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reproduction & sexual health > HIV > Flashcards

HIV Flashcards

1
Q

What type of virus is HIV?

A

RNA retrovirus

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2
Q

Describe the different types of HIV

A

HIV1 - group M responsible from the global epidemic

HIV2 - localised to west Africa, few cases in the UK

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3
Q

When does replication occur in HIV?

A

Very late and very early infection - new generation every 6-12 hours

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4
Q

What cells are infected in HIV?

A

CD4+ cells in the mucosal tissue then transfers into the blood stream via lymphatic drainage

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5
Q

How soon is infection established in the body?

A

72 hours

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6
Q

What is the target site for HIV?

A

T helper lymphocytes

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7
Q

State the four functions of T helper lymphocytes

A
  • recognise MHC2 antigen presenting cells
  • activate B cells
  • activate cytotoxic T cells
  • cytokine release
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8
Q

How does HIV alter immune system?

A

Reduced circulation and proliferation of CD4+ T cells
Reduced CD8+ T cells
Reduced antibody affinity
Chronic immune activation (microbial translocation -GALT)

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9
Q

What is normal CD4 T cell count?

A

500-1600 cells/mm3

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10
Q

At what CD4 T cell level is there the highest risk fo opportunistic infections?

A

<200 cells/mm3

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11
Q

What are the four key stages in HIV infection?

A

Primary
Asymptomatic
Symptomatic
AIDS

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12
Q

With no treatment how long does HIV take to progress from primary to AIDS?

A

9-11 years

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13
Q

How many people present with HIV primary infection?

A

80%, 2-4 weeks after infection

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14
Q

How does primary HIV present?

A

Fever, maculopapular rash, myalgia, pharyngitis, headache, aseptic meningitis

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15
Q

What happens in the asymptomatic phase?

A

Ongoing viral replication, CD4 depletion, immune activation and risk of onward transmission

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16
Q

Define opportunistic infections

A

An infection that pathogen does not normally cause disease in a healthy individual

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17
Q

What infection can HIV cause in the lungs?

A

Pneumocystic Pneumonia

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18
Q

When does PCP occur and what are the signs/symptoms?

A

CD4 <200
Symptoms - insidious onset, SOB, dry cough
Signs - exercise oxygen desaturation (pulse up and oxygen down fast)

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19
Q

What will a CXR of PCP show?

A

Normal, interstitial infiltrates, reticulonodular markings

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20
Q

How is PCP diagnosed?

A

Broncho-alveolar lavage, PCR/immunoflorescence

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21
Q

How is PCP treatment?

A

High dose co-trimoxazole

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22
Q

What types of TB are more common in HIV positive patients?

A

Symptomatic primary infection, reactivation of latent TB, lymphadenopathies, miliary TB, extra pulmonary TB, multi-drug resistant, immune reconstitution syndrome

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23
Q

What organism causes cerebral toxoplasmosis?

A

Toxoplasma gondii

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24
Q

At what CD4 count can cerebral toxoplasmosis occur?

A

<150

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25
Q

What can reactivation of toxoplasma gondii cause?

A

Cerebral abscess

Chorioretinitis

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26
Q

How will cerebral toxoplasmosis present?

A

Headache, fever, seizures, focal neurology, reduced consciousness, raised ICP

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27
Q

What will a CT of toxoplasmosis show?

A

Multiple ring enhancing lesions

28
Q

At what CD4 count can cytomegalovirus occur?

A

<50

29
Q

What screening is done for CMV?

A

Ophthalmic screening

30
Q

Name the consequences of reactivated CMV

A

Retinitis
Colitis
Oesophagus

31
Q

How does reactivation of CMV present?

A

Reduced visual acuity, floaters, abdominal pain, PR bleeding can lead to blindness

32
Q

How can HIV associated neurocognitive impairment present?

A

Reduced short term memory +/- motor dysfunction

33
Q

How will neurocognitive HIV impairment appear on CT?

A

Enlarged ventricles - signs of atrophy

34
Q

What can JC virus reactivation cause?

A

Progressive multifocal leukoencephalopathy

35
Q

At what level of CD4 will PML present and how will it present?

A

<100
Rapidly progressing, focal neurology, confusion, personality change
MS type picture

36
Q

Name three skin infections HIV can increase your chance of getting

A
  • herpes zoster (multidermatomal/recurrent)
  • herpes simplex (extensive, treatment resistant)
  • HPV (chance of dysplasia)
37
Q

What can cause HIV associated wasting?

A 
Metabolic immune activation 
Anorexia
Malabsorption 
HIV enteropathy 
Hypogonadism
38
Q

What tumour can herpes virus 8 cause?

A

Kaposi’s Sarcoma - vascular tumour

39
Q

How will kaposi’s sarcoma present?

A

Cutaneous, mucosal, visceral (pulmonary, GI)

40
Q

How is kaposi’s sarcoma treated?

A

Anti-retroviral, local therapies, systemic chemo

41
Q

What haematological malignancy can HIV cause?

A

Non-Hodgkins lymphoma

42
Q

When can non-AIDS symptomatic HIV occur?

A

During asymptomatic phase

43
Q

State factors that increase transmission of HIV

A

Anoreceptive sex
Trauma
Genital ulceration
Concurrent STI

44
Q

Why is the rectum more easy to transmit HIV compared to the vagina?

A

It is only 1 cell thick and has lots of lymphoid tissue

45
Q

Name three ways HIV can be transmitted

A

Parenteral

Mother to child

46
Q

How can HIV be transmitted parenterally?

A

Injection drug use
Infected blood produced
Iatrogenic

47
Q

How can HIV be transmitted from mother to child ?

A

In utero
Delivery
Breast feeding

48
Q

Where is HIV a pandemic?

A

Sub Saharan Africa
Caribbean
South East Asia

49
Q

Where is HIV an epidemic ?

A

Russia

Eastern Europe

50
Q

What percentage of people are misdiagnosed in the UK?

A

6%

51
Q

Name four testing techniques for HIV testing

A

Universal testing
Opt-out testing
Screening high risk groups
Testing on clinical grounds

52
Q

Name high risk groups

A 
MSM 
Female partners MSM
Black Africans 
Prisoners 
Trans women 
PWID 
Partners of people living with HIV 
Endemic areas
53
Q

Name blood markers measured in HIV

A
  • antibodies (3 months to become detectable)
  • antigen - p24
  • viral RNA
54
Q

Describe a rapid HIV test

A

Fingerpick blood specimen/saliva get results in 20-30 minutes measures both the antibody and antigen

55
Q

What prophylaxis treatment can be given for PCP?

A

Co-trimoxazole 480mg daily

56
Q

Name four targets of HIV treatment

A

Reverse transcriptase
Integrase
Protease
Entry to cell - fusion or CC5R receptor

57
Q

Define highly active anti-retroviral

A

A combination of 3 drugs from at least 2 classes to which the virus is susceptible

58
Q

How does drug resistance occur?

A

Mutations can occur in low compliance leading to resistance

59
Q

What does U=U mean?

A

Undetectable = untransmitable

60
Q

What side effects can occur from anti-retroviral treatment?

A 
GI side effects 
Skin - rash, hypersensitivity, SJS 
CNS - mood, psychosis 
Renal complications 
Osteomalacia 
CVD
Haematological complications
61
Q

Describe pre-exposure prophylaxis

A

2 drugs to prevent acquiring HIV in high risk individuals

- tenofovir and emtricitabine daily or on demand

62
Q

What are the side effects of PrEP

A

Renal health can be affected
Drug-drug interactions
Requires regular monitoring

63
Q

Describe post exposure prophylaxis

A

72 hours within high risk exposure

Prep and rategravir for 4 weeks

64
Q

In pregnant women if the viral load is detectable what form of delivery is required?

A

C section

65
Q

How long should PEP be given in a neonate?

A

2-4/52

reproduction & sexual health (36 decks)

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