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HIV Flashcards

1
Q

what does HIV cause

A

Acquired Immunodeficiency Syndrome (AIDS)

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2
Q

how is AIDS preventable

A

early HIV diagnosis

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3
Q

what is HIV

A

retrovirus

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4
Q

what is the target site for HIV

A

CD4+ receptors

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5
Q

where are CD4+ receptors found

A

T helper lymphocytes (“CD4+ cells”)
Dentritic cells
Macrophages
Microglial cells

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6
Q

what is the function of CD4+ Th lymphocytes

A

Essential for induction of adaptive immune response

  • Recognition of MHC2 antigen-presenting cel
  • activate B cells
  • activate cytotoxic T-cells [CD8+]
  • cytokine release
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7
Q

what affects does HIV infection have on immune response [5 things]

A

Reduced circulating CD4+ cells

Reduced proliferation of CD4+ cells

Reduction CD8+ (cytotoxic) T cell activation

Reduction in antibody class switching = Reduced affinity of antibodies produced

Chronic Immune Activation

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8
Q

what does the affect on the immune response that HIV has make people susceptible to

A

viral infections
fungal infections
mycobacterial infections
infection-induced cancers

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9
Q

what is the normal CD4+ Th cell parameters

A

500-1600

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10
Q

when is there a risk of opportunistic infections

A

when CD4+ Th cell < 200

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11
Q

what are the key features of HIV viral replication

A

rapid replication in very early and very late infection

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12
Q

what cells does the HIV virus first infect

A

mucosal CD4 cells [Langerhans and Dendritic cells]

transported to regional lymph nodes

infection established within 3 days of entry

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13
Q

when can post-exposure prophylaxis be given and why

A

within 72 hours of exposure

as the infection needs 3 days to become established

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14
Q

when does the primary HIV infection symptoms occur

A

2-4 weeks after infection

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15
Q

what are the Sx seen in the primary HIV infection period

A 
fever
maculopapular rash
myalgia 
pharyngitis 
headache/aseptic meningitis
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16
Q

why are people in the primary HIV infection stage high risk

A

they have high viral load

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17
Q

what is happening during asymptomatic HIV infection

A

Ongoing viral replication
Ongoing CD4 count depletion
Ongoing immune activation

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18
Q

what is the definition of an opportunistic infection

A

infection caused by a pathogen that does not normally produce disease in a healthy individual

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19
Q

what type of pneumonia is seen in HIV

A

pneumocystis pneumonia

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20
Q

what organism causes pneumonia and what CD4 threshold is needed for it to cause Sx

A

Pneumocystis jiroveci

< 200

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21
Q

Sx of pneumocystis pneumonia

A

insidious onset
SOB
dry cough

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22
Q

Signs of pneumocystis pneumonia

A

exercise desaturation - when oxygen saturations drop after exercise

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23
Q

what Ix can be done of pneumocystis pneumonia

A

CXR = may be normal, interstitial infiltrates, reticulonodular marking

Diagnostic = Bronchoalveolar lavage and immunofluorescence +/- PCR

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24
Q

Tx of pneumocystis pneumonia

A

high dose co-trimoxazole +/- steroids

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25
Q

what forms of TB are HIV +ve more prone to

A 
Symptomatic primary infection
Reactivation of latent TB
Lymphadenopathies
Miliary TB
Extrapulmonary TB
Multi-drug resistant TB
26
Q

what organism causes Cerebral toxoplasmosis and what CD4 threshold is require for it to appear

A

Toxoplasma gondii = fungal infection

< 150

27
Q

what is seen on CT of Cerebral toxoplasmosis

A

multiple ring enhancing lesions

28
Q

Sx of Cerebral toxoplasmosis

A 
Headache
Fever
Focal neurology (weakness, sensory problem)
Seizures
Reduced consciousness
Raised ICP
29
Q

when does CMV cause Sx in HIV

A

when CD4 <50

30
Q

what does CMV cause

A

retinitis
colitis
oesophagitis

31
Q

how does CMV present

A 
reduced visual acuity 
floaters
abdo pain
diarrhoea 
PR bleeding
32
Q

what is offered to HIV patients to try prevent serious Sx of CMV

A

Ophthalmic screening for all individuals with CD4 <50

33
Q

what skin infections are common in HIV

A 
herpes zoster 
herpes simplex
HPV
Penicilliosis
Histoplasmosis
34
Q

what form of HIV is associated with “HIV-associated neurocognitive impairment”

A

HIV-1

35
Q

what CD4 threshold in HIV-associated neurocognitive impairment seen

A

ANY

increased incidence with increased immunosuppression

36
Q

Sx of HIV-associated neurocognitive impairment

A

Reduced short term memory

+/- motor dysfunction

37
Q

what organism causes Progressive multifocal leukoencephalopathy and what CD4 threshold is it seen

A

JC virus

< 100

38
Q

Sx of Progressive multifocal leukoencephalopathy

A

Rapidly progressing
Focal neurology
Confusion
Personality change

39
Q

what is “Slim’s disease”

A

HIV-associated wasting/cachexia

40
Q

what are the cancers related to AIDS

A

Karposi’s sarcoma
Non-Hodgkins lymphoma
Cervical cancer

41
Q

what organism is associated with Kaposi’s sarcoma and at what CD4 threshold is it seen

A

Human herpes virus 8 (HHV8)

Any
however, increased incidence with increased immunosuppression

42
Q

what is the pathology of a Kaposi’s sarcoma

A

vascular tumour

43
Q

where can kaposi’s sarcoma occur

A

cutaneous
mucosal
visceral - pulmonary, GI

44
Q

kaposi’s sarcoma Tx

A

HAART
Local therapies
Systemic chemotherapy

45
Q

excluding opportunistic HIV, what can be seen in symptomatic HIV

A 
Mucosal candidiasis
Seborrhoeic dermatitis
Diarrhoea
Fatigue
Worsening psoriasis
Lymphadenopathy
Parotitis
46
Q

what haematology manifestations are seen in HIV

A

anaemia

thrombocytopenia [commonly ITP]

47
Q

through what ways is HIV transferred

A

sexual transmission
parenteral transmission
mother-to-child

48
Q

how can HIV be transferred mother-to-child

A

In utero/trans-placental
Delivery
Breast-feeding

49
Q

where is there opt-out HIV testing

A 
Abortion services
GUM clinics 
Drug dependency services
Antenatal services 
Assisted conception services
50
Q

what are the high risk groups that are screened for HIV

A 
MSM
Females of bisexual partners
IVDU
Partners of people with HIV
Adults from endemic areas
Children from endemic areas
Sexual partners from endemic areas
51
Q

what are the endemic areas of HIV

A

Sub-Saharan Africa
Caribbean
Thailand

52
Q

what markers are used by the lab to detect HIV infection

A

RNA
p24 antigen
HIV-1 and HIV-2 [IgM and IgG] antibody (only positive after 3 months of being infected)

53
Q

what is currently the best test to date for HIV

A

4th gen HIV test

combined antibody and antigen (p24)

54
Q

how can the 4th gen HIV test be interpreted

A

A negative 4th generation test performed at 4 weeks following an exposure is highly likely to exclude HIV infection

55
Q

what is HAART

A

Highly active anti-retroviral therapy

i.e. a combination of 3 drugs from at least 2 drug classes to which the virus is susceptible

56
Q

what is the purpose of HAART therapy

A

Reduce viral load to undetectable
Restore immunocompetence
Reduce morbidity and mortality
Minimise toxicity (maximise tolerability)

57
Q

what are examples of single tablet formulations of HAART

A

Tenofovir
Emtricitabine
Efavirenz

58
Q

what are examples of HAART side effects

A 
GI = nausea, diarrhoea, abdominal pain, vomiting 
Skin = rash, hypersensitivity, Stevens-Johnsons syndrome
CNS = mood changes, psychosis
Renal = proximal renal tublopathies 
Bone = osteomalacia
CVS = increased MI risk
Haematology = anaemia
59
Q

what are conception options for HIV couples where male is +ve, female is -ve

A

Timed unprotected sex with HAART

Treatment as Prevention

60
Q

what are conception options for HIV couples where female is +ve, male is -ve

A

self-insemination
timed unprotected sex with HAART
Tx as prevention

61
Q

what can be done to prevent transmission of HIV from mother to child

A

HAART during pregnancy

Vaginal delivery if undetected viral load

Caesarean section if detected viral load

4/52 Post-Exposure Prophylaxis for neonate

Exclusive formula feeding

Reproduction SB (30 decks)

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