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Reproduction SOH > HIV > Flashcards

HIV Flashcards

1
Q

What is the end result of an HIV infection?

A

AIDS

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2
Q

People with treated HIV have a reduced life expectancy. True or false?

A

False

- Near normal life expectancy

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3
Q

What kind of virus is HIV?

A

Retrovirus

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4
Q

What is a retrovirus?

A

When RNA is transcribed it uses reverse transcriptase enzyme which doesn’t have proof reading ability and makes lots of mistakes. This enzyme turns RNA -> DNA

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5
Q

Which type of HIV is responsible for the global pandemic of HIV?

A

HIV-1

group M

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6
Q

HIV is a multi-system disease. True or false?

A

True

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7
Q

Name 3 modes of transmission of HIV

A

Sexual
Parenteral
Vertical

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8
Q

Which mode of transmission is most common?

A

Sexual

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9
Q

Who are the most common group of people affected by HIV in the UK?

A

Men who have sex with men (MSM)

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10
Q

Name 3 factors which increase the sexual transmission risk?

A

Anoreceptive sex (MSM)
Concurrent STI
Genital ulceration

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11
Q

Parenteral transmission - name 3 examples

A

Injection drug use
Infected blood products
Iatrogenic

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12
Q

It is only possible to acquire HIV from injecting drug use if….

A

You are sharing needles

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13
Q

What are the 3 ways which vertical transmission can occur?

A

In utero
During delivery
Breast feeding

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14
Q

Where is the global burden of infection?

A

Sub saharan Africa

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15
Q

Who is more likely to have UNDIAGNOSED HIV (M/F) and why?

A

Males

- women are picked up in antenatal screening

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16
Q

Which ethnicity is it more common in?

A

Black African

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17
Q

What is the target site for HIV?

A

CD4+ receptors

- it is here that HIV links to the host cell

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18
Q

CD4 is found on the surface of a variety of cells including …

A

T helper lymphocytes (CD4+ T cells)
Dendritic cells
Macrophages

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19
Q

What happens to CD4+ T cells in HIV

A

Reduction of CD4+ cells as they are caught up in lymphoid tissue and not produced as much

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20
Q

What is the normal CD4+ Th cell count

A

500-1600 cells/mm3

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21
Q

At what CD4 count is there risk of opportunistic infection?

A

<200 cells/mm3

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22
Q

What happens to CD8+ T cells in HIV

A

There is over production

- but they are dysregulated so this increases the susceptibility to viral infections

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23
Q

HIV is all about immunosuppression and there is no immune activation. True or false?

A

False
- mainly about immunosuppressionbut there is immune activation due to chronic inflammation in the blood which occurs as a result of the gut becoming more leaky

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24
Q

What is the natural course of the infection? (4 stages)

A

Primary infection
Asymptomatic infection
Opportunistic disease
Death

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25
Q

Describe the immunopathogenesis

A
  1. Virus is transmitted
  2. Virus attaches to a mucosal CD4 cell and binds to one type of co-receptor (CCR5 or CXCR4)
  3. HIV Virus fuses with cell and infects it
  4. Virus is transported to regional lymph nodes
  5. Virus is disseminated to other sites in the body
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26
Q

There is a ____ day window from when the virus enters the body to when it reaches the regional lymph nodes? What is significant about this?

A

3 day

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27
Q

Which enzyme cleaves HIV chains ?

A

Protease

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28
Q

Primary HIV infection - when do most patients present with symptoms ?

A

2-4 weeks after infection is established

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29
Q

Primary HIV infection - clinical features

A 
Very non specific 
Fever
Skin abnormalities - rash 
Myalgia
Sore throat (pharyngitis)
Headache
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30
Q

Primary HIV infection - risk of transmission is HIGH/LOW ?

A

High

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31
Q

Primary HIV infection - what happens to CD4+ Th count?

A

It declines rapidly

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32
Q

Asymptomatic HIV infection - everyone is asymptomatic. True or false?

A

False

  • lots of people still experience symptoms such as:
  • mucosal candidiasis
  • seborrheic dermatitis
  • diarrhoea
  • fatigue
  • lymphadenopathy
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33
Q

Asymptomatic HIV infection - definition

A

There is ongoing viral replication of the infection but it is sub-clinical (in some cases)

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34
Q

Opportunistic infections (OI) - definition

A

An infection caused by a pathogen that does not normally produce disease in a healthy individual.
It uses the opportunity of a weakened immune system to cause disease

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35
Q

OI - Pneumocystis pneumonia (PCP) - causative organism

A

Pneumocystis jiroveci

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36
Q

OI - Pneumocystis pneumonia (PCP) - clinical features

A

Gradual onset
SOB
Dry cough

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37
Q

OI - Pneumocystis pneumonia (PCP) - CXR findings

A 
Initially normal 
Interstitial infiltrates (looks like PO)
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38
Q

OI - Pneumocystis pneumonia (PCP) - diagnosis

A

BAL
Immunofluoresence
Low CD4 count < 200

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39
Q

OI - Pneumocystis pneumonia (PCP) - management

A

High dose co-trimoxazole

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40
Q

If patient has low CD4+ Th count and a +ve diagnosis for HIV but they do NOT have PCP, what do you give as prophylaxis?

A

Low dose co-trimoxazole

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41
Q

TB related conditions are less common in patients with HIV. True or false?

A

False

- more common

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42
Q

OI - cerebral toxoplasmosis - how do you get it ?

A

From cats

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43
Q

OI - cerebral toxoplasmosis - causative organism

A

Toxoplasma gondii

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44
Q

OI - cerebral toxoplasmosis - clinical features

A 
Headache 
Fever 
Focal neurology 
- cerebral abscesses 
Seizures 
Reduced consciousness
Raised ICP
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45
Q 
Reduced visual acuity with floaters.
Abdominal pain
Diarrhoea 
PR bleding 
With a CD4 count < 50
What is the opportunistic infection?
A

CMV

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46
Q

OI - herpes zoster

A

Multidermatomal zoster

Recurrent

47
Q

HIV can cause cognitive impairment. True or false?

A

True

48
Q

What does the JC virus cause?

A

Progressive multifocal leukoencephalopathy

49
Q

OI - PML - clinical features

A

Rapidly progressing
Focal neurology
- confusion
- personality change

50
Q

Name 3 AIDs related cancers

A

Kaposi’s sarcoma
Non-hodgkins lymphoma
Cervical cancer

51
Q

Kaposi’s sarcoma - organism

A

Human Herpes Virus 8

52
Q

Kaposi’s sarcoma - pathology

A

Vascular tumour with violet coloured papules

53
Q

Kaposi’s sarcoma - clinical features

A

Violet papules on skin

54
Q

Kaposi’s sarcoma - management

A

HAART

Chemotherapy - if visceral involvement

55
Q

Non-Hodgkins lymphoma - causative organism?

A

EBV

56
Q

Cervical cancer - causative organism?

A

HPV

57
Q

HIV testing - who should be tested

A

Universal testing in high prevalence areas (opt out)

High risk groups

  • MSM
  • Female partners of bi- men
  • PWID
  • Partners of people with HIV

When HIV falls within the DD x

People in certain clinical settings

58
Q

HIV testing - Should be offered to everyone in which clinical settings?

A 
TOP services 
GUM clinics 
Drug dependency services
Antenatal services 
Assisted conception services
59
Q

HIV testing - obtaining consent

A

Explain to patient they are being offered an HIV test and why
- “to make sure immune system is working properly”

Benefits of testing

  • improve long term health
  • protect partners

Reassure confidentiality

60
Q

HIV testing - if patient refuses, what should you do?

A

Document refusal

61
Q

HIV testing - incapacitated patient - you must consent relative beforehand. True or false?

A

False

62
Q

HIV testing - incapacitated patient - what would be the ideal solution?

A

If safe, wait until the patient regains capacity

63
Q

HIV testing - Name 3 markers that are used to detect infection?

A

Viral RNA
Antigen
Antibody

64
Q

HIV testing - what is the first marker to become positive?

A

Viral RNA

65
Q

HIV testing - which antigen are you testing?

A

p24

66
Q

HIV testing - antibody testing - how long is the window period?

A

20-25 days (will be -ve within these days and will only be +ve after the window period_

67
Q

HIV testing - 3rd generation HIV tests

A

HIV-1 and HIV-2 antibody
+ve result anywhere from 3 months onwards
Very sensitive/specific

68
Q

HIV testing - 4th generation

A

Combined antibody and antien (p24)

69
Q

HIV testing 3rd generation / 4th generation has a shorter window period?

A

4th generation (+ve result anywhere from 4 weeks onwards)

70
Q

HIV testing - rapid - when can you get results?

A

Within 20-30 mins

71
Q

HIV testing - rapid - advantages

A

Simple to use
No anxious wait
Good sensitivity
No venipuncture required

72
Q

HIV testing - rapid - disadvantages

A

Expensive

Quality control

73
Q

Can Rapid HIV testing be relief on in early infection?

A

NO

74
Q

Recent infection testing algorithm (RITA) - what is it used for?

A

To identify if an infection occurred within preceding 4-6 months

75
Q

Recent infection testing algorithm (RITA) - is it reliable?

A

No

- large margin of error

76
Q

Investigations

  • CD4 count = high/low
  • Platelet count = high/low
  • LFTs = high/low
A 
CD4 count = Low 
Platelet count = Low
LFTs = high
77
Q

Management (general)

A

HAART

78
Q

Name 3 targets for anti-retroviral drugs?

A

Reverse transcriptase
Integrase
Protease

79
Q

HAART - how many drugs are used?

A

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

80
Q

HAART - why use a 3 drug combo?

A

It prevents resistance

81
Q

HAART - 3 drug combo is given as 3 separate tablets. True or false?

A

False

- co-formulated and given in 1 tablet

82
Q

HAART - aims

A

Reduce viral load to undetectable
Restore CD4 Th count
Reduce morbidity and mortality

83
Q

HAART - NRTI - definition

A

Nucleoside analogue reverse transcriptase inhibitors

84
Q

HAART - NRTI - examples (4)

A

Abacavir
Emtricitiabine
Tenofovir
Zidovudine

85
Q

HAART - NRTI - side effects - abacavir

A

Skin rash
Hypersensitivity
SJS

86
Q

HAART - NRTI - side effects - tenofovir

A

Renal toxicity

Osteomalacia

87
Q

HAART - NNRTI -definition

A

Non Nucleoside analogue Reverse Transcriptase Inhibitors

88
Q

HAART - NNRTI - 2 examples

A

Nevirapine

Efavirenz

89
Q

HAART - NNRTI - Efavirenz side effects

A

CNS side effects

90
Q

HAART - what are the newest class of drugs?

A

Integrase inhibitors

91
Q

HAART - which class of drugs are only used when dealing with resistant HIV ?

A

Protease inhibitors

92
Q

HAART - protease inhibitor - example

A

Atazanvir

93
Q

Partner notification - partner referral

A

Affected patient themselves tells their partner of their diagnosis

94
Q

Partner notification - provider referral

A

Doctor contacts the patients partner on behalf of the patient and asks them to come for an HIV test

95
Q

Partner notification - If the patient’s partner is also one of your patients but the patient doesn’t want to let them know…what do you do?

A

You have a duty of care to tel the patients partner

96
Q

Partner notification - If the patient’s partner is not one of your patients and the patient doesn’t want to let them know…what do you do?

A

You have NO duty of care to them and your duty is to support your patient

97
Q

Partner notification is needed for genital warts - true or false?

A

False

98
Q

Partner notification is not needed for herpes. True or false?

A

True

99
Q

If +ve HIV person is on HAART, what is the risk of transmission to their partner at that time?

A

0 (no risk)

100
Q

You are more likely to transmit HIV if you have an STI. True or false?

A

True

101
Q

Post exposure prophylaxis

A

Medication taken after exposure to reduce risk of infection.

Start 3 anti-retrovirals within 72 hours of exposure

102
Q

How long should you take post exposure prophylaxis ?

A

28 days

103
Q

Pre-exposure prophylaxis

A

Medication taken before exposure to reduce the risk of infection.
-ve partner takes a daily pill that prevents HIV in that person

104
Q

How long should -ve partner take pre exposure prophylaxis for ?

A

Take until +ve partner viral load becomes undetectable

105
Q

Prevention of vertical transmission

A

HAART during pregnancy

106
Q

Can +ve HIV female have a vaginal delivery?

A

Vaginal delivery acceptable if viral load is undetectable at 36 weeks

107
Q

HIV +ve female must have a cesarean section. True or false?

A

False

- Caesarean section required if viral load is not undetectable at 36 weeks gestation

108
Q

If mother has detectable viral load, what does baby need?

A

Needs post exposure prophylaxis for 4 weeks

109
Q

HIV +ve females must not breastfeed. True or false?

A

True

- there is risk of transmission in breast milk so exclusive formula feeding required.

110
Q

HIV is a single/double stranded DNA/RNA virus

A

Single stranded RNA virus

111
Q

Risk of opportunistic infection occurs when the CD4 count is less than

A

200

112
Q

How is the diagnosis of pneumocystic jirovecii made

A

BAL

113
Q

What condition can JC virus resemble?

A

MS

114
Q

Which organism causes Kaposi’s sarcoma?

A

Human herpes virus 8

Reproduction SOH (50 decks)

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