HIV Flashcards
How can HIV be spread?
Sexual transmission IV drug abuse Blood products Vertical transmission Organ transplant
When can you perform an HIV test on an unconscious patient?
If you think it is in the patients best interest
What does HIV do to the immune system?
Destroys the cells, especially T-helper cells with CD4 receptors on their surface
What is the natural history of HIV infection?
CD4 count declines and HIV viral loads increases
What are patients with HIV at increased risk?
Infections
Tumours
How can severity of illness in HIV be assessed?
Lower CD4 counts mark more severe infections
When does an AIDS diagnosis occur?
CD4<200
What occurs at stage 1 HIV?
Asymptomatic
Persistent generalised lymphadenopathy
What occurs at HIV stage 2?
Weight loss <10% of body weight
Minor mucocutaneous infections
Herpes zoster within last 5 years
Recurrent Upper resp infections
What occurs at HIV stage 3?
Weight loss >10% body weight Unexplained chronic diarrhoea Unexplained prolonged fever Oral candidiasis Oral hairy leukoplakia Pulmonary TB Severe bacterial infections
What occurs at HIV stage 4?
HIV wasting syndrome Pneumocystic carinii syndrome Toxoplasmosis of the brain Cryptosporidosis with diarrhoea Cryptococcis extrapulmonary Cytomegalovirus disease of organ other than liver, spleen, or lymph nodes HSV infection mucocutaneous Disseminated endemic mycosis Candidiasis of oesophagus or resp tract
What is the difference between HIV and AIDS?
HIV is an immune suppressant virus
AIDS is symptoms suffered as a result of the immune system being weakened by HIV
What are respiratory AIDS defining conditions?
TB
Pneumocystitis
What are neurological AIDS defining conditions?
Cerebral toxoplasmosis
Primary cerebral lymphoma
Cryptococcal meningitis
Progressive multifocal leucoencephalopathy
What are neurological conditions where HIV testing should be offered?
Aseptic meningitis/encephaliltis Cerebral abscess Space occupying lesion of unknown cause Guillan-Barre syndrome Transverse myelitis Peripheral neuropathy Dementia Leucoencephalopathy
What is an AIDS defining dermatological condition?
Kaposi’s sarcoma
What is a GI AIDS defining condition?
Persistent cryptosporidosis
What oncological condition is AIDS defining?
Non-Hodgkin’s lymphoma
What Gynaecological condition is AIDS defining?
Cervical cancer
What is the natural history of HIV infection?
Acute infection Asymptomatic HIV related illness AIDS defining illness Death
What is HIV seroconversion?
When HIV antibodies are first produced
What are symptoms of HIV seroconversion?
Flu-like illness Fever Malaise and lethargy Pharyngitis Lymphadenopathy Toxic exanthema
What are features of pneumocystis jiroveci pneumonia?
Late stage AIDS infection
Opportunistic infection
CD4 cell count usually <200
Classical history of dry cough and increasing breathlessness over several weeks
What investigations are done for pneumocystis jiroveci pneumonia?
CXR
Induced sputum or broncoscopy for Polymerase Chain Reaction
What is used to treat pneumocystis jiroveci pneumonia?
Cotrimoxazole
Pentamidine
How long is treatment given for pneumocystis jiroveci pneumonia?
Until CD4 >200
What is used to treat HIV?
Combination Antiretroviral Therapy
What is Combination Antiretroviral Therapy?
Pill containing 3 drugs from at least 2 groups
What is the required patient adherence for combination antiretroviral therapy to work?
90%
How long does HIV treatment need to be taken?
For life
What are different types of antiviral drugs?
Nucleoside reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Protease inhibitors
Integrase inhibitors
What are side effects of nucleoside reverse transcriptase inhibitors?
Marrow toxicity
Neuropathy
Lipodystrophy
What are side effects of non-nucleoside reverse transcriptase inhibitors?
Skin rashes
Hypersensitivity
Drug interactions
Neuropsychiatric effects
What are side effects of protease inhibitors?
Drug interactions
Diarrhoea
Lipodystrophy
Hyperlipidaemia
What are side effects of integrase inhibitors?
Rashes
Disturbed sleep
What demographics have the most HIV prevalence?
Men who have sex with men
Black african population
How can HIV be transmitted?
Sexual intercourse - anal/vaginal Vertical transmission - mother to baby via pregnancy, childbirth, or breastfeeding Sharing needles Needlestick injury Blood transfusion Organ transplant
What is the virology of HIV?
HIV attaches to cells with CD4 which leads to low levels of CD4 cells
How is HIV tested for?
Antibody Antigen Viral load CD4 count Typing
What is the diagnostic window?
The point of infection before it can be detected by diagnostic tests - before antibodies are made
How is HIV infection monitored?
CD4 cell count
HIV viral load
Clinical features
What body fluids can spread HIV?
CSF Pleural/peritoneal/pericardial fluid Breast milk Amniotic fluid Vaginal secretions/semen Saliva Synovial fluid
What should be done after exposure to HIV?
Wash off splashes on skin with soap and running water
Exposed mucous membranes should be irrigated with water
Encourage bleeding if skin broken
Wash out splashes in the eye
What is HIV PEP?
Post exposure prophylaxis
What drugs are given for HIV PEP?
Truvada
Raltegravir
When should HIV PEP be administered?
Within 72 hours of exposure for 28 days
