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HIV Flashcards

1
Q

What type of virus is HIV

A

Single stranded enveloped RNA virus (retrovirus)
Family: retroviridae
Genus: Lentivirus

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2
Q

Two types of HIV

A

HIV-1 (most common), HIV-2 (West Africa, more indolent, less vertical transmission, intrinsic resistance)

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3
Q

How does HIV cause disease

A

Destroys CD4 helper lymphocytes, creating acquired immunodeficiency

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4
Q

Most common mode of transmission of HIV in paediatrics

A

Vertical transmission (Mother to baby), highest risk of transmission is intrapartum

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5
Q

HIV clinical presentation

A

FTT, unexplained prolonged fever, chronic diarrhoea, opportunistic infections, lymphadenopathy, splenomegaly, persistent oral/napkin candidiasis

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6
Q

Acute retroviral syndrome

A

Adolescents; fever, malaise, lymphadenopathy, rash 7 - 14 days post infection (Glandular fever type illness)

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7
Q

Laboratory criteria for HIV diagnosis <18 months

A

Positive HIV NAT, HIV DNA or HIV RNA. x2 positive tests. Serology not useful, as maternal antibodies transfer

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8
Q

Laboratory criteria for HIV diagnosis >18 months

A

Positive HIV antigen/antibody test (fourth generation tests) which can detect HIV-1/HIV-2 Ab and HIV-1 p24 antigen (can be detected as early as 10 - 14 days after infection. PLUS positive on different supplemental test (Western blot, HIV-1/2 differentiation immunoassay)

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9
Q

CAR T-Cell therapy and HIV

A

HIV tests can be false positive in patients who have had this, as same lentivirus can be used as viral vector for CAR T-Cell

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10
Q

Four main ART classes

A

NRTI (Nucleoside Reverse Transcriptase Inhibitor) NNRT (Non Nucleoside Reverse Transcriptase Inhibitor), ISTI (Integrase Inhibitor), PI (Protease Inhibitor)

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11
Q

Treatment for Paediatric HIV

A

2 NRTIs + third drug (NNRTI, PI or ISTI) Most evidence from Odyssey Trial for ISTI

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12
Q

NRTI examples

A

Zidovudine, Tenofovir, Lamivudine, Abacavir

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13
Q

NNRTI examples

A

Nevirapine

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14
Q

ISTI examples

A

Raltegravir, Dolutegravir

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15
Q

PI examples

A

Lopinavir/Ritonavir, Atazanavir

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16
Q

Side effects of NRTI

A

Lactic acidosis, mitochondrial toxicity, Zidovudine causes anaemia, and Tenofovir causes renal tubular dysfunction. Abacavir has hypersensitivity with HLA B5701

17
Q

Side effects of NNRTI

A

Rash, hepatitis, SJS within 6 weeks

18
Q

Side effects of PI

A

Lipodystrophy, hyperlipidemia, diabetes CYP3A4 metabolism (drug interactions)

19
Q

Side effects of INSTI

A

Insomnia, mood changes

20
Q

What percentage of HIV in kids is acquired through vertical transmission?

21
Q

What is the risk of HIV vertical transmission without intervention?

22
Q

When is highest risk of vertical transmission and what percentage?

A

60-70%, at delivery

23
Q

Maternal risk factors for vertical transmission

A

High viral load, low CD4 count, STIs, placental infection

24
Q

Delivery risks for vertical transmission

A

Prematurity, LBW. PROM. vaginal birth assisted delivery, episiotomy, ARM, chorio

25
Q

What is the risk of infection in utero?

26
Q

What intrapartum interventions can be instituted if high maternal viral load at 36 weeks?

A

Intrapartum antivirals, elective caesarean at 38 - 39 weeks gestation

27
Q

What type of feeding recommended for HIV positive mothers

A

Formula/donor EBM. RIsk of breast feeding transmission 5 - 20%, and with good ART suppression and supported breastfeeding reduces to <1% but not zero

28
Q

Risk factors for post partum transmission

A

Detectable viral load, longer feeding, mixed feeding, neonatal mouth or breast inflammation

29
Q

Neonatal post exposure prophylaxis

A

Commenced <4 hours after birth, 2 weeks for very low risk, 4 weeks for low to high risk

30
Q

When to start PCP prophylaxis

A

HIV PCR positive at any time or infant confirmed to have HIV.

31
Q

What is used for PCP prophylaxis and from what age

A

Cotrimoxazole, from 1 month age

32
Q

What is U = U

A

Undetectable = Untransmissible for sexual transmission, but doesn’t prevent other STIs so still need to use barrier protection

33
Q

Definition of undetectable viral load

A

VL <200 copies/mL for >6 months

34
Q

What is PREP

A

Pre-exposure prophylaxis in high risk, HIV negative populations. Daily ART given to reduced risk of transmission. 90% effective

35
Q

What is nPEP

A

Non occupational post exposure prophylaxis. Risk of HIV transmission = risk of HIV viraemia in source x exposure activity risk

36
Q

When to start nPEP and duration

A

Start <72 hours, duration 28 days, then test baseline serology then 3 months

37
Q

Which age group is HIV related mortality rising>

A

Adolescents. Poorer ART adherence.

Infectious Diseases (9 decks)

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