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Infection > HIV > Flashcards

HIV Flashcards

1
Q

How is HIV spread?

A 
sexual transmission 
- multiple partners
- MSM
Injection drug misuse
Blood products (haemophiliacs etc)
Vertical transmission 
Organ transplant
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2
Q

What does HIV do to the body?

A

Infects and destroys of the immune system, especially T helper cells that are CD4+

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3
Q

What does CD4+ mean?

A

Have a CD4 receptor on their surface

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4
Q

What are CD4 receptors present on the surface of?

A 
LYMPHOCYTES
macrophages and monocytes
Cells in the brain 
skin 
probably many other sites
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5
Q

Over the course of the infection, relationship between CD4 count and HIV viral load

A

CD4 declines and viral load increases

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6
Q

Normal CD4 count

A

> 500

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7
Q

What CD4 count do most AIDs diagnoses occur at?

A

< 200

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8
Q

As the viral load increases, what is there an increased risk of?

A

Developing infections and tumours

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9
Q

Levels of CD4 over time of infection

A

The immune system brings the virus under control after a while -> until the HIV RNA increases
Then the CD4 starts to plummet -> this is where you get symptoms and opportunistic infections

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10
Q

What does AIDs stand for?

A

Acquired immune deficiency syndrome

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11
Q

Clinical stages and their presentations of HIV

A

Clinical stage I

  • asymptomatic
  • persistent generalised lymphadenopathy
  • performance scale 1 (asymptomatic, normal activity)

Clinical stage II

  • weight loss < 10% of body weight
  • minor mucocutaneous manifestating (fungal nail infections, recurrent oral ulcerations, seborrheic dermatitis)
  • herpes zoster (within last 5 years)
  • recurrent URTIs
  • and/or performance scale 2 (symptomatic, normal activity)

Clinical stage III

  • weight loss > 10% of body weight
  • unexplained chronic diarrhoea > 1 month
  • oral candidiasis (thrush)
  • oral hairy leucopenia
  • pulmonary TB within past year
  • severe bacterial infections
  • and/or performance score 3 (bedridden <50% of the day during the last month)

Clinical stage IV

  • HIV wasting syndrome
  • Toxoplasmosis of brain
  • pneumocystic cariniipneumonia
  • Cryptospiridosis with diarrhoea > 1 month
  • CMV disease of an organ other than liver, spleen or lymph nodes
  • HSV (mucocutaneous > 1 month, visceral any duration)
  • PML
  • candidiasis of oesophagus, trachea, bronchi or lungs
  • atypical mycobacteriosis, disseminated
  • extrapulmonary TB (lymphoma)
  • HIV encephalopathy
  • And/or performance score 4 (bedridden > 50% of the day during the last month)
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12
Q

What is the average time on average from getting HIV to progressing to AIDs?

A

7-8 years

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13
Q

What is the time on average from AIDs to dying?

A

Roughly 2 years

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14
Q

What would be classified as an AIDs illness?

A

Certain infections and tumours that develop due to weakness in the immune system

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15
Q

If have no symptoms, do you have an HIV or an AIDs illness?

A

No symptoms = HIV illness only

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16
Q

AIDs defining conditions for an adult infection

A 
TB, pneumocisitis
Cerebral toxoplasmosis, PML
Cryptococcal meningitis
Kaposi's sarcoma
Peristen cryptosporidiosis
Non-hogkin's lymphoma
Cervical cancer
Cytomegalovirus retinitis
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17
Q

Relationship between CD4 count and mortality

A

The lower the CD4 count, the higher the mortality

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18
Q

Natural history of HIV infection

A
  1. acute infection
  2. asymptomatic
  3. HIV related illness
  4. AIDs defining condition
  5. Death
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19
Q

What happens during a seroconversion illness?

A

The HIV antibodies are first developing

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20
Q

Presentation of HIV seroconversion illness

A 
Like a dose of glandular fever that lasts longer and has associated features
Diarrhoea
Rashes
liver dysfunction 
malaise
lethargy 
pharyngitis
lymphadenopathy 
toxic exanthema
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21
Q

When after exposure does seroconversion illness occur?

A

2-4 weeks after exposure time

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22
Q

What does ART stand for?

A

Antiretroviral therapy

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23
Q

Before the CD4 count drops to what do you want to start ART?

A

approx. 320

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24
Q

what is key to ART to work?

A

Adherence needs to be over 90%

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25
Q

Types of antivirals

A 
AZT
DDI
DDC
3TC
D4T
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26
Q

When to start ART?

A

consider starting all patients at diagnosis regardless of CD4
If CD4 > 350 = can start later depending on circumstance e.g. going off shore
If pregnant = start before the third trimester

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27
Q

Can pregnant women with HIV have normal vaginal delivery?

A

Yes - if the viral load is undetected

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28
Q

Treatments of HIV fail due to….

A 
Poor adherence (leading to viral mutation and resistance) 
Incomplete suppression 
- inadequate potency 
- inadequate drug levels
- inadequate adherence 
- pre existing resistance
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29
Q

What does CD4 nadir mean?

A

Lowest CD4 before starting on therapy

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30
Q

Life expectancy of a patient diagnosed at 20 with a CD4 nadir of <100

A

52 y/o

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31
Q

Life expectancy of a patient diagnosed at 20 with a CD4 nadir of 100-200

A

62 y/o

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32
Q

Life expectancy of a patient diagnosed at 20 with a CD4 nadir of > 200

A

70+ y/o

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33
Q

Even in well controlled HIV, what seems to accelerate and what does this result in?

A 
Your ageing is accelerated
Results in more likely to develop the following at a younger age 
- osteoporosis
- cognitive impairment 
- malignancy 
- cerebrovascular disease
- renal disease
- ischaemic heart disease
- DM
34
Q

HIV prevention

A 
Behaviour change
Condoms
Circumcision (resource poor settings) 
Treatment as a prevention 
Pre-exposure prophylaxis (PrEP)
Post-exposure prophylaxis (PePSE)
35
Q

Treatment of PJP

A

Co-trimoxazole

36
Q

Treatment of toxoplasmosis

A

Co-trimoxazole

Steriods

37
Q

When to test for HIV after sex?

A

3 months

38
Q

What is in an ART for HIV?

A

Nucleotide reverse transcriptase inhibitor
Non nucleotide reverse transcriptase inhibitor
Protease inhibitor
Integrade inhibitor

39
Q

Side effects of ART

A

GI upset
Rash
Neuropathy

40
Q

What is the most common opportunistic infection in AIDs?

A

PJP

41
Q

What does PJP stand for?

A

Pneumocystitis jiroveci

42
Q

Who should receive PJP prophylaxis?

A

All HIV patients with CD4+ count < 200

43
Q

Presentation of PJP

A

SOB
Dry cough
Fever
Very few chest signs

44
Q

Complications of PJP

A

Pneumothorax

45
Q

How common is extra pulmonary manifestations of PJP and what are they?

A

RARE - 1-2%

Hepatosplenomegaly, lymphadenopathy, choroid lesions

46
Q

Investigations of PJP

A

CXR
Exercise induced desaturation
BAL

47
Q

Treatment of PJP

A

Co trimoxazole
IV pentamidine in severe cases
Steroids if hypoxic

48
Q

Causative organism of Kaposis sarcoma

A

HHV-8 (human herpes virus 8)

49
Q

Who is kaposis sarcoma seen in?

A

HIV patients

50
Q

Presentation of kaposis sarcoma

A

Purple plaques or paperless on skin or mucosa (e.g. GI or resp tract)
Resp involvement may lead to massive haemoptysis and pleural effusion

51
Q

Treatment of kaposis sarcoma

A

Radiotherapy

Resection

52
Q

What are the HIV neuro complications?

A 
Toxoplasmosis 
Primary CNS lymphoma
TB
Encephalitis
Crypto coccus
PML
AIDs dementia complex
53
Q

What % of cerebral lesions in patients with HIV are due to toxoplasmosis?

A

50%

54
Q

Presentation of toxoplasmosis

A

Systemic symptoms
Headache
Confusion
Drowsiness

55
Q

Investigation of Toxoplasmosis

A

CT

Thallium spect

56
Q

What is seen on CT in toxoplasmosis?

A

Ring enhancing lesions

Mass effect may be seen

57
Q

Thallium spect status in toxoplasmosis

A

-ve

58
Q

Treatment of toxoplasmosis

A

Sufadiazine and Pyrimethamine

59
Q

What % of cerebral lesions does primary CNS lymphoma make up?

A

30%

60
Q

What is primary CNS lymphoma assosiated with?

A

EBV

61
Q

Investigation for primary CNS lymphoma

A

CT

62
Q

What is seen on CT for primary cerebral lymphoma?

A

Single or multiple homogenous enhancing lesions

63
Q

Treatment of primary CNS lymphoma

A

Steroid (decrease tumour size)
Chemo
+/- whole brain irridation
Surgery may be considered for lower grade tumours

64
Q

Thallium spect status of primary CNS lymphoma

A

+ve

65
Q

TB brain effects due to HIV - is it common and what is the investigation and what would it show?

A

Much less common than toxoplasmosis or primary CNS lymphoma

CT - single enhancing lesion

66
Q

What may encephalitis be due to?

A

CMV or HIV itself

67
Q

How common is HSV encephalitis in the context of HIV

A

Relatively rare

68
Q

Investigation of encephalitis in HIV and what would it show?

A

CT - oedematous brain

69
Q

What is the most common fungal infection of the CNS?

A

Crypto coccus

70
Q

Presentation of cryptococcus

A 
Headache
Fever
Malaise
N + V
Seizures
Focal neurological deficit
71
Q

Investigations of cryptococcus

A

LP

CT

72
Q

What would LP and CT show in cryptococcus?

A

LP - increased opening pressure and India ink test +ve

CT - meningeal enhancement, cerebral oedema

73
Q

Typical presentation of cryptococcus but what can it also present as?

A

Meningitis but can also present as a SOL

74
Q

What does PML stand for?

A

Progressive multifocal leukoencephalopathy

75
Q

Pathology of PML

A

Widespread demyelination due to infection of oligodendrocytes by JC virus

76
Q

Presentation of PML

A 
Subacute onset 
Behavioural change 
Speech 
Motor 
Visual impairment
77
Q

Investigations for PML and what would be seen

A

CT - single or multiple lesions, no mass effect, doesn’t usually enhance
MRI - high signal demyelination white matter lesions seen

78
Q

What is AIDs dementia complex caused by?

A

HIV itself

79
Q

Presentation of AIDs dementia complex

A

Behavioural changes

Motor impairment

80
Q

Ix for AIDs dementia complex and what would it show

A

CT - cortical and subcritical atrophy

81
Q

PEP for HIV

A

Oral ARVT for 4 weeks

Infection (16 decks)

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