HIV

Question 1

If there is no treatment, how long is the period from diagnosis to death?

Answer 1

15 years, but it’ll be 8 years until the patient shows signs of rare infections and cancers

Question 2

What fraction of people with HIV are unaware that they have it?

Answer 2

1 in 4

Question 3

In which situations is routine testing of HIV necessary?

Answer 3

• Pregnancy
• GUM clinic
• If HIV prevalance exceeds 2/1000 local population
• Healthcare services for those with TB, HBV, HCV and lymphoma

Question 4

How is HIV treated in pregnancy?

Answer 4

Antiretrovirals to both mother and baby

Question 5

What are the consequences of HIV?

Answer 5

• Opportunistic infections
• Malignancy (Karposis sarcoma, rectal cancer)
• Direct effect of HIV itself (kidney, CNS damage)

Question 6

What is the natural history of untreated HIV infection (5 stages)?

Answer 6

1. Primary infection (high VL, fall in CD4 count)
2. Early stage (CD4>500) usually asymptomatic
3. Middle stage (CD4 200-500)
4. Advanced stage (CD4 50-200) AIDS, develops aids defining illnesses
5. Late stage (CD4<50)

Question 7

Name some AIDS defining illnesses?

Answer 7

PCP, Kaposi’s sarcoma, lymphomas, mycobacterium avium complex, TB, cervical cancer, CMV, oral candidiasis, leukoplakia (EBV)

Question 8

What is HAART?

Answer 8

Highly Active Antiretroviral Therapy (for life) uses at least 3 drugs from at least 2 groups:

• Nucleoside reverse transcriptase inhibitors
• Non-nucleoside reverse transcriptase inhibitors
• Protease inhibitors
• Integrase inhibitors

Question 9

If you have HIV, how often if your viral load and CD4 count monitored?

Answer 9

6 monthly

Question 10

Which sexual activity gives the highest risk of HIV transmission?

Answer 10

Receptive anal

Question 11

In what window can post-exposure prophylaxis be given for HIV?

Answer 11

72 hours post exposure

- patient should be aware that it could induce vomiting diarrhoea and rash

Question 12

What type of virus is HIV

Answer 12

ssRNA, retrovirus

Question 13

What is p24, gp120 and gp41?

Answer 13

p24 - viral protein composing capsid

gp120/41 - Docking and transmembrane glycoproteins

Question 14

What is a seroconversion illness?

Answer 14

An illness occurring 2-4 weeks post exposure and lasting 1-2 weeks, causing RASH (maculopapular), FEVER and SORE THROAT

Question 15

What is pneumocystis cairn pneumonia?

Answer 15

A yeastlike fungal micro-organism which commonly causes death in HIV

Question 16

Name some dermatological manifestations of HIV

Answer 16

Recurrent HSV
Molloscum contagiosum
Oral leukoplakia (can't be scraped away)
Recurrent shingles
Seborrhoeic dermatitis
Crusted scabies
HPV (warts)

Question 17

How does the HIV test work?

Answer 17

Looks for HIV antibody and HIV itself (p24)
Results are accurate at 3 months (not necessarily before)

Dont forget to write that consent was taken in the notes

Question 18

How many pills does someone with HIV take for treatment each day?

Answer 18

1

Question 19

What is the global prevalence of HIV?

Answer 19

0.8%

Question 20

Which areas in the world have the highest prevelance of HIV?

Answer 20

Sub-saharan africa, then south america

Question 21

What are the features of PCP?

Answer 21

Insidious onset pneumonia with exertional dyspnoea and bilateral CXR signs, on a background of HIV

Question 22

How are PCP and toxoplasmosis treated?

Answer 22

Co-trimoxazole

Question 23

What are the features of toxoplasmosis?

Answer 23

Neurological symptoms, ring-enhancing lesions

Question 24

What are the features of CMV retinitis?

Answer 24

Visual impairment, ‘tomato and cheese pizza’ retina