Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Infection Medicine > HIV > Flashcards

HIV Flashcards

1
Q

How many distinct HIV viruses are there?

A

Two:

  • HIV-1
  • HIV-2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most predominant type of HIV virus?

A

HIV-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What type of virus is the HIV virus?

A

Retrovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How many RNA chains does the HIV virus have?

A

Two single chains of RNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the life-cycle of the HIV virus

A
  1. Binding: virus binds to host CD4 receptor molecules via the envelope glycoprotein gp 120 and co-receptors CCR5 and CXCR4.
  2. Fusion: subsequent conformational change results in the fusion between gp41 and the cell membrane.
  3. Reverse transcription: entry of the viral capsid followed by uncoating of RNA. DNA copies are made from both RNA templates. DNA polymerase from the host cell leads to formation of dsDNA.
  4. Integration: virally encoded DNA is inserted into the host genome - Integrase
  5. Transcription: regulatory proteins control transcription (an RNA molecule is now synthesized from the DNA template).
  6. Budding: the virus is reassembled (protease - needed for mature virus progeny) in the cytoplasm and budded out from the host cell
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 4 distinct strains of HIV?

A
  • Group M - 98% of infections worldwide
  • Group N
  • Group O
  • Group P
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the general progression of infection in HIV?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the pathogenesis of HIV

A
  1. Virus transported by dendritic cells from mucosal surfaces
  2. GP120 reacts with CD4 and CCR5/CXCR4 -> entry into CD4 T cells, monocytes, macrophages and neural cells
  3. CD4 +ve cells migrate to lymphoid tissue
  4. Viral contents becomes integrated into nucleus of cell -> reverse transcription can take place
  5. As infection progresses - CD4 depletion/impaired function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How can HIV be transmitted?

A

All fluids

  • Sexual intercourse - Semen, cervical secretions
  • Mother-to-child
  • Contaminated blood, blood products, organ donation
  • Contaminated needles (IVDU, Injections, Needle-stick injuries)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where is HIV-2 most commonly found?

A

Most parts of WEst Africa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What enzyme integrates viral RNA into host DNA?

A

Viral integrase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What viral enzymes cleave initial viral proteins into enzymes and building blocks of the virus?

A

Viral proteases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is seroconversion?

A

The time period during which a specific antibody develops and becomes detectable in the blood. After seroconversion has occurred, the disease can be detected in blood tests for the antibody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How soon after initial exposure does seroconversion occur?

A

2-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are features of HIV seroconversion?

A

Presents with flu-like syndrome:

  • Fever
  • Malaise
  • Myalgia
  • Pharyngitis
  • Maculopapular rash
  • Lymphdenopathy
  • Mucosal ulceration
  • Headache/asceptic meningitis - rare
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What cells are susceptible to HIV infection?

A
  • CD4+ T cells
  • Macrophages
  • Monocytes
  • Neurons
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What follows seroconversion?

A

Asymptomatic infection, or persistent generalised lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How long can asymptomatic infection last for following seroconversion?

A

Can last for years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What defines the first clinical stage of HIV infection?

A

Asymptomatic infection or PGL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What features define clinical stage II of HIV infection?

A
  • Weight loss < 10%
  • Minor cutaneous manifestations
  • Herpes zoster in last 5 years
  • Recurrent URTI
  • Performance scale 1 - normal activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What features define clinical stage III HIV infection?

A
  • Weight loss > 10%
  • Unexplained chronic diarrhoea > 1 month
  • Unexplained prolonged fever > 1 month
  • Oral candidiasis
  • Oral hairy leukoplakia
  • Pulmonary TB within past year
  • Several bacterial infections
  • Performace scale 3 - bedridden <50% of day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What features suggest clinical stage IV HIV infection (AIDS defining illnesses)?

A
  • HIV wasting synrome
  • PCP
  • Toxoplasmosis of the brain
  • Cryptosporidiosis with diarrhoea > 1 month
  • CMV of organ other than liver, spleen or lymph nodes
  • HSV > 1 month
  • Progressive multifocal leukoencephalopathy
  • Any disseminated endemic mycosis
  • Candidiasis of oesophagus/trachea/bronchi/lung
  • Atypical disseminated TB
  • Extrapulmonary TB
  • Kapose’s sarcoma
  • HIV encephalopathy
  • Performace scale 4 - bedridden > 50% day in last month
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What respiratory conditions are regarded as AIDS defining illnesses?

A
  • TB
  • Pneumocystis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What proportion of individuals develop persistent generalised lymphadenopathy?

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What neurological conditions would you consider doing HIV testing in?

A

AIDS defining illnesses, plus:

  • Aseptic meningitis/encephalitis
  • Cerebral abscess
  • SOL of unknown cause
  • Guillain-Barre syndrome
  • Transverse myelitis
  • Unexplained Peripheral neuropathy
  • Lecuoencephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What dermatological conditions are regarded as AIDS defining illnesses?

A

Kaposi’s sarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is persistent generalised lymphadenopathy?

A

Lymph nodes >1cm in diameter at >/= 2 extra-inguinal sites, persisting for > 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What GI disorders are regarded as AIDs defining illnesses?

A

Persistent cryptosporidiosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What GI conditions would you consider offering an HIV test in?

A
  • Persistent cryptosporidiosis
  • Oral candidiasis
  • Oral hairy leukoplacia
  • Chronic diarrhoea of unknown cause
  • Weight loss of unknown cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What oncological problems are regarded as AIDs defining illnesses?

A

Non-Hodgkin’s Lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is Kaposi’s Sarcoma?

A

A cancer that causes patches of abnormal tissue to grow under the skin, in the lining of the mouth, nose, and throat, in lymph nodes, or in other organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the following?

A

Oral hairy leucoplakia - a white patch on the side of the tongue with a corrugated or hairy appearance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the following?

A

Oral candidiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What eye disease is regarded as an AIDs defining illness?

A

CMV retinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What neurological conditions are regareded as AIDS defining illnesses?

A
  • Cerebral toxoplasmosis
  • Primary cerebral lymphoma
  • Cryptococcal meningitis
  • Progressive multifocal leucoencephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is important to remember when trying to determine if someone has HIV with regards to test results?

A

Remember the diagnostic window - time during which diagnostic markers are not detectable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What dermatological conditions would you consider doing HIV testing in?

A
  • Kaposi’s Sarcoma
  • Severe/intractable seborrhoeic dermatitis
  • Severe/reclacitrant psoriasis
  • Recurrent/multidermatomal HSV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How does cerebral toxoplasmosis present?

A
  • Confusion
  • Seizures
  • Fever
  • Headache
  • Drowsiness/Coma
  • Signs of braainstem/spinal cord problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is progressive multifocal leukoencephalopathy?

A

A rare and usually fatal viral disease characterized by progressive damage (-pathy) or inflammation of the white matter (leuko-) of the brain (-encephalo-) at multiple locations (multifocal).

54
Q

What virus is responsible for progressive multifocal leukoencephalopathy?

A

JC virus

57
Q

What is the definition of AIDS?

A

HIV + AIDs defining illness

58
Q

What CD4 count will someone with AIDs usually have?

A

<200x106/L

59
Q

What are the main signs which suggest that HIV is progressing?

A
  • Chronic fever
  • PGL
  • Cough > 1 month
  • Chronic diarrhoea
  • Oral thrush
  • 10% weight loss in last month
  • TB/HZ
60
Q

If you suspected HIV, what investigations would you consider doing?

A
  • Bedside - Rapid HIV serum test, Mantoux test
  • Bloods - FBC, U+E’s, LFTs, Hep B/C, Toxoplasma serology, Pregnancy test
  • HIV specific - 4th Gen. ELISA for HIV Ab + Ag (p24 antigen), HIV RNA/nucleic acid PCR
  • Imaging - CXR
62
Q

When are serum IgG and IgM levels detectable for HIV?

A

After 3 months, then fall after AIDs develops

63
Q

What is P24 antigen?

A

p24 protein is present during high viral replication and so is detectable in the blood during acute infection (first 3 months) and again during late stages of infection (AIDS). Its use, therefore, is as a supplementary test during the window period

64
Q

What might you find on CXR in someone with HIV?

A
  • Pneumocystis jirovecii pneumonia
  • TB
65
Q

If someone was tested for HIV and came back as being antigen/antibody negative, would this confirm that they were not infected with HIV?

A

No - have to retest tro make sure diagnosis has not been missed

66
Q

What should HIV patients be monitored for regularly?

A

TB infection

67
Q

What might the following be in someone with SOB and dry cough with HIV?

A

PCP - perihilar infiltrates is classic sign

68
Q

What investigations would you do to monitor HIV?

A
  • Clinical assessment
  • Viral RNA load
  • CD4 count
  • HIV resistance testing
  • Other bloods - FBC, U+Es, LFT, lipid profile, glucose
69
Q

How often would you monitor CD4 levels?

A

3-6 months

70
Q

What is viral load used for?

A

Determine effectiveness of antiviral therapy

71
Q

What infections should all newly diagnosed HIV patients be screened for?

A
  • TB
  • Toxoplasma
  • CMV
  • Hepatitis B + C
  • Syphilis
72
Q

When is viral load highest?

A

Initially high during acute infection, then falls to low levels, then rises again in later stages of the disease (6-8 years after infection)

73
Q

How is viral load measured?

A

Viral PCR quantitation

74
Q

What is the normal CD4 level?

A

500-1500

75
Q

At what CD4 level would you consider starting someone on antiretrovirals?

A

<350

76
Q

What are indications for starting antiviral therapy in HIV?

A
  • CD4 < 350
  • AIDS defining illness
  • Pregnant women
  • HIV-associated nephropathy
  • Co-infection with HBV
77
Q

What are the main types of anti-retroviral drugs used in HIV?

A
  • Nucleoside recerse transcriptase inhibitors
  • Non-nucleoside reverse transcriptase inhibitors
  • Protease inhibitors
  • CCR5 antagonists
  • Integrase strand transfer inhibitors
  • Pharmakokinetic enhancers/boosters
78
Q

What is the reason for someone to have persistent generalised lymphadenopathy?

A

Due to follicular hyperplasia caused by HIV infection

79
Q

How much does 4th generation HIV testing reduce the window period to (in terms of number of days that a false negative can occur in)?

A

Approximately 10 days

80
Q

How do nucleoside/nucleotide reverse transcriptase inhibitors work?

A

Inhibit reverse transcriptase and the conversion of viral RNA into DNA

81
Q

How do CCR5 antagonists work?

A

Inhibit entry of the virus into the cell by blocking the CCR5 receptor

82
Q

How do integrase strand transfer inhibitors work?

A

Inhibit integrase and prevent HIV DNA integrating into the nucleus

83
Q

How do protease inhibitors work?

A

Inhibit protease, an enzyme ivolved in the maturation of virus particles

84
Q

What are examples of Rapid point-of-care testing for HIV?

A
  • Finger-prick
  • Mouth swab
85
Q

What is viral load used for?

A
  • Quantification of HIV RNA
  • Monitoring of ART efficacy
86
Q

Is rapid testing confirmatory of HIV?

A

No - needs serological confirmation with 4th Gen ELISA

87
Q

What is viral/nucleic acid PCR used for?

A

Used to test for presence of virus

88
Q

What are features of PCP infection in HIV?

A
  • Progressive SOB on exertion
  • Malaise
  • Dry cough
  • Tachypnoea
90
Q

What are features of cryptococcal meningitis in someone with HIV?

A
  • Meningism - headache, fever, neck stiffness
  • Molloscum-like skin lesions
  • Lung disease
91
Q

How can CMV infection present in HIV?

A
  • Retinitis
  • Encephalitis
  • GI disease
  • Hepatitis
  • Bone marrow suppression
  • Pneumonia
92
Q

What would be your differential diagnosis for a fever in an HIV patient?

A
  • Intraoral abscess
  • Sinusitis
  • Pneumonia
  • TB
  • Endocarditis
  • Meningitis
  • Encphalitis
  • Pyomyositits
  • Lymphoma
  • Any non-HIV cause
93
Q

What would be your differential for lyphadenopathy in HIV patients?

A
  • PGL
  • TB
  • Syphillis
  • Histoplasmosis
  • Cryptococcus
  • Lymphoma
  • Kaposi’s Sarcoma
  • Local infection
94
Q

What would be your differential diagnosis for a rash in someone with HIV?

A
  • Drug reaction
  • Herpes zoster
  • Scabies
  • Cutaneous cryptococcus
  • Kaposi’s Sarcoma
  • Seborrhoeic dermatitis
95
Q

What would be your differential diagnosis for someone presenting with a cough/SOB in someone with HIV?

A
  • CAP
  • PCP
  • TB
  • Bronchial compression - lymphoma, TB, kaposi’s
  • Pulmonary Kaposi’s sarcoma
  • Cardiac failure - HIV cardiomyopathy, pericardial effusion, HIV vasculopathy
96
Q

What would be your differential diagnosis for someone with diarrhoea who had HIV?

A
  • Slamonella
  • Shigella
  • C. diff
  • Amoebiasis
  • Giardia
  • Cryptosporidia
  • CMV
  • HIV enteropathy - diagnosis of exclusion
97
Q

What might cause abdominal pain in those with HIB?

A
  • TB
  • CMV colitis
  • Pancreatitis
  • Pregnancy
98
Q

What could cause headaches/seizures/focal neurology in HIV patients?

A
  • Meningitis - bacterial, TC, syphillis
  • Empyema
  • SOL - toxo, lymphoma, TBoma
  • Adverse drug reaction
  • HIV encephalopathy
  • Progressive multifocal leukoencephalopathy
  • Stroke
99
Q

What could cause dysphagia in someone with HIV?

A
  • Candidiasis
  • HSV
100
Q

What might cause eye disease in HIV?

A
  • CMV
  • Herpes zoster
101
Q

What might cause deranged LFTs in HIV?

A
  • Viral hepatitis
  • Drug-induced liver injury
  • HIV cholangiopathy
  • Lymphoma
  • CCF
106
Q

What is the main purpose of pharmacokinetic enhancers/boosters?

A

Increase the effectiveness of antiretroviral drugs allowing lower doses

107
Q

What would you consider for treatment-naive individuals in HIV?

A

2 NRTIs, plus one of:

  • Boosted protease inhibitor
  • NNRTI
  • Integrase inhibitor
108
Q

What are examples of NRTIs?

A
  • Zidovudine (AZT)
  • Didanosine (ddI)
  • Zalcitabine (ddC)
  • Lamivudine (3TC)
  • Stavudine (d4T)
  • Abacavir
109
Q

What are side effects of NRTI’s?

A
  • Marrow toxicity
  • Neuropathy
  • Lipodystrophy
  • GI disturbance
  • Anorexia
  • Pancreatitis
  • Hepatic dysfunction
  • Lactic acidosis
110
Q

What are the adverse reactions associated with protease inhibitors?

A
  • Hyperglycaemia
  • Lipodystrophy
  • Diarrhoea
  • Insulin resistance
  • Dyslipidaemia
  • Jaundice
  • Hepatitis
111
Q

What are adverse reactions of NNRTIs?

A
  • Nausea and vomiting, abdominal pain and diarrhoea common
  • Hypersenstivity reaction
  • Rash (can be severe)
  • CNS / psychiatric disturbance
  • Hepatotoxicity
112
Q

What are side effects of integrase inhibitors?

A
  • Rash
  • GI disturbance
  • Insomnia
113
Q

Why is adherence incredibly important in HIV treatment?

A

Deccreased adherence causes increased resistance due to error prone replication process of virus

114
Q

What baseline tests should you consider doing in somone you are about to start on ART treatment for HIV?

A
  • CD4
  • Viral load
  • FBC
  • LFT
  • U+E’s
  • Pregnancy Test
  • Viral genotyping for resistance
115
Q

What measures would you take for managing a pregnant woman with HIV who are having a vaginal delivery?

A
  • Continue HAART through labour
  • Avoid foetal blood sampling
  • Avoid amniotomy
  • Use oxytocin for augmentation
  • Avoid rotational/mid-cavity forceps
116
Q

When should C-section be offered to women with HIV?

A

38 weeks gestation if:

  • AZT monotherapy
  • Viral load > 50 copies/mL
  • Co-infected with hepatitis C
117
Q

What post-partum measures should be taken in a mother with HIV?

A
  • Avoid breastfeeding - cabergoline to suppress lactation
  • ART for newborn within 4hrs birth
  • Test at 1wk, 6 wks, 12 wks and 18 months for HIV
  • Dicuss contraception, annual smears with mother

Infection Medicine (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions