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Infection (Milly's) > HIV > Flashcards

HIV Flashcards

1
Q

What does HIV stand for?

A

Human Immunodeficiency Virus

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2
Q

What is the structure of HIV?

A

SsRNA with envelope

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3
Q

HIV is a retrovirus, What is meant by retrovirus?

A

Is turns ssRNA into DNA and back again

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4
Q

What cells will HIV infect?

A

Cells with a CD4 surface receptor:
T helper lymphocytes
(Monocytes/macrophages)

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5
Q

How does HIV infect a cell?

A
  1. Binds to CD4 and other receptors on cell
  2. Inserts contents
  3. Reverse transcriptase turns the ssRNA from the virus into DNA
  4. Viral DNA is integrated into cells DNA by integrase enzyme (which is why it is so hard to treat)
  5. When infected cells divide, viral DNa is read and long chains of proteins are made
  6. Protein buds off and forms new virus (proteases create mature virus)
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6
Q

How is HIV transmitted?

A

Contact of infected bodily fluids with mucosal tissue/blood/broken skin

Ie sexual contact, transfusions (other medical procedures: skin grafts,organ donation), contaminated needles, perinatal transmission (during delivery through infected birth canal or result of ingestion of breast milk carrying virus)

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7
Q

What are the 4 stages of HIV infection?

A
  1. Primary infection/seroconversion (very infectious)
  2. Latent infection (CD4 count in much larger than viral load)
  3. Symptomatic infection (point at which viral load is greater than Cd4 count) ~350 - point at which people will notice they are unwell
  4. Severe infection/AIDS ~ <200 - at risk of severe infections/cancer/AIDS
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8
Q

What are the main symptoms and signs that are associated with an acute HIV infection?

A

Systemic:
Fever, weight loss

Mouth: sores, thrush

Oesophagus: sores

Muscles: myalgia

Liver and spleen: enlargement

Central: malaise, headache, neuropathy

Lymph nodes: lymphadenopathy

Skin: rash

Gastric: nausea, vomiting

Pharyngitis

Anaemia

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9
Q

Give examples of conditions associated with severe HIV

A

Brain: AIDS dementia complex

Eyes: CMV

Mouth: thrush

Blood: hyperglycaemia

Bones: osteoporosis

Heart: heart disease, stroke

Liver: Hep C

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10
Q

What does a low viral load in the blood mean in terms of HIV transmission?

A

Transmission is unlikely if undetectable VL

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11
Q

How can someone with HIV live a normal length life?

A

Early detection
Treatment
Adherence
Healthy living (smoking, alcohol, metabolic problems)

*the later the detection = worse prognosis

**the higher the CD4 count is when diagnosis is made the Better the chances of increases those levels

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12
Q

What blood tests would you do when confirming HIV?

A

Serology (looking at Ag and Ab)
PCR (detects HIV nuclei acid)
‘Rapid’ tests

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13
Q

How accurate is the serology blood test at diagnosing HIV?

A

Can detect both Ag and Ab within 4 weeks

Results can be given on the same day

*may get a false negative if test is performed too early

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14
Q

What are the pros and cons to doing a PCR blood test on someone with HIV?

A

Highly sensitive, detects very early infection (few days)

Expensive, results are slow

**this is used for follow up/treatment response not for initial HIV testing

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15
Q

What is a “rapid’ test for HIV?

A

Portable test for diagnosing HIV

Usually detect HIV antibody

Can be a finger print (blood) or oral (saliva) test

They have very accurate negative readings but it can give false positive results - would need to confirm result with serology

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16
Q

Who should be tested for HIV?

A

Everyone who presents with unexplainable symptoms ie pneumonia/ TB/ meningitis/ dementia/ weight loss/ blood abnormality / any STI etc

People with conditions known to have an association; lymphoma, anal cancer

17
Q

What are the aims of HIV treatment? (6)

A 
Undetectable HIV VL (not enough just to lower the viral lode)
Reconstituted CD4 count/ immune system 
Reduce general inflammation 
Reduce risk of transmission 
Good quality of life 
Normalise lifespan
18
Q

What is used to treat HIV?

A

ARV drugs

Anti-retro viral drugs

19
Q

At what stages within the HIV’s infection mechanism would you target drugs?

A
  1. Binding and fusion stage
  2. Reverse transcription stage
  3. Integration into cells DNA stage
  4. Maturation of budded virus stage
20
Q

When should someone be started on ARV drugs to treat HIV?

A

Straight away- regardless of CD4 count

21
Q

Which ARVs are given to treat HIV?

A

Combination of:

Nucleoside reverse transcriptase inhibitor (NRTI)

AND

Nuceloside reverse transcriptase inhibitor (NRTI)

AND (one of the following)

Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Protease inhibitor
Integrate inhibitor
CCR5 (entry) inhibitor

22
Q

Why are 3 ARVs given at once to treat HIV?

A

Because HIV is very prone to mutation and it is harder to develop resistance against 3 drugs

**it is vital that the patient keeps taking their drugs

23
Q

What strategies can be used to treat and reduce the prevalence of HIV?

A
  • increase condom use
  • prevention of mother-to-child transmission (c-section, no breast feeding)
  • ARV treatment as prevention (stops onwards transmission)
  • medical circumcision
  • PEP- post exposure prophylaxis
  • PrEP- pre exposure prophylaxis (someone who is likely to have a potential exposure to HIV)
24
Q

How might someone have immunity to HIV?

A

If they are lacking necessary proteins/ receptors on their cells so the HIV cannot enter the cell

25
Q

What are the ethical dilemmas that can be associated with HIV?

A

-psychological impact of diagnosis
-dealing with stigma
-patient confidentially vs:
Health of patient
Health of unborn child
Health of sexual partners
Health of older children
Risk to patients/staff at workplace

26
Q

Which initial investigation would you request from someone you susceptible of having HIV?

A 
Full blood count- Hb levels, white blood cells 
CRP- looking for inflammatory markers 
UandEs
LFT 
HIV tests (Serology and PCR)
CD4 count

chest x ray and head scan etc depending on other presenting symptoms

Infection (Milly's) (32 decks)

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