HIV

Question 1

definition of HIV

Answer 1

the prescence of antibiodies against the virus

-chronic viral infection

Question 2

definition of AIDS

Answer 2

CD4 count of <200

Question 3

AIDS assoc. illnesses

Answer 3

• candidiasis (not in mouth)
• cervical cancer
• cmv
• encephalopathy
• herpes simplex
• isoporiasis
• karposi sarcoma
• lymphoma
• p.jiroveci
• leukoencephalopathy
• salmonella
• toxoplasmosis of the brain
• wasting syndrome

Question 4

transmission hiv

Answer 4

• sexual: anal higher risk than vaginal
• IVDU
• transfusion/ blood products
• mother to child 25%

Question 5

2 types of HIV

Answer 5

type 1-worldwide

type 2-western africa

Question 6

dx of hiv

Answer 6

• point of care test=antibodies to HIV serology

- PCR can do viral load

Question 7

biological features of hiv

Answer 7

• Hypervariability especially envelope
• Error-prone replication
• High level kinetics of replication (lots of viruses)
• Rapid evolution of mutants
• Integration into host dna-latency within cells
• Infects long lived cells (eg macrophages) as well as short lived lymphocytes

Question 8

boundaries of high,med and low viral load

Answer 8

high >100,000
medium 10,000-100,000
low <10,000

Question 9

monitoring hiv

Answer 9

• viral load
• cd4 count
• antibodies

Question 10

what brings the initial viremia of hiv under control

Answer 10

the hiv specific immune response which leads to a decrease in virus concentration

Question 11

what type of virus is hiv

Answer 11

rna retrovirus so has reverse transcriptase to make dna

Question 12

clinical presentationof primary infection of AIDS and seroconversion

Answer 12

-incubation period 2-4 weeks
-50% asymptomatic
-fever, headache
-lymphadenopathy, rash-maculopapula, roseola rash like
pharyngitis
-neuro involvement eg meningoencephalitis

seroconversion=when develop antibodies

Question 13

how long till blood tests are positive

Answer 13

positive within 3-4 weeks

Question 14

non-specific symptoms of hiv

Answer 14

-weight loss
-fever
-malaise
-mild immunodeficiency
-shingles and candidia, recurrent hsv, hairy oral leucoplakia, molluscum contagiosum
-parotid enlargement
-immunodysregulation
so immune thrombocytopaenia, drug allergies, s
-sebhorrheic dermatitis

Question 15

what type of TB is more common in europe

Answer 15

extra pulmonary or non-cavitiating rather than cavitiating

Question 16

% of patients with aids with tb at post-mortem

Answer 16

50%

Question 17

lymphoma assoc. to aids

Answer 17

-non hodgkin large b cell immunoblastic and cerebral lymphoma

Question 18

cancer assoc. to aids

Answer 18

kaposi sarcoma

Question 19

resp illness assoc. to aids

Answer 19

recurrent pneum

pneum jiroveci

Question 20

neuro illness asssoc. to hiv

Answer 20

hiv encephalopathy
cmv, hsv encephalitis
Progressive multifocal leukoencephalopathy
-	Toxoplasma encephalitis
-	Cryptococcal or tb meningitis
-	Peripheral neuropathy

Question 21

gi illness assoc. to hiv

Answer 21

GI illness

• Diarrhoea, weight loss and colitis
• RUQ pain, abnormal LFTs, cholangiopathy

Question 22

hiv treatment

Answer 22

antiretroviral drugs triple therapy eg zidovudine

Question 23

targets for hiv therapy

Answer 23

• entry inhibitors
• reverse transcriptase
• integrase
• protease

Question 24

serology hiv

Answer 24

• HIV serology is 100% sensitive and specific
• Persists in all those who have been infected- positive serology=active infection
• Spontaneous resolution doesn’t occur
• Clinical disease will occur eventually in >95% of infected persons

Question 25

hiv testing

Answer 25

to establish informed consent for HIV testing. Lengthy pre-test HIV counselling is not a requirement, unless a patient requests or needs this.
 The essential elements that the pre-test discussion should cover are:
• the benefits of testing to the individual
• details of how the result will be given.