HIV Flashcards
risk factors for HIV
MSM
PWID - low risk
location - sub Saharan/African/Caribbean countries
what type of virus is HIV
what does this cause
retrovirus
mistakes in RNA transcription
which type of HIV caused the global pandemic
HIV1 M
how can HIV be transmitted (4)
which is the most common form of transmission
sex - 94%
parenteral/vertical transmission - for mum to baby
infected blood products
sharing needles (PWID)
what are the 3 enzymes involved in replication of HIV
hence are targets for treatment
reverse transcriptase enzyme
integrase enzyme
protease enzyme
which is high and which is low in HIV between CD4+ and CD8+
CD4+ low - KNOW this
CD*+ high - less relevant, bc of negative feedback of low CD4+
why does low CD4+ cause immunosuppression
decreased CD4+ = decreased antibody formation = immunosuppressed = more susceptible to infection
which immune cell is predominantly low in HIV, and hence is the cause of the immunosuppression
CD4+
CD4+ levels in HIV late stage
what is normal levels
<200 cells/mm3
normal 500-1600 cells/mm3
how long between entry of virus and start of infection is there
clinical significance of this
3 days
can give PEP (post exposure prophylaxis)
presentation of primary HIV infection (2-4 weeks after infection) (4)
fever
rash
pharyngitis (sore throat)
myalgia
initially presents like another other viral infection! - not good bc can be missed
if young male with viral infection symptoms (fever, rash, sore throat, myalgia), what should you always check for
HIV!
don’t just send away to increase fluids, bc this will make them feel better but infection will go undiagnosed
reassure them its standard procedure, just checking their immunosuppression - and you just want to rule it out (better to be safe than sorry)
document if they decline
what happens to psoriasis in HIV
why
gets worse
psoriasis is CD8+ mediated, and CD8+ is high in HIV
what happens to rheumatoid arthritis in HIV
why
gets better
RA is mediated by CD4+, and CD4+ is low in HIV
which neuro condition can present in HIV
HIV dementia
which resp condition is common in HIV (be specific)
pneumocystis pneumonia
microbio of pneumocystis pneumonia
pnemocystic jirovecii
presentation of pneumocystis pneumonia
SOB
dry cough
management of pneumocystis pneumonia
high dose co-trimoxazole
?HIV
night sweats
fever
weight loss
cough
TB
?HIV
SOB dry cough (from lung consolidation)
pneumocystis pneumonia
if someone is diagnosed with HIV what other condition must you test for
TB (where HIV is common TB is also common)
treatment of TB
2 RIPE 4 RI
2 months of rifampicin, isoniazide, pyrazinamide and ethambutol
4 months of rifampicin and isoniazide
what microbio cause of cerebral abscess is common in people with HIV
toxoplasma gondii
?HIV
headache
fever
seizures papilloedema
reduced consciousness
cerebral toxoplasmosis
brain abscess caused by toxoplasma gondii
?HIV
blindness
CMV retinitis
if you offer someone a HIV test and they decline, what should you do
document it
what markers do you investigate for HIV infection (4)
viral load (viral RNA) - PCR
p24
antibody - detects IgM and IgG
CD4+ (TLC)
what investigation is used to look at viral load (PCR) and p24 and DIAGNOSE HIV
serum/salivary ELISA
what investigation is used to look at viral load (PCR) and p24 and monitor PROGRESS of HIV
how long til you get results
rapid HIV test (POCT) - finger prick/saliva
30 mins = good bc decreased anxiety
is HIV treatable
yes!!
treatment for HIV
HAART (highly active anti-retroviral therapy)
3 drugs from 2 diff classes - NtRTI, NRTI, NNTRI
what is a NRTI
example
nucleoside reverse transcriptase inhibitor
eg emtricitabine
what is a NNRTI
example
non nucleoside reverse transcriptase inhibitor
eg efvirenz
NtRTI example
eg tenofovir
what is the aim of HARRT treatment for HIV
to gain an undetectable viral load
when is PEP (Post Exposure Prophylaxis) used in HIV
if condom breaks
infected person doesn’t tell partner til after
within what time frame of having sex and being infected is PEP effective
<3 days
when is PrEP (PRe Exposure Prophylaxis) used in HIV
regular partner infected
MSM unprotected sex >2 per year with partners
PrEP example
eg tenofovir
what contraceptive measure is PrEP similar to (in principle)
COCP
what contraceptive measure is PEP similar to (in principle)
morning after pill
diagnosis of HIV requires what type of screening
STI screening
if someone is diagnosed with HIV what do you want to do to partner
get partner tested too
what is it called when you give the patient 1 month to tell their partner and if they don’t get tested you can contact them
conditional testing
what obligations does a HIV clinician have to the partner of someone infected with HIV
none if theyre not your patient
cant break confidentiality
your care is to your patient - you need to get them to trust you
what obligations does a GP have to the partner of someone infected with HIV if they are also your patient
obligation to both
encourage HIV patient to tell partner
if not; could try test them sneakily eg if they come in with a cough, would test for ‘immunosuppression’
if not; give them the chance again to tell them and warn them if not youll have to break confidentiality
PHONE DEFENCE UNION foe help lol
can someone with HIV still have sex
what about if untreated or treated but viral load still detectable
what about if treated and viral load not detectable
yes
if untreated/viral load still detectable; need to use condom/partner on PrEP/PEP
if treated and viral load undetectable; no risk of transmission!
is there a risk of HIV transmission if you share the same cup
no
is there a risk of HIV transmission if you share the same razor
yes - bc risk of bleeding
legal consequence in Scotland if you have HIV and have unprotected sex and don’t tell partner
charged for reckless behavior
main complication of HIV
psychosocial wellbeing (exclusion, stigma etc)
NOT AIDS! actually rare
rare complication of HIV
AIDS
how can HIV cause AIDS
if untreated
do all people with HIV get AIDS
no - not if treated
in the past yes bc of lack of treatment
what does AIDS stand for
acquired immunodeficiency syndrome
which vascular tumour can occur in AIDS
Kaposi sarcoma
how does Kaposi sarcoma present
papules on skin (vascular tumour)
which type of lymphoma can occur with AIDS
non hodgekins lymphoma
what type of cancer are women with HIV screened for more regularly than normal
cervical cancer
if untreated HIV, how long til death
10 years
why are MSM higher risk for HIV
anoreceptive sex = anal mucosa is only 1 cell thick (vagina is 30)
what is viral load measuring
viral RNA