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Y3 OBS AND GYNAE > HIV > Flashcards

HIV Flashcards

1
Q

HIV = AIDS. True/False? How is it prevented?

A

False
HIV does not mean you have AIDS but it increases the risk of getting AIDS
Early diagnosis and treatment

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2
Q

What type of virus is HIV?

A

Retrovirus

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3
Q

Which immune receptors are the target of HIV infection?

A

CD4+ receptors

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4
Q

What effect does HIV attacking CD4 receptors have on the immune system?

A 
Reduced circulating CD4
Reduced CD8 activation
Reduced antibody class switching
Chronic immune activation
Basically, increases susceptibility to infection!
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5
Q

What is the normal range of CD4 cells?

A

500-1600 cells/mm3

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6
Q

What is meant by opportunistic infection? What range of CD4 cells puts a person at risk of this infection?

A

Infection that would not normally occur in a healthy individual
<200 cells/mm3

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7
Q

At what points of infection does HIV rapidly replicate?

A

Early and late points

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8
Q

When do clinical presentations of HIV typically occur?

A

2-4 weeks after onset of infection

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9
Q

List some clinical features of primary HIV infection

A 
Fever
Maculopapular rash
Myalgia
Pharyngitis
Headache
Meningism
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10
Q

Is there a high risk of transmission of HIV?

A

Very high risk through normal routes (i.e. not airborne)

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11
Q

Asymptomatic HIV infection involves a latent/dormant virus. True/False?

A

False!

Infection is ongoing even though person is asymptomatic; still risk of transmission

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12
Q

What cause of pneumonia is a common opportunistic infection occurring in HIV/AIDS patients? What are the clinical signs?

A

Pneumocystis jirovecii

Insidious onset, SOB, dry cough, reduced exercise tolerance

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13
Q

How is pneumocystis jirovecii pneumonia diagnosed?

A

Bronchoalveolar lavage and immunofluorescence

+/- PCR

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14
Q

What is the treatment for pneumocystis jirovecii?

A

Co-trimoxazole +/- steroid

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15
Q

Cerebral toxoplasmosis is another opportunistic infection. What organism causes it? What are the clinical signs?

A

Toxoplasma gondii

Headache, fever, focal signs, seizures, reduced consciousness, raised ICP

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16
Q

What happens pathologically in cerebral toxoplasmosis?

A

Chorioretinitis - multiple cerebral abscesses

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17
Q

Which animal/pet is particularly infamous for transferring toxoplasma to humans?

A

Cats

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18
Q

What is the CD4 threshold for cerebral toxoplasmosis?

A

CD4 less than 150

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19
Q

CMV is another opportunistic infection. What is the CD4 threshold for this?

A

CD4 less than 50

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20
Q

How does CMV usually present?

A 
Reduced visual acuity
Floaters
Abdo pain
Diarrhoea
PR bleeding
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21
Q

List some opportunistic skin infections that may occur with HIV

A

Herpes zoster
Herpes simplex
Human papilloma virus

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22
Q

Which HIV strain is associated with neurocognitive impairment? What are the clinical signs?

A

HIV-1

Reduced short-term memory, motor dysfunction

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23
Q

Which condition is caused by JC virus as an opportunistic inffection? What are the clinical signs?

A

Progressive multifocal leukoencephalopathy

Rapid, focal neuro, confusion, personality change

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24
Q

What is “Slim’s disease” in association with HIV?

A

HIV-associated wasting due to metabolic disorder, anorexia, malabsorption and/or hypogonadism

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25
Q

What is the most common AIDS-related cancer?

A

Kaposi’s sarcoma

26
Q

Which organism causes Kaposi’s sarcoma? What are the clinical signs?

A

Human herpes virus 8

Cutaneous, mucosal, visceral (pulmonary, GI)

27
Q

How is Kaposi’s sarcoma treated?

A

HA anti-retroviral therapy
Local therapy
Systemic chemotherapy

28
Q

Which AIDS-related cancer is caused by EBV? What are the clinical signs?

A

Non-Hodgkins lymphoma

Advanced, B symptoms, bone marrow involvement, extranodal disease, CNS signs

29
Q

Which AIDS-related cancer is caused by HPV?

A

Cervical cancer

30
Q

What are the 3 main modes of transmission of HIV?

A

Sexual
Parenteral
Mother-to-child

31
Q

Is HIV more common in men who have sex with men or women who have sex with men who have sex with men?

A

Men who have sex with men

32
Q

What sexual factors increase the risk of getting HIV?

A

Anoreceptive
Trauma
Genital ulceration
Concurrent STI

33
Q

How might HIV be acquired parenterally?

A

Injection drug use
Infected blood products
Iatrogenic

34
Q

Who should be tested for HIV?

A

Those in high prevalence areas
Screening of high-risk groups
Those with clinical indicators
Opt out testing in clinical settings (TOP, GUM, drug dependancy, antenatal, ACT clinics)

35
Q

What are high-risk groups for HIV?

A 
Men who have sex with men
Women who have sex with men who have sex with men
Injecting drug users
People living with people who have HIV
Endemic areas
36
Q

What markers of HIV are used to detect infection?

A

Antibody
Antigen (p24)
Viral RNA

37
Q

List markers of HIV in order of first appearance

A

Viral load
Antigen
Antibody

38
Q

What is the window period of 3rd generation antibody tests for HIV compared to 4th generation antibody tests?

A

20-25 days (3rd gen)

14-28 days (4th gen)

39
Q

How do 4th gen antibody tests differ from 3rd gen antibody tests for HIV?

A

3rd gen: antibody only

4th gen: antibody + antigen

40
Q

What is the BASHH guidance on a negative 4th gen antibody test with regards to HIV?

A

Negative antibody test performed 4 weeks after exposure is highly likely to exclude HIV infection

41
Q

What rapid HIV tests can be done?

A

Fingerprick
Recent infection testing algorithm
Home sampling
Home testing

42
Q

Which drug class has in vitro activity against HIV? Give an example of a drug under this class

A

Nucleoside analogues reverse transcriptase inhibitors (NRTI)

Zidovudine

43
Q

What is highly-active anti-retroviral therapy (HAART)?

A

Combination of 3 drugs from at least 2 drug classes to which the virus is susceptible

44
Q

Partner notification of HIV is a voluntary process. True/False?

A

True

45
Q

There is no risk of HIV transmission with casual/household contact. True/False?

A

True

46
Q

Outline the immunopathogenesis of HIV infection

A

Primary infection –>
Acute HIV syndrome/wide dissemination of virus/seeding of lymphoid organs –>
Asymptomatic infection –>
Constitutional symptoms/opportunistic diseases/death

47
Q

List some non-opportunistic manifestations of HIV

A 
Mucosal candidiasis
Seborrhoeic dermatitis
DIarrhoea
Fatigue
Worsening psoriasis
Lymphadenopathy
Parotitis
STIs/Hep B/Hep C
48
Q

State the two main haematological manifestations of HIV

A

Anaemia

Thrombocytopaenia

49
Q

State sites of HIV pandemics on a global scale

A

Sub-saharan Africa
Caribbean
South-east Asia

50
Q

How do NNRTI’s work?

A

Replaces AA picked up by reverse transcriptase causing chain termination

51
Q

List sites in the HIV cycle targeted by treatment

A 
Reverse transcriptase
Integrase
Protease
Entry
Maturation
52
Q

What is the primary way in which drug resistance is prevented in HIV?

A

Adherence

53
Q

List common side effects of HAART therapy

A 
Skin rashes
CNS changes
Renal toxicity
Osteomalacia
CV risk
Anaemia
GI side effects
54
Q

Protease inhibitors are potent liver enzyme inhibitors/inducers

A

Inhibitors

55
Q

NNRTIs are potent liver enzyme inhibitors/inducers

A

Inducers

56
Q

List other non-pharmacological aspects of management in HIV

A

Psychosocial couselling
Co-infections (Hep B, Hep C, TB)
Partner notification
Prevention on onward HIV transmission (condom use, STI screening, PrEP)

57
Q

What are the conception options for sero-discordant couples (one partner is HIV+, and one HIV-)?

A

Treatment as prevention (+/- timed condomless sex)

HIV PrEP for HIV- partner

58
Q

Pregnant mothers are given HAART therapy to prevent mother-child transmission. How is the child delivered if viral load is undetected?

A

C-section

Vaginal delivery if undetected

59
Q

A newborn baby with a HIV+ mother can be breastfed. True/False?

A

False

Should be exclusively formula-fed

60
Q

What criteria would a patient be ‘high risk’ for HIV and qualigy for HIV pre-exposure prophylaxis (PrEP)?

A

HIV+ partner with undetectable viral load
or MSM who has had UPAI >2 partners in a year and likely to do so in 3 months
or has had a confirmed bacterial rectal STI in last year
or has another high risk factor agreed by clinician

61
Q

What criteria must a patient meet to be eligible for PrEP?

A

Age 16 or over and HIV- and can commit to 3 months follow up and willing to stop if eligibility criteria no longer applies and resident in Scotland

62
Q

What is the interval period for testing for HIV?

A

4 weeks

Y3 OBS AND GYNAE (44 decks)

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