HIV Flashcards by Nicole H

HIV CD4 350-500 cells - clinical stage

Asymptomatic
Lymphadenopathy

Recurrent respiratory tract infections
Herpes zoster
Recurrent oral ulcers
Eosinophilic folliculitis

How well did you know this?

Not at all

Perfectly

HIV CD4 200-350 cells - clinical stage

Persistent oral candidiasis
Oral hairy leukoplakia
Pulmonary TB
Severe bacterial infections
Ulcerative stomatitis/gingivitis/periordontitis

How well did you know this?

Not at all

Perfectly

HIV CD4 <200 clinical stage

HIV wasting
PCP
Oesophageal candidiasis
Extrapulmonary TB
Kaposi’s sarcoma
CNS toxoplasmosis
Extrapulmonary cryptococcosis
Disseminated NTB mycobacterial infection
Chronic isosporidiosis
Chronic cryptosporidiosis
Disseminated mycosis
Lymphoma
Progressive multifocal leukoencephalopathy

How well did you know this?

Not at all

Perfectly

Cerebral toxoplasmosis - summary

Toxoplasma gondii

PCR on CSF
Serology
Neurimaging (multiple ring enhancing lesions)

Co-trimoxazole 4 weeks + ART

How well did you know this?

Not at all

Perfectly

TB meningitis - summary

CSF: Lymphocytic, low glucose, high protein
RHZE 9-12 months
Steroids

How well did you know this?

Not at all

Perfectly

Cryptococcal meningitis

Headache, meningism, focal neurology
CSF: CrAg and culture

Treatment:
Induction: flucytosine + fluconazole + single dose amphotericin B
Fluconazole consolidation

How well did you know this?

Not at all

Perfectly

Molluscum contagiosum in HIV

Poxvirus
Can become widespread (IRIS)
Differentials: cryptococcus, histoplasmosis, talaromycosis

How well did you know this?

Not at all

Perfectly

Hepes zoster in HIV

Reactivation of VZV –> painful vesicles that do not cross the midline
Valaciclovir/IV aciclovir

How well did you know this?

Not at all

Perfectly

Papular pruritic eruption in HIV

Eosinophilic foliculitis - cause unknown - symmetrical itchy papulaes on the face/trunk/extremeties

How well did you know this?

Not at all

Perfectly

Chronic diarrhoea in HIV - causes

HIV itself
Medication
Infections
- Cyptosporidium - ART
- CMV colitis
- TB
- Schistosomiasis
- Amoebiasis
- NTM

How well did you know this?

Not at all

Perfectly

Oesophageal lesions in HIV - causes

Oesophageal candidiasis
CMV
Malignancy

How well did you know this?

Not at all

Perfectly

Oral hairy leukoplakia

EBV related, no specific treatment

How well did you know this?

Not at all

Perfectly

PCP in HIV - diagnostics and treatment

PCR +/- microscopy on BAL/sputum
BD glucan
Treatment: co-trimoxazole

How well did you know this?

Not at all

Perfectly

What is kaposi sarcoma?

Vascular tumour with red/brown bigmentation secondary to infection with HHV-8
Commonly affects skin but can affect the palate, lungs, GI tract and lymph nodes

How well did you know this?

Not at all

Perfectly

How do you make a diagnosis of HIV?

2 serological assays p24 AG +/- AB
Immunotyping for HIV1/2
Viral load (quantitative PCR)

How well did you know this?

Not at all

Perfectly

Whats the first line treatment for HIV (as per WHO guidelines, no Hep B)

Tenofovir disoproxil fumarate (TDF) + Lamivudine (3TC) + Dolutegravir

How well did you know this?

Not at all

Perfectly

When to start treatment for HIV?

ASAP EXCEPT:
Cryptococcal meningitis
TB meningitis

What kind of virus is HIV?

Retrovirus - i.e. inserts a DNA copy of its genome into the host cell to replicate

What are some things to check before initiating on ART?

HTN
CVD
DM
Pregnancy
TB
LFTs
Proteinuria
Hepatitis B surface antigen

NRTI

Nucleoside reverse transciptase inhibitors

Block reverse transcriptase enzyme, preventing HIV RNA from converting to DNA

e.g. tenofovir, zidovudine, lamuvidine

SE: severe renal impairment, hypersensitivity, liver disease
Avoid TDF in osteoporosis

NNRTI

Non nucleoside reverse transciptase inhibitors

Bind directly to the reverse transciptase enzyme to prevent HIV RNA converting to DNA

e.g. Efavirenz

Rash, hepatotoxicity, CNS effects (psychological), high rates of resistance

Protease inhibitors in HIV

Atanivir, ritonavir

Severe liver disease
Hyperlipidaemia
Hyperglycaemia
Avoid in CVD
Advise giving in renal disease

Integrase inhibitors in HIV

Dolutegravir
Weight gain, hypersensitivity, hepatotoxicity
Harmlessly can increase creatinine - usually plateaus at week 4 and should not be progressive

HIV associated nephropathy (HIVAN)

Nephrotic syndrome
Dx Biopsy required - Collapsing FSGS, tubular microcystic dilation, and interstitial inflammation
Enlarged bright kidneys on US
Limited to black patients APOL-1 gene

Progressive multifocal leukenencephalopathy (PML) in HIV

PML - reactivation of JC virus (affects oligodendrocytes) Symptoms - muscle weakness, sensory deficits, hemianopia, gait disturbance Multiple lesions are hypodense with no surrounding changes like odoema

HIV patient presenting with headache, confusion and drowsiness. Her CT shows multiple ring enhancing lesions with some surrounding odoema

Toxplasmosis Mx: sulfadiazine and pyrimethamine (+folinic acid)

HIV patient presenting with weight loss and a single homogenous enhancing lesion on CT brain

Lymphoma

Patient with HIV presenting with headache, fever, malaise and seizures. LP - lymphocytosis and high opening pressure. CT shows meningeal enhancement and cerebral odoema

TB Cryptococcal meningitis

HIV patient with subacute speech and motor impairment with hemianopia. CT shows multiple non-enhancing lesions.

PML

Approach to lymphadenopathy in HIV

Any CD4 count TB Syphilis Lymphoma KS NTM CD4 <100 Dimorphic fungal infections Nocardia Cryptococcus

Which ART is it normal to have a raised bilirubin?

Atazanavir (ATZ)

Which ART class is most linked with resistance and should be switched if there is a rebound jump in viral load?

NNRTI

Preferred option for PEP in adults

Tenofovir + lamuvidine + dolutegravir

Preferred option for PEP in children

Zidovudine + lamuvidine + dolutegravir

Management of HIV vertical transmission

For infants - dual prophylaxis with daily Zidovudine and Nevirapine for the first six weeks of life (or 12 weeks if considered high risk)

What monitoring is required for ART monitoring?

CD4 count can be stopped once established on ART HIV viral load preferable for monitoring LFTs Renal function

When should NNRTIs be avoided?

Previous resistance Population resistance is >10%

Treatment for cryptococcal meningitis in HIV

1 week induction Amphotericin B + flucystosine (or fluconazole + flucytosine) followed by fluconazole 8 weeks

Treatment of disseminated histoplasmosis in HIV

Check histoplasma antigens 2 weeks amphotericin B (renal function) 12 months itraconazole

When to give prophylactic co-trimoxazole?

CD4 <350

How do you do a TB screen in patients living with HIV?

Four-symptom screen: current cough, fever, weight loss or night sweats Consider also CXR + PCR if symptomatic or in endemic region

Treatment for latent TB (including in HIV)

1. 6-9 months isoniazid 2. 3 months of isoniazid + rifapentine 3. 3 months of isoniazid + rifampicin