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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
Give some examples of kaposis sarcoma supportive care? (4)
Analgesia Topical salycic acid - itching Crushed metronidazole to reduce smell K+ permanganate to dry excess oozing
26
What stage of HIV - Pnumocystitis jirovecii pneumonia?
stage 4 Most common AIDS defining condition in UK/USA
27
What is the serum B glucan test and its use in PJP?
Detects fungal antigens in bodily fluid High levels suggest PJP
28
PJP work up in low resource setting? (one key diagnostic test) (3)
1. O2 desaturated test 2. CXR 3. Blood tests - Investigations for HIV and Tb 4. Low threshold for TB tx if unsure
29
Treatment for pneumocystitis jirovecci?
Co trimoxazole IV or PO for 21/7 Severe cases IV plus pred CPT - lifelong co-trimox preventative therapy
30
What is the most common form of adult meningitis in Southern Africa?
Cryptococcal meningitis
31
What stage of HIV - cryptococcal meningitis?
Stage 4
32
Syndromic diagnosis - HIV +ve, CN6 palsy, headache?
Cryptococcal meningitis ddx Tb meningitis
33
What are the 3 phases of treatment in cryptococcal meningitis (general phases)
1. Induction Phase 2. Consolidation phase 3. Maintenance Phase
34
What is the treatment guideline of cryptococcal meningitis in resource rich settings?
2 weeks Amp B and Flucytosin 8 weeks Fluconazole high dose 12 weeks Fluconozole normal dose
35
What is the treatment guideline of cryptococcal meningitis in a resource poor setting?
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
When should you start ART in new HIV diagnosis and cryptococcal meningitis and why?
After 4-6 weeks Risk of IRIS | As per WHO guidelines Management of CM in HIV
37
What is IRIS in the context of HIV?
Immune reconstitution inflammatory syndrome
38
What are environmental risk factors for Talaromycosis?
1. Areas of high rainfall 2. The bamboo rat (only known animal reservoir) 3. Endemic in Asia only
39
What is the treatment for Tararomycosis
Antifungal Tx (Lip) Amp B 2 weeks Itraconizole/voriconozole 10-12 weeks
40
What is someones CD4 count likely to be if you diagnose Talaromycosis?
Less than 100
41
What is the causative organism in Talaromycosis?
Talaromyces Marneffei - a dimorphic fungus
42
Do steroids have a role in the management of cryptococcal meningitis?
No. Charlie's paper
43
Give differentials for SOL in HIV?
Pyogenic abcess Cryptococcoma Tuberculoma Cerebral Toxoplasmosis PML (progressive multifocal leukoencephalopathy Primary CNS Lymphoma
44
Spot diagnosis: Low CD4 count, CNS symptoms, 'multiple ring enhancing lesions' on CTB
Cerebral Toxoplasmosis
45
What is PML?
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
What causes PML?
JC virus - Polyomavirus Reactivation when CD4 is <200
47
What is the treatment for PML?
Antiretroviral treatment
48
What is the treatment for cerebral toxoplasmosis?
Pyrimethamine + sulfadiazine + folonic acid or cotrimoxazole

DTMH (15 decks)

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