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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
What is the most common AIDS-related cancer?
Kaposi's sarcoma
26
Which organism causes Kaposi's sarcoma? What are the clinical signs?
Human herpes virus 8 | Cutaneous, mucosal, visceral (pulmonary, GI)
27
How is Kaposi's sarcoma treated?
HA anti-retroviral therapy Local therapy Systemic chemotherapy
28
Which AIDS-related cancer is caused by EBV? What are the clinical signs?
Non-Hodgkins lymphoma | Advanced, B symptoms, bone marrow involvement, extranodal disease, CNS signs
29
Which AIDS-related cancer is caused by HPV?
Cervical cancer
30
What are the 3 main modes of transmission of HIV?
Sexual Parenteral Mother-to-child
31
Is HIV more common in men who have sex with men or women who have sex with men who have sex with men?
Men who have sex with men
32
What sexual factors increase the risk of getting HIV?
Anoreceptive Trauma Genital ulceration Concurrent STI
33
How might HIV be acquired parenterally?
Injection drug use Infected blood products Iatrogenic
34
Who should be tested for HIV?
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
What are high-risk groups for HIV?
``` 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
What markers of HIV are used to detect infection?
Antibody Antigen (p24) Viral RNA
37
List markers of HIV in order of first appearance
Viral load Antigen Antibody
38
What is the window period of 3rd generation antibody tests for HIV compared to 4th generation antibody tests?
20-25 days (3rd gen) | 14-28 days (4th gen)
39
How do 4th gen antibody tests differ from 3rd gen antibody tests for HIV?
3rd gen: antibody only | 4th gen: antibody + antigen
40
What is the BASHH guidance on a negative 4th gen antibody test with regards to HIV?
Negative antibody test performed 4 weeks after exposure is highly likely to exclude HIV infection
41
What rapid HIV tests can be done?
Fingerprick Recent infection testing algorithm Home sampling Home testing
42
Which drug class has in vitro activity against HIV? Give an example of a drug under this class
Nucleoside analogues reverse transcriptase inhibitors (NRTI) | Zidovudine
43
What is highly-active anti-retroviral therapy (HAART)?
Combination of 3 drugs from at least 2 drug classes to which the virus is susceptible
44
Partner notification of HIV is a voluntary process. True/False?
True
45
There is no risk of HIV transmission with casual/household contact. True/False?
True
46
Outline the immunopathogenesis of HIV infection
Primary infection --> Acute HIV syndrome/wide dissemination of virus/seeding of lymphoid organs --> Asymptomatic infection --> Constitutional symptoms/opportunistic diseases/death
47
List some non-opportunistic manifestations of HIV
``` Mucosal candidiasis Seborrhoeic dermatitis DIarrhoea Fatigue Worsening psoriasis Lymphadenopathy Parotitis STIs/Hep B/Hep C ```
48
State the two main haematological manifestations of HIV
Anaemia | Thrombocytopaenia
49
State sites of HIV pandemics on a global scale
Sub-saharan Africa Caribbean South-east Asia
50
How do NNRTI's work?
Replaces AA picked up by reverse transcriptase causing chain termination
51
List sites in the HIV cycle targeted by treatment
``` Reverse transcriptase Integrase Protease Entry Maturation ```
52
What is the primary way in which drug resistance is prevented in HIV?
Adherence
53
List common side effects of HAART therapy
``` Skin rashes CNS changes Renal toxicity Osteomalacia CV risk Anaemia GI side effects ```
54
Protease inhibitors are potent liver enzyme inhibitors/inducers
Inhibitors
55
NNRTIs are potent liver enzyme inhibitors/inducers
Inducers
56
List other non-pharmacological aspects of management in HIV
Psychosocial couselling Co-infections (Hep B, Hep C, TB) Partner notification Prevention on onward HIV transmission (condom use, STI screening, PrEP)
57
What are the conception options for sero-discordant couples (one partner is HIV+, and one HIV-)?
Treatment as prevention (+/- timed condomless sex) | HIV PrEP for HIV- partner
58
Pregnant mothers are given HAART therapy to prevent mother-child transmission. How is the child delivered if viral load is undetected?
C-section | Vaginal delivery if undetected
59
A newborn baby with a HIV+ mother can be breastfed. True/False?
False | Should be exclusively formula-fed
60
What criteria would a patient be 'high risk' for HIV and qualigy for HIV pre-exposure prophylaxis (PrEP)?
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
What criteria must a patient meet to be eligible for PrEP?
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
What is the interval period for testing for HIV?
4 weeks

Y3 OBS AND GYNAE (44 decks)

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