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HIV Flashcards

1
Q

What does HIV stand for?

A

human immunodeficiency virus

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2
Q

Where is HIV most prevalent?

A

Africa

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3
Q

What are the routes of acquisition, which is the most common?

A
  1. sex (most common)
  2. vertical (mainly birth or breast milk)
  3. Blood/organs
  4. Needles - IVDU
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4
Q

Can it be spread by normal household contact?

A

no

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5
Q

What factors enhance transmission of HIV?

A

MSM

coexistent STIs esp ulcers

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6
Q

WHat are the two main subtypes and what differentiates them?

A

HIV1- global epidemic

HIV2 - West Africa, less pathogenic

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7
Q

What are the tests used to diagnose HIV?

A
  1. HIV ab test - screening ELISA test and confirmation Western Blot Assay
  2. p24 antigen test
  3. HIV PCR
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8
Q

After how long do people develop HIV abs so that they can be detected?

A

4-6 weeks

99% do by 3m

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9
Q

After how long after a person becomes infected with HIV will a p24 antigen test be positive

A

1-3/4 weeks

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10
Q

What is the management of HIV? At what CD4 count should it be started?

A

HAART

any CD4 count

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11
Q

How is HIV monitored?

A

CD4 count - T helper lymphocytes, monocytes and macrophages have CD4 receptor on surface, part of the innate immune system and directly attack HIV virus
Viral load - quantity of virus per ml of serum

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12
Q

What is CD4 count used for?

A

reflects the degree of immunocompromise in people infected with HIV and indicates the risk of opportunistic disease

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13
Q

Explain how the CD4 count changes through the stages of untreated HIV infection

A

Acute infection - increases rapidly then decreases as HIV infection depletes T cells etc
Clinical latency - slowly decreases
AIDS - CD4 count falls below 200

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14
Q

When should a repeat test for HIV be done? how long should you wait?

A

If -ve + asymptomatic after 12 weeks

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15
Q

What type of virus is HIV

A

retrovirus - it encodes reverse transcriptase, allowing DNA copies to be produced from viral RNA

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16
Q

READ UP THE STAGES OF HIV INFECTION

A

:)

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17
Q

What is seroconversion ? When does it typically occur?

A

period in which HIV antibodies develop and become detectable
usually occurs within weeks of initial infection

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18
Q

How does primary acute infection usually present?

A

Symptomatic in 80%
2–4 weeks after infection
Symptoms:
Non-specific - include sore throat, fever, maculopapular rash, malaise, myalgia (glandular fever type illness)

lasts up to 3 weeks and recovery is usually complete

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19
Q

What is primary acute infection also known as?

A

seroconversion illness

acute retroviral syndrome

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20
Q

How does clinical latency present?

A

usually asymptomatic

can be persistent generalised lymphadenopathy = >1cm in 2 or more non-contiguous sites for >3m

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21
Q

What is the normal range of CD4 count?

A

450-1600

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22
Q

What infections is a patient at increased risk of w a CD4 count of 200-500?

A 
Oral thrush (Candida albicans)
Hairy leukoplakia (EBV)
Shingles (Herpes zoster)
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23
Q

What conditions is a patient at increased risk of w a CD4 count of 100-200

A 
Cryptosporidiosis
Cerebral toxoplasmosis
Progressive multifocal leukoencephalopathy
Pneumocystis jirovecii pneumonia
HIV dementia
Kaposi sarcoma (HHV-8)
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24
Q

What conditions is a patient at increased risk of w a CD4 count of 50-100

A

Aspergillosis
Oesophageal candidiasis
Cryptococcal meningitis
Primary CNS lymphoma (EBV)

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25
What infections is a patient at increased risk of w a CD4 count of <50
Cytomegalovirus retinitis | Mycobacterium avium-intracellulare infection
26
What levels can viral load reach in uncontrolled infection?
>500000
27
What is the general rule regarding viral load levels that are undetectable?
undetectable = untransmittable
28
What are the features of pneumocystis jirovecii pneumonia
``` SOB Dry cough fever few chest signs exercise induced low sats ```
29
What is a complication of PCP?
Pneumothorax
30
What is the treatment of PCP?
Co-trimoxazole pentamidine prednisolone
31
What makes an AIDS diagnosis?
CD4 count <200 | Presence of AIDS defining illness + HIV +ve
32
What are the AIDS defining illnesses?
``` PCP CMV TB Sentinal tumours: Kaposi's sarcoma, lymphoma Encephalopathy Candidiasis ```
33
What lymphomas does HIV put u at increased risk of ?
non-hodgkins lymphoma including: - diffuse large B cell - Burkitts - primary CNS
34
What is the treatment of lymphoma associated with HIV?
steroids +/- whole brain irradiation
35
What are the sx of MAI?
fever sweats abdo pain diarrhoea
36
What should be done to confirm a diagnosis of MAI?
``` blood cultue BM examination (bone marrow) ```
37
What is the Rx of MAI
rifabutin ethambutol clarithromycin
38
What is the most common cause of diarrhoea in HIV and how do u treat it?
cryptosporidium | rx w supportive therapy
39
What is the cause of kaposi's sarcoma?
HHV-8
40
How does Kaposi's sarcoma present?
purple papule or plaques on the skin or mucosa | resp involvement: haemoptysis or pleural effusion
41
how would you confirm kaposis sarcoma?
histologicaly
42
What is the treatment of kaposi's sarcoma?
ART Intralesional retinoids or vinblastine radiotherapy for cosmoses/pain chemo+ ART in advanced disease
43
How does CMV present?
``` retinitis (blurred then loss of vision) encephalitis oesophagitis, colitis hepatitis BM suppression pneumonia ```
44
What investigations would you do to diagnose CMV
serial CMV viral laod retinal lesions GI ulceration 'Owls eye' inclusions on biopsy
45
What is the treatment of CMV and what are their side effects
ganciclovir/valganciclovir SE: rash, diarrhoea, bone myelosuppression
46
What is the commonest systemic fungal infection in HIV?How does it present?
cryptococcus neoformans | Presentation: meningitis, headache, fever, meningism variable
47
How would you investigate a cryptococcus neoformans infection
LP | CSF stain
48
How would you treat cryptococcus neoformans infection
induction w liposomal amphotericin
49
What is the commonest cause of intracranial mass lesions when CD4 <200? How would it present?
toxoplasma abscesses due to toxoplasma gondii Presentation: - Focal euro signs +/- seizures - signs of raised ICP
50
What investigations would you do for toxoplasma gondii infection?
MRI - ring enhancing lesions + oedema | CSF PCR
51
What is the treatment of toxoplasma gondii infection
pyrimethamine sulfadiazine folinic acid
52
What are the causes of diarrhoea in HIV patients?
1. HIV enteritis (effects of virus itself) 2. Cryptosporidium 3. CMV 4. MAI 5. Giarda
53
What are the causes of focal neurological lesions in HIV? | How would you differentiate between them?
1. Toxoplasmosis: multiple lesions, ring enhancement, thallium SPECT -ve 2. primary CNS lymphoma (EBV): single lesion, solid enhancement, thallium SPECT +ve
54
What are the causes of generalised neurological disease in HIV?
1. encephalitis - due to CMV or HIV itself 2. Cryptococcus 3. progressive multifocal leukoencephalopathy 4. AIDS dementia complex
55
What does HAART involve? | Generally how does it work?
Combo of 3 drugs, typically 2 NRTIs + NNRTI/PI | works by reducing replication and therefore reducing risk of viral resistance
56
What are NRTIs? Give examples and SEs
``` Nucleoside reverse transcriptase inhibitors - Abacavir + lamivudine - Tenofovir + emtricitabine SE: - GI disturbance - anorexia - pancreatitis - hepatic dysfunction - ↓bone-mineral density. ```
57
When should you avoid abacavir?
high risk of CVD
58
When should you avoid tenofovir?
egfr<30
59
What are protease inhibitors? Give examples and SE
``` atazanavir, darunavir SE: hyperglycaemia insulin resistance dyslipidaemia jaundice hepatitis ```
60
What are NNRTIs? Give examples and SEs
Non-nucleoside reverse transcriptase inhibitors Rilpivirine Efavirenz - CNS toxicity, assoc w suicidality Other SE: rash + GI disturbance
61
Give examples of integrase inhibitors and their SEs
dolutegravir elvitagravir SE: rash, GI disturbance, insomnia
62
How can HIV via sexual transmission be prevented?
condom
63
What is PEP? What does it involve?
Post-exposure prophylaxis | Short term use of ART after potential HIV exposure
64
How soon after exposure should PEP be given?
up to 72hrs, ideally <24hr
65
What is 1st line PEP?
truvada - tenofovir/emtricitabine + raltegravir
66
How soon after exposure should HIV be tested for ?
8-12 weeks
67
What does PREP involve? Who is it recommended in?
ART in high risk of acquiring HIV serodifferent relationships w/o suppression of viral load condomless anal sex in MSM
68
How is vertical transmission prevented?
1. commence all pregnant women w HIV on ART by 24weeks gestation 2. CS delivery if viral load <50 3. give neonatal PEP from birth to 4wks w formula feeding
69
What factors reduce vertical transmission?
1. maternal ART 2. mode of delivery - CS 3. Neonatal ART 4. Bottle feeding
70
When is HIV tested for in pregnancy and alongside which other infections?
10 weeks alongside hep B and syphilis
71
When is vaginal delivery indicated?
viral load <50 at 36 weeks
72
What should be started alongside CS in delivery?
zidovudine IV 4 hours before
73
What is the regimen for neonatal antiretroviral therapy?
triple ART for 4-6 weeks | Zidovudine oral if maternal viral load <50

Infectious diseases (8 decks)

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