stage I HIV

A

Mo symptoms
PGL

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22
Q

Typical diseases Stage II hIV

A

Cutaneous manifestation folliculitis, dermatomal herpes varicella zoster

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23
Q

Typical diseases Stage III HIV

A

Oral candidiasis, oral hairy leukopenia, pulmonary TB

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24
Q

Typical diseases Stage IV HIV

A

Karposis sarcoman, oral KS MAC, severe chronic herpes ulcers, tozoplasmosis, cryptococcus

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25
Q

CD4 counts in each stage of HIV

A

1 >500
2 - 500-350
3 - 350 TO 250
4 - <200

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26
Q

Vrial load and stage of HIV

A

I - 10^3 - 0.000000010
II - 10^3 to 10^4
III - 10^4 to 10^5
IV - 10^5 -10^6

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27
Q

Life cycle of HIV

A

Fusion w CD4 positive T cell
Reverse transcription HIV RNA -> proviral DNA
Integration
Maturation and polyprotein cleavage
Co-receptor binding

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28
Q

What drugs target reverse transcription of HIV

A

Nucleoside reverse transcriptase inhibitors

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29
Q

START study

A

Immediate treatment reduces death and serious complications by half
Prev onl treat if CD4<350

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30
Q

Combination therapy for HIV what is used

A

Two different NRTIs and a third agent from another class

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31
Q

Preferred tratment HIV

A

Tedofovir + FTC
ATV/r, DRV/r - protease inhibiors
EVG/COBI, RAL - integrase inhibitors

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32
Q

Why need multi therapy treatments for HIV

A

Mutations accumulate within person themselves from reverse transcriptase
Multiple strains of HIV circulating

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33
Q

Speed of HIV mutation is dependent on…

A

The viral load
300,000 one mitation in hours
30 - 2.5 years before mutation

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34
Q

What is blurring on optic disc known as

A

Papilloedema - can be due to raised ICP

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35
Q

Differentials for raised ICP

A

Space occupying lesion
CNS inflammation eg meningitis

36
Q

HIV positive further test

A

CD4 count to quantify

37
Q

What are raised lymphocytes on CSF a signal of

A

Viral, fungal, treponemal + mycpbacterial, AI conditions, paraneoplastic

38
Q

What do to investigate atypical infections of CSF

A

ZN (Tb)
India ink - cryptococcus
PCR
culture

39
Q

What stain use for cryptococcus

A

India ink
Encapsulated yeast

40
Q

Treatment for crytpococaal meningiits

A

Lisposomal amphotericinB and flucytosine then oral fluconazole
Co-trimaxaxole prophylaxis for PCP

41
Q

What give prophylactivally when CD4 count under 200 resp

A

Co-trimaxaxole prophylaxis for PCP

42
Q

When should you start ART opportunistic infections

A

within 2 weeks

43
Q

Why sometimes delay ART therapy w opportunistic infection HIV

A

delay 5 weeks w eg cryptococcal meninigitis
risk of IRIS

44
Q

What is IRIS

A

Immune reconstitution infllammatory syndrome
Failing immune system recovers -> exaggerated inflammatory responses

45
Q

Types of IRIS

A

Paradoxical and unmasking
Paradoxical - Inflam response to known opportunistic infection becomes more pronounced
Unmasked - no evidenev of opportunistic infection until immune system improves -> signs and symptoms emerge

46
Q

Treatment IRIS

A

NSAIDs or steroids
Can be dangerous

47
Q

tYPES OF CRYPTOCOCCUS

A

C.neoformans var neoformas/gattii/grubii
C gattii: infection rare in ummunocompetent hosts
var neoformans is found worldwide (pigeon droppings)
var gattii: Tropical and sub-tropical (eucalyptus trees)

48
Q

Risk factors for cryptococcal infection

A

T cell depletion eg HIV, haemotological disorders, iatrogenic immunosupression, steroids, Hodgkins lymphoma

48
Q

Route of cryptococcal infection

A

Inhalation

49
Q

Features of OHL vs oral candidiasis

A

OHL->
White linear/shaggy or hairy appearance
Non tender
Can’t be scrapped off
Usually on sides of the tongue

50
Q

What causes oral hairy leukopenia

A

EBV
Indicates immunosupression

51
Q

How confirm PCP diagnosis

A

Deep sputum sample - induced sputum or Bronchoscopic alveolar lavage - BAL
Staining and sluroscopuc examination for cysts

52
Q

Treatment PCP

A

High dose Co-trimoxazole and steroids

53
Q

Clinical features of PCP

A

Dry cough
Fevers
Malaise
Weight loss
Exertional dyspnoea/de-saturation
Hypoxia

54
Q

Investiagtion results in PCP - ABG, CXR, BAL

A

Hypoxia/T1 resp failure
CXR - diffuse intersitial infiltrates with bat wing distribution, 1/4 normal if early
BAL - PJP oocysts

55
Q

What is ring enhancing lesion on CT head

A

Oedema around lesion - suggests reactive inflammation
Metabolically active lesions eg abscesses, tumours, parasites

56
Q

Common causes of neurological deficits in advanced HIV

A

Cerebral toxoplasmosis
CNS lymphoma
Tuberculoma

Primary brain tumour, cerebral metastases
PML, cryptococcus and syphilis can rarely cause SOLs

57
Q

What is IGRA

A

Interferon gamma release assay

58
Q

What does IGRA measure

A

Blood test measures production of IG by T cells - increases if T cells exposed to TB antgens, therefore diagnoses latent TB or TB expisyre

59
Q

What test tests for TB latent or exposure

A

IGRA

60
Q

How get definitive diagnosis of toxoplasmosis

A

Brain biopsu - high risk

61
Q

Treatment for toxoplasmosis

A

2 weeks sulphadiazone and pyrimthamine
Trial and repeat imaging in 2 weeks
If no improvement - brain biops for lymphoma

62
Q

What causes toxoplasmosis

A

Toxoplasma gondii
Protazoan parasite

63
Q

Route of transmission of toxoplasmosis

A

Eating undercooked meat of animals with tissue cysts
Food or water w cat faeces or contaminated encironemntal samples eg soil, litter box
Blood transfusion or organ transplantiton
Transplacentally

64
Q

How can toxoplasmosis present in immmunocompromised patients

A

Glandular fever like
Myalgai, lymphadenopathy
May go unnoticed, lie dormant and reactivate
Causes CNS comps space occpying lesinos/chorioretinitis

65
Q

Toxoplasmosis pregnancy

A

COngenital infection - miscarriage, stillbirth, severe disability

66
Q

What does toxoplasma cause in CNS immunocomp patients

A

Reactivation - space occupying lesions
Multiple and concentrated round basal ganglia
Rim enhances w IV contrast

67
Q

When can or0-pharyngeal candidiasis occur

A

Recent anibitocis or incorrect steroid inhaler use
HIV immunocompromise

68
Q

Cause of kaposis sarcoma

A

HHV 8 - human herpes virus 8

69
Q

What is kaposis sarcoma

A

Skin cancer ass w AIDs causing purple brown raised lesions on lower limbs or head an neck but can be anywhere
If visceral - bronchial walls, haemoptysis/dyspnoea
GI tract - haematemesis, dysphagia, bowel obstruction, melaena

70
Q

Treatment kaposis sarcoma

A

If only skin may regress w antiretrovirals
If visceral or extenisve - chemotherapy

71
Q

What weight loss is definitive for AIDs

A

> 10% BW loss

72
Q

What parasite GI tract is AIDs efining

A

Cryptosporidiosis (self limiting if immunocompetent)
If persistent = AIDs defining

73
Q

Causes of diarrhoea in HIV bacteria

A

Campylobacter
C difficile
E coli
Salmonella
Sjigella
Myconbacterium TB
Mycobacteruum avium intracellulareae

74
Q

Parastitic causes of iarrhoea HIV

A

Cryptosporidium
Cyclospora
Cayetaness
Giardia amlia
Entamoeba histolytica
Isospora belli
Microsporidia
Strongyloides stercoralis

75
Q

Virus and other causes of diarrhoea HIV

A

CMV
HSV
Rotavirus
Norovirus

ART
Kaposis sarcoma
Non hodgkin and hodgkin lymphoma

76
Q

How cryptosporidium contracted

A

Protozoan parasite - drinking water contaminated with oocysts
Not killed chlorine
If immunocompetent normally clear without treatment
Treat w ART

77
Q

When test for HIV in patients

A

TOP/GUM/ante-natal/drug dependency/TB.hepatitis/lymphoma services
All medical admissions >2/1000 prevalence of HIV
All adults register w GP
Indicator diseases/AIDs defining condition

78
Q

AIDs defining conditions

A

TB, PCP
Cerebral Toxoplasmosis, Cryptococcal meningits, PML
Karposi Sarcoma
Persistent cryptosporidiosis
NHL
Cervical cancer
CMV retinitis

79
Q

Examples of entry inhibitors

A

Maraviroc -CCR5
Enfuviritide - gp41
Prevent HIV entry into cells therefore infection

80
Q

Examples of integrase inhibitors

A

Raltegravir, elvitegravir, dolutegravir

81
Q

NRTI examples

A

zidovudine (AZT), abacavir, emtricitabine, didanosine, lamivudine, stavudine, zalcitabine, tenofovir

82
Q

Tenofovir side effects

A

Renal impairment
Osteoporosis

83
Q

General NRTI side effect

A

Peripheral neuropathu

84
Q

NNRTI examples and side effects

A

Nevirapine - CYP450 inducer
Efavirenz
Rashes

85
Q

Protease inhibitors examples

A

Indinavir, nefanivir, retionavir, saquinavir

86
Q

Side effects of protease inhibtiors

A

DM, hyperlipidaemia, buffalo hump, central obestiy, P45- inhibitors
Indaniviri - renal stones, increased bilirubin
Retinovir is esp potent P450 inhibitor

Infectious disease (37 decks)

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