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Infection > HIV > Flashcards

HIV Flashcards

1
Q

Spread of HIV

A 
Sexual transmission
Injection drug misuse
Blood products
Vertical transmission
Organ transplant
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2
Q

Point of Care HIV test

A

Blood sample from finger

60sec test

Standard test will confirm results

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3
Q

Immunology of HIV

A

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

CD4 receptors are not exclusive to lymphocytes - also present on surface of macrophages and monocytes

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4
Q

Natural history of HIV

A

Over course of infection;

CD4 count declines and HIV viral load increases

Increased risk of developing infections and tumours

Severity of these illnesses is greater the lower the CD4 count

Most AIDS diagnoses occur at CD4 count <200

Acute infection - seroconversion, asymptomatic, HIV related illness, AIDS defining illness, death

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5
Q

HIV classification

A

Original classification was clinical

Clinical stage I-IV

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6
Q

HIV Clinical Stage 1

A

Asymptomatic
Persistent generalised lymphadenopathy

Performance scale 1; asymptomatic, normal activity

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7
Q

HIV Clinical Stage 2

A
  • Weight loss <10% of body weight
  • Minor mucocutaneous manifestations
  • Herpes zoster within last 5 yrs
  • Recurrent URTIs

and/or performance scale 2; symptomatic, normal activity

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8
Q

HIV Clinical Stage 3

A
  • Weight loss >10% body weight
  • unexplained chronic diarrhoea >1 month
  • Unexplained prolonged fever >1month
  • Oral candidiasis
  • Oral hairy leukoplakia
  • Pulmonary TB within past year
  • Severe bacterial infections

and/or performance scale 3; bedridden, <50% of day during last month

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9
Q

HIV Clinical Stage 4

A
  • Pneumocytic carinii pneumonia
  • toxoplasmosis of brain
  • cryptosporidiosis with diarrhoea >1month
  • cryptococcus extrapulmonary
  • cytomegalovirus
  • HSV
  • progressive multifocal leukoencephalopathy
  • candidiasis of oesophagus, trachea, bronhchi, lungs
  • atypical mycobacteriosis

and/or performance scale 4 ; bedridden, <50% day last month

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10
Q

AIDS defining respiratory conditions

A

Tuberculosis

Pneumocystitis

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11
Q

AIDS defining neurology conditions

A
  • Cerebral Toxoplasmosis
  • Primary cerebral lymphoma
  • Cryptococcal meningitis
  • Progressive multifocal leucoencephalopathy
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12
Q

AIDS defining dermatology conditions

A

Kaposi’s sarcoma

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13
Q

AIDS defining oncology conditions

A

Non-Hodgkin’s lymphoma

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14
Q

AIDS defining gynaecology conditions

A

Cervical cancer

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15
Q

AIDS defining opthalmology conditions

A

Cytomegalovirus retinitis

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16
Q

What is HIV/seroconversion?

A

A seroconversion illness is when HIV antibodies first develop

Abrupt onset 2-4weeks post-exposure, self-limiting 1-2weeks

Symptoms generally non-specific and differential diagnosis includes a range of common condition

17
Q

Describe symptoms of HIV seroconversion

A 
Flu-like illness
Fever
Malaise and lethargy
Pharyngitis
Lymphadenopathy
Toxic exanthema

“looks like glandular fever but EBV serology not in keeping”

18
Q

Describe pneumocystitis jiroveci pneumonia

A

Commonest late stage (AIDS) infection

Opportunistic infection

CD4 cell count usually <200

Classical history of dry cough and increasing breathlessness over several weeks

Treatment; cotrimoxazole, pentamidine

19
Q

Describe HIV antiretroviral therapy

A

Different classes of drugs acting on different stages in HIV lifecycle

Combination therapy is at least 3 drugs from at least 2 groups

Adherence needs to be >90%

cART can lead to normal life but side effects can be significant eg metabolic, lipodystrophy

20
Q

Where do HIV treatments work?

A

Binding and entry

Reverse transcription

Integration

Transcription

Assembly

Release and Protease

21
Q

When to start HIV patients on medication?

A

All patients at diagnosis regardless of CD4 and viral load

If CD4 < 350 cells/mm3 patients at risk of developing symptoms without being on treatment

If CD4 < 200 start asap

Any pregnant woman - start before third trimester

Three drug combo w/ treatment adjustment if viral load not adequately suppressed after 4-6weeks

22
Q

Current HIV life expectancy

A

Life expectancy according to CD4 nadir (lowest before starting therapy)

<100 = 52
100-200 = 62
>200 = 70+
23
Q

Describe nucleoside reverse transcriptase inhibitors

A

HIV antiviral

Side effects include marrow toxicity, neuropathy, lipodystrophy

24
Q

Describe non-nucleoside reverse transcriptase inhibitors

A

HIV antiviral

Side effects include skin rashes, hypersensitivity, drug interactions, neuropsychiatric effects

25
Q

Describe protease inhibitors

A

HIV antiviral

Drug interactions, diarrhoea, lipodystrophy and hyperlipidaemia

26
Q

Describe integrase inhibitors

A

HIV antiviral

Side effects include rashes and disturbed sleep

27
Q

What to do if a patient develops lipodystrophy?

A

Change drugs

Less likely to happen with newer agents

Cosmetic procedures

  • facelift
  • liposuction
  • fillers
28
Q

Describe HIV prevention

A

Behaviour change and condoms

Circumcision

Treatment as prevention

Pre-exposure prophylaxis (PrEP)

Post- exposure prophylaxis for sexual exposure

29
Q

Describe the virology of HIV

A

Two types; 1 and 2

4 groups

  • HIV-1-M responsible for epidemic
  • N, O and P uncommon

Within N group there are 9 subtypes; ABCDFGHJK

HIV is a lentivirus (belongs to retrovirus group)

  • cause slow infections with long incubation
  • RNA to DNA using reverse transcriptase
30
Q

HIV tests

A 
Antibody (during first month tests may be negative)
Antigen
Then; 
- viral load
- CD4 count 
- typing
- avidity
- tropism
- resistance tests
- drug levels
31
Q

Describe HIV resistance testing

A

Sequencing of the polymerase and protease genes

Identification of specific mutations that confer resistance to antiviral drugs

Used for

  • baseline at diagnosis
  • suboptimal treatment response
  • treatment failing
  • want to change treatment for another reason
32
Q

Body fluids to be handled with the same precautions as blood

A 
CSF
Pleura, peritoneal, pericardial fluid
Breast milk
Amniotic fluid
Vaginal secretions/semen
Synovial fluid 
Any other body fluid w/visible blood
Unfixed tissues and organs
Saliva - dental procedures
Exudate/tissue fluid from burns or skin lesions
33
Q

What to do after body fluid exposure risk?

A

Wash off splashes on skin with soap and running water

Exposed mucous membranes including conjunctivae should be irrigated copiously with water

Encourage bleeding if broken skin

Wash out splashes in eye, nose, mouth

Involve Occupational Health

Send BBV screen for storage

34
Q

Describe HIV post-exposure prophylaxis

A

if high risk blood/body fluid

Commence within 72hours of exposure

Complete 28day course

HIV test 2 months after PEP

Infection (15 decks)

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