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Sexual Health > HIV > Flashcards

HIV Flashcards

1
Q

What are the 3 major structural genes of HIV?

A

Gag, Pol, Env

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2
Q

What does gag encode?

A

nuclear proteins

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3
Q

What does pol encode?

A

viral enzymes: reverse transcriptase, intergrase, protease

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4
Q

What other genes make up the structure of HIV?

A

Rev, tat and nef

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5
Q

What does env encode?

A

envelope glycoproteins?

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6
Q

Name the fungal infections that commonly cause fungal disease in HIV?

A

Candida albicans
Cryptococcus neoformans (CN)
Cryptococcal meningitis
Pneumocystis Jiroveci (PCP)

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7
Q

What is the most common feature of candida albicans in HIV infection, and how else can it occur?

A

Oral thrush = most common opportunistic infection
Oesophageal candidiasis = AIDs defining
Candida septicaemia = rare (IVDU and Neutropaenic conditions)

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8
Q

What are the signs and symptoms of oral thrush?

A

Creamy white plaques can be stripped off from surface of tissue (unlike OHL), Erythematous patches, Angular chelitis

Asymptomatic.
Tongue perversion, oral discomfort, pharyngeal discomfort on swallowing

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9
Q

What are the symptoms of oesophageal candidiasis?

A
  • Nausea & Dysphagia
  • Retrosternal pain on swallowing (odynophagia)
  • Creamy white plaques
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10
Q

How is candida albicans diagnosed?

A
  • Clinically
  • Trial of therapy
  • Endoscopy (if no response to therapy)
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11
Q

What is the treatment for candida albicans?

A
  1. Topical Nystatin/ Amphotericin lozenges
  2. Fluconazole 50-100mg/d
  3. If resistant: long term use of F or CD4<50: Itraconazole, IV amphotericin
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12
Q

How does CN occur?

A

High incidence in Africa
• Inhaled from bird faeces
• Sites: skin, lungs, meninges, brain

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13
Q

What are the signs and symptoms of CN, and how is it diagnosed?

A

Skin = umbilical papules & ulceration (like MC)

Lungs (40% CN):
Cough, SOB, fever
CXR = consolidation +/- cavitation, interstitial infiltrates, effusions

Dx = Broncho alveolar lavage

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14
Q

How does CM occur?

A

Cryptococcal meningitis

50-85% with CN
Life threatening
CD4 <50

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15
Q

What are the signs and symptoms of CM?

A

Headache (most common), Fever, Mental change

Signs:
may be absent, meningeal irritation, Neuro signs (uncommon)

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16
Q

How is cryptococcal meningitis diagnosed?

A 
Serum CRAG (cryptococcal Ag)
CSF: Indian ink stain (cryptococci), CRAG

Culture +/- lymphocytes

low glucose, high protein, high ICP

17
Q

What is the treatment for CM?

A

Treat for 6 WEEKS MIN or until CSF FREE:

  1. IV AMPHOTERICIN +/- FLUCOCYSTEINE if severe
  2. Then oral fluconazole
  3. Repeat LP to confirm sterilisation

Prophylaxis: fluconazole
Manage = intracranial hypertension

18
Q

How does PCP occur in HIV?

A

CD4 < 200

Less common since 1ary prophylaxis

19
Q

What are the S + S of PCP?

A
  • Dyspnea on exertion
  • Non protective cough
  • Fever, weight loss
  • diarrhoea

Signs
• Pyrexia
• Chest signs
• O2 desat on exertion

20
Q

How is PCP diagnosed?

A

CXR: Bilateral infiltrates (bat wings), Atypical appearance (effusions, cavitations, consolidation), Upper lobes only (pentamidine nebs prophylaxis)
ABG
O2 desaturation on exercise
BAL: SILVER STAINING, IMF, PCR

21
Q

How is PCP treated?

A
  1. CO-TRIMOXAZOLE 120mg/kg in 3 divided doses/d
  2. IV PENTAMIDINE
  3. Clincamycin & Primaquine

In severe PCP pO2 <10kPa: (steroids)
• Iv methylprednisolone
• Oral prednisolone

Prophylaxis = co-trimoxazole, pemtamidine nebuliser, Dapsone

22
Q

List the common protozoal infections in HIV?

A 
Toxoplasmosis gondii (TG)
Cryptosporidium parvum
Microsporidiosis
Isoporiadiasis
Aspergillus fumigatus
HIstoplasmosis
Peniclliosis
Coccidioidomycosis
23
Q

What are the clinical features of Toxoplasmosis gondii?

A
  • Cat faeces
  • CD4 <200
  • Common in Europe, france 80% IgG anti-Tg positive

3 F’s:

  1. Fever
  2. Focal neurological signs: CN palsies
  3. Fits

Headache, Confusion, eventually coma

Dx: IgM not helpful and Negative IgG does not exclude TG (only in countries of low prevalence in anti-TG Abs)

24
Q

What is the treatment for TG?

A

Sulphadiazine + Pyramethamine (or Dapsone or Clindamycin)

6 weeks of treatment

Prophylaxis: Dapsone + Pyramethamine

25
Q

What are the clinical features of Cryptosporodium?

A

Avoid by boiling or fine-filter water

Watery diarrhoea
Sclerosing cholangitis
o	Dilated biliary tree
o	Raised ALP
o	RUQ pain

Dx: Ziehl-Neelson staining of steel = made need up to 10, Rectal biopsy

26
Q

How is cryptosporidium treated?

A

Difficult to eradicate if CD4 <200
• HAART
• Paromycin
• Symptomatic Tx = Anti-diarrhoea, rehydration

27
Q

What are the clinical features of Microsporidiosis?

A

Sub Saharan Africa
Low volume diarrhoea

Dx = IF staining of stool

28
Q

What is the management of Microsporidiosis?

A
  • HAART
  • Albendazole
  • High dose erythromycin
29
Q

What is the common feature of protozoal infections?

A

Diarhhoeal illness and Lung disease

30
Q

What are the clinical features of Aspergillus fumigatus?

A 
Uncommon in HIV
RF:
•	CD4 <30
•	Neutropaenia
•	Steroids
•	Cannabis

Sx: lung Sx: cough, SOB, fever

Dx: CXR: cavitation

Mx: Amph and Itraconazole

31
Q

What are the CF for Histoplasmosis?

A

AIDS defining
• CD4 < 200
• Reactivation
• Severity of disease depends on degree of immunosuppression

Constitional Sx = fever
Respiratory disease

Signs:
•	Hepatosplenomegaly
•	Enlarged lymph nodes
•	Chest signs
•	10% rash = like molluscum, folllicitis
•	Neuro signs

Similar signs in Penicillosis (haemorrhagic molluscum)

Mx: Amph or Itroconazole

32
Q

What are the CF of coccidiodimycosis

A

CD4 < 200
Lung = diffuse & reticulonodular
AIDS defining = extra-pulmonary disease

Mx: Amph

33
Q

List the bacterial infection in HIV?

A 
Mycobacterial disease
Pneumococcus
Haemophilus
Salmonella
Staph
34
Q

What are the differences between MTB and MAI presentation in HIV-infected individuals?

A

MTB: Reactivation of disease, usually chest, occurs early in HIV disease, responds quickly to Rx and may form granulomas

MAI: New infection?, occurs in late disease (CD4<100), involves GIT, hepatosplenomegalu, abdo lymphadenopathy and anaemia, responds slowly to Rx

Sexual Health (3 decks)

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