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DTMH > HIV > Flashcards

HIV Flashcards

Basic concepts HIV and ART

1
Q

What are the 3 main types of HIV tests? (3)

A
  1. Antibody tests
  2. Antigen antibody tests
  3. NATs (nucleic acid tests) or PCR
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2
Q

What are the advantages and disadvantages of antibody tests for HIV?

A
  • Can take 23-90 days to detect HIV antibodies.
  • Results 5-10 days
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3
Q

What are the advantages and disadvantages of antigen/antibody test for HIV?

A
  • p24 antigen produced before antibodies develop thus earlier detection 18-45 days
  • in general note blood from vein better than skin prick etc
  • can do rapid test 20 min
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4
Q

What is the issue of doing HIV serological tests on newborns?

A

HIV specific maternal antibodies cross placenta. Can have maternal antibodies up to 18m even if uninfected.
Need PCR

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5
Q

What are the advantages and disadvantages of HIV PCR testing?

A
  • Look for actual virus in blood
  • Good for people recent exposure and early sx of HIV with neg antigen/antibody test
  • a NAT detect HIV 10-33 days post exposure
  • Difficult in low resource settings!!!
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6
Q

What is the western blot test?

A

Can be used confirm an HIV diagnosis.
Detects HIV ANTIBODIES.

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7
Q

Describe the ELISA test in the context of HIV

A

Enzyme linked immunosorbent assay - detects ANTIBODIES.

Very accurate when combined with western blot

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8
Q

What is stage 1 HIV? (3)

A

Acute HIV infection

  • Sore throat
  • Maculopapular rash
  • Persistant lymphadenopathy
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9
Q

What is involved in stage 2 HIV? (general points no specific diseases) (3)

A
  • Moderate unexplained weight loss (<10%)
  • Recurrent URTIs, sinusitis, tonsilitis, otitis media, pharyngitis
  • Various conditions affecting skin, nails, mucous membranes
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10
Q

What stage of HIV - papular pruritic eruptions?

A

Stage 2

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11
Q

What stage of HIV - Herpes zoster/complications?

A

Stage 2

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12
Q

What stage of HIV - Seborrhoeic dermatitis?

A

Stage 2

Treat with ketoconozole - improves on ART

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13
Q

What is the treatment for localised (dermatomal HSV)

A

Acyclovir 800mg 5x day for 7-10 days

Other - Valacyclovir/famcyclovir

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14
Q

What stage of HIV - fungal nail infections?

A

Stage 2

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15
Q

What stage of HIV - oral hairy leukoplakia?

A

Stage 3

EBV associated - membranes cannot be scraped off –> improves on ART

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16
Q

What stage of HIV? Oral candidiasis and oesophageal candidiasis?

A

Stage 3
Stage 4

Oral anti fungal - Fluconazole

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17
Q

What stage of HIV? Pulmonary TB

A

Stage 3

Note as CD4 count drops - less likely to see granulomas as very limited immune response.

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18
Q

What stage of HIV - disseminated TB?

A

Stage 4

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19
Q

Describe the clinical picture of Tb in high CD4 count HIV?
a) symptoms
b) Imaging
c) sputum smear
d) Extra-pulmonary involvement?

A

a) severe cough + haemoptyiss
b) cavities - particularly upper lobe
c) positive
d) rare <20%

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20
Q

Describe the clinical picture of Tb in low CD4 count HIV?
a) symptoms
b) Imaging
c) sputum smear
d) Extra-pulmonary involvement?

A

a) minimal cough ,rare hamoptysis
b) No cavities - hilarious lymphadenopathy, miliary pattern - can be normal
c) often negative
d) common >50% disseminated disease

21
Q

Describe what conditions are in WHO stage 3 (general themes, not specific diseases)? (5)

A
  1. Severe weight loss
  2. Chronic diarrhoea ( >1 month)
  3. Persistent fever (intermittent or constant for >1 month)
  4. Severe bacterial infections
  5. Unexplained aanemia +/- chronic thrombocytopenia (plts <50)
22
Q

What is the viral cause of kaposis sarcoma?

A

HHV8

Human Herpesvirus-8

23
Q

What stage of HIV is kaposis sarcoma?

A

stage 4 - AIDS defining

24
Q

What is the treatment of kaposis sarcoma?

A

Mainstay - ART and analgesia

Consider chemo - mucosal/internal organ involvement, nodular involvement, assoc oedema, kids

Tricky - chemo in rural sub saharan Africa??

25
Q

Give some examples of kaposis sarcoma supportive care? (4)

A

Analgesia

Topical salycic acid - itching

Crushed metronidazole to reduce smell

K+ permanganate to dry excess oozing

26
Q

What stage of HIV - Pnumocystitis jirovecii pneumonia?

A

stage 4

Most common AIDS defining condition in UK/USA

27
Q

What is the serum B glucan test and its use in PJP?

A

Detects fungal antigens in bodily fluid

High levels suggest PJP

28
Q

PJP work up in low resource setting? (one key diagnostic test) (3)

A
  1. O2 desaturated test
  2. CXR
  3. Blood tests - Investigations for HIV and Tb
  4. Low threshold for TB tx if unsure
29
Q

Treatment for pneumocystitis jirovecci?

A

Co trimoxazole IV or PO for 21/7

Severe cases IV plus pred

CPT - lifelong co-trimox preventative therapy

30
Q

What is the most common form of adult meningitis in Southern Africa?

A

Cryptococcal meningitis

31
Q

What stage of HIV - cryptococcal meningitis?

A

Stage 4

32
Q

Syndromic diagnosis - HIV +ve, CN6 palsy, headache?

A

Cryptococcal meningitis

ddx Tb meningitis

33
Q

What are the 3 phases of treatment in cryptococcal meningitis (general phases)

A
  1. Induction Phase
  2. Consolidation phase
  3. Maintenance Phase
34
Q

What is the treatment guideline of cryptococcal meningitis in resource rich settings?

A

2 weeks Amp B and Flucytosin
8 weeks Fluconazole high dose
12 weeks Fluconozole normal dose

35
Q

What is the treatment guideline of cryptococcal meningitis in a resource poor setting?

A

Lip Amp B (stat) + Flucytosin + Fluconozole 2 weeks
Fluconozole high dose 8 weeks
Normal dose fluconazole 12 weeks

WHO guidelines - until CD4 over 200 and viral loads supressed

36
Q

When should you start ART in new HIV diagnosis and cryptococcal meningitis and why?

A

After 4-6 weeks
Risk of IRIS

As per WHO guidelines
Management of CM in HIV

37
Q

What is IRIS in the context of HIV?

A

Immune reconstitution inflammatory syndrome

38
Q

What are environmental risk factors for Talaromycosis?

A
  1. Areas of high rainfall
  2. The bamboo rat (only known animal reservoir)
  3. Endemic in Asia only
39
Q

What is the treatment for Tararomycosis

A

Antifungal Tx

(Lip) Amp B 2 weeks
Itraconizole/voriconozole 10-12 weeks

40
Q

What is someones CD4 count likely to be if you diagnose Talaromycosis?

A

Less than 100

41
Q

What is the causative organism in Talaromycosis?

A

Talaromyces Marneffei - a dimorphic fungus

42
Q

Do steroids have a role in the management of cryptococcal meningitis?

A

No. Charlie’s paper

43
Q

Give differentials for SOL in HIV?

A

Pyogenic abcess
Cryptococcoma
Tuberculoma
Cerebral Toxoplasmosis
PML (progressive multifocal leukoencephalopathy
Primary CNS Lymphoma

44
Q

Spot diagnosis:
Low CD4 count, CNS symptoms, ‘multiple ring enhancing lesions’ on CTB

A

Cerebral Toxoplasmosis

45
Q

What is PML?

A

Progressive multifocal leuoencephalopathy

Severe demyelination disorder

Often insidious onset and progression of symptoms

Caused by a virus infection (polyomavirus JC)

  • preferentially affects the CNS
  • pathophysiology - reactivation due to poor immune system of HIV
  • subacute focal neurology
46
Q

What causes PML?

A

JC virus - Polyomavirus
Reactivation when CD4 is <200

47
Q

What is the treatment for PML?

A

Antiretroviral treatment

48
Q

What is the treatment for cerebral toxoplasmosis?

A

Pyrimethamine + sulfadiazine + folonic acid or cotrimoxazole

DTMH (15 decks)

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