HIV Flashcards
The so-called_______ is where the plasma viral
load drops to a steady level for many years
‘set point’
Patients invariably recover to enter a long period of
good health for_____ years
5
_______is
the commonest presentation of AIDS
Pneumocystis jiroveci (ex carinii ) pneumonia (PJP)
Approximately_______ of HIV-positive children
are infected from HIV-infected mothers
15–40%
Infants born to these mothers may develop the
disease within a few months, with 30% affected by
the age of _____
18 months.
The time for the onset of AIDS in HIV-affected adults
varies from 2 months to 20 years or longer; the
median time is around ____
10 years
In family practice the most common presentation of
HIV-related illness is seen in the ______
for example, candidiasis and herpes
skin/oral mucosa,
____is a common, serious but treatable complication
of HIV
TB
HIV antibody testing is a two-stage process: the
_____ test for screening followed by
another method (e.g. Western blot) if positive
antigen–antibody
The seroconversion period from acquiring HIV
infection to a positive antibody test varies between
individuals: this period is known as the_____
‘window
period
The level of immune depletion is best measured
by the ________
count—the CD 4 cell count
CD 4 positive T-lymphocyte (helper T-cell)
What are clinical stages of HIV
1 2 3 4 5
- Seroconversion illness (self-limited 1–3 weeks)
- Asymptomatic
- Symptomatic—early
- Symptomatic—late
- Advanced
The illness usually occurs
within 6 weeks of infection and is characterised by
fever, night sweats, malaise, severe lethargy, anorexia,
nausea, myalgia, arthralgia, headache, photophobia,
sore throat, diarrhoea, lymphadenopathy, generalised
maculoerythematous rash and thrombocytopenia
Acute (seroconversion) illness
Main Sx of acute seroconversion
The main symptoms are headache, photophobia
and malaise/fatigue
Close ddx of acute seroconversion
resembles infectious mononucleosis
labs of acute seroconversion
neutropenia,
lymphopenia, thrombocytopenia, and mildly
elevated ESR and serum transaminase
fever + severe malaise +
lymphadenopathy
acute HIV
CD4 count
Seroconversion illness
Transient decrease, commonly
followed by a return to nearnormal
level
CD4 count
Asymptomatic
Usually >500 cells/μL
Gradual decrease of
50–80 cells/μL
CD4 count
Symptomatic—early
Usually 150–500 cells/μL
CD4 count
Symptomatic—late
Usually <150 cells/μL
CD4 count
Advanced
Usually <50 cells/μL
What stage of HIV
Headaches
Persistent generalised lymphadenopathy
Asymptomatic
What stage of HIV
Oral and vaginal candidiasis, oral hairy leukoplakia,
seborrhoeic dermatitis, psoriasis, recurrent varicella
zoster infection, cervical dysplasia, unexplained
fever, sweats, weight loss, diarrhoea, tuberculosis
Symptomatic—early
What stage of HIV
PJP, Kaposi sarcoma, oesophageal candidiasis,
cerebral toxoplasmosis, lymphoma, HIV-1 associated
dementia complex, cryptococcal meningitis
Symptomatic—late
What stage of HIV
CMV retinitis, cerebral lymphoma, Mycobacterium avium complex (MAC) infection
Advanced
T or F
Severe PJP can have little or no chest signs, and, unless
treated, patients can rapidly deteriorate and die
T
Oral manifestations of patients with HIV
• Aphthous ulcers • Angular cheilitis • Periodontal/gingival disease • Tonsillitis • Oral candidiasis • \_\_\_\_\_\_\_\_ (frequently mistaken for candidiasis but affects lateral border of tongue)
Oral hairy cell leukoplakia
Cutaneous manifestations of HIV
1 2 3 4 5 6
- Impetigo
- Warts
- HSV
- Shingles, especially multidermatomal
- Seborrhoeic dermatitis
- Cutaneous mycoses
painless red-purple lesions on
any part of the body including palms, soles, oral
cavity and other parts of the GIT
Kaposi sarcoma
the strongest predictor
of possible clinical manifestations of HIV infection
CD 4 lymphocyte counts
a measure of the serum level of RNA
of the HIV virus—correlates with response to
treatment and progression to AIDS and death
Viral load
T or F,
Monotherapy is important in HIV Tx
F
In HIV Tx
______ is the limiting factor, no matter how
potent an individual drug may be at reducing viral
load initially.
Viral resistance
The trials of combined ______ and ________demonstrated both a more sustained
decrease in plasma viral load than either drug did alone,
and a more delayed development of viral resistance
zidovudine and
lamivudine
Most acceptable HIV Tx
(HAART)
Subcutaneous injections of
______have been shown to boost immunity
interleukin-2
Current thinking favours early treatment. The
most widely used and preferred regimen consists of _________
2
NTIs plus either an NNRI or a protease inhibitor
This is a combination of three (or more) agents with
one or more penetrating the blood–brain barrier.
HAART (highly active antiretroviral therapy
This is an important cause of pneumonia and not
usually seen until the CD 4 + cell count is <200/ μ L
Pneumocystis jiroveci 9
Tx of Pneumocystis jiroveci
It is usually treated with trimethoprim +
sulfamethoxazole (cotrimoxazole) oral or IV for
21 days depending on severity, which is also given
orally as prophylaxis when the cell count reaches
<200
Alterantive Tx of Pneumocystis jiroveci
Alternative agents are IV pentamidine or oral
dapsone, clindamycin and atovaquone.
T or F
You need a Repeat HIV antibody test
T
T or F
You need a G6PD test for all HIV pts
T
Prophylaxis—this is managed according to
immune status: if CD 4 count <200 cells/ μ L
use ______ to prevent opportunistic
infections, particularly PJP
cotrimoxazole
