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Infectious diseases > HIV > Flashcards

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
Q

What infections is a patient at increased risk of w a CD4 count of <50

A

Cytomegalovirus retinitis

Mycobacterium avium-intracellulare infection

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26
Q

What levels can viral load reach in uncontrolled infection?

A

> 500000

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27
Q

What is the general rule regarding viral load levels that are undetectable?

A

undetectable = untransmittable

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28
Q

What are the features of pneumocystis jirovecii pneumonia

A 
SOB 
Dry cough
fever
few chest signs 
exercise induced low sats
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29
Q

What is a complication of PCP?

A

Pneumothorax

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30
Q

What is the treatment of PCP?

A

Co-trimoxazole
pentamidine
prednisolone

31
Q

What makes an AIDS diagnosis?

A

CD4 count <200

Presence of AIDS defining illness + HIV +ve

32
Q

What are the AIDS defining illnesses?

A 
PCP
CMV
TB
Sentinal tumours: Kaposi's sarcoma, lymphoma 
Encephalopathy
Candidiasis
33
Q

What lymphomas does HIV put u at increased risk of ?

A

non-hodgkins lymphoma including:

  • diffuse large B cell
  • Burkitts
  • primary CNS
34
Q

What is the treatment of lymphoma associated with HIV?

A

steroids +/- whole brain irradiation

35
Q

What are the sx of MAI?

A

fever
sweats
abdo pain
diarrhoea

36
Q

What should be done to confirm a diagnosis of MAI?

A 
blood cultue
BM examination (bone marrow)
37
Q

What is the Rx of MAI

A

rifabutin
ethambutol
clarithromycin

38
Q

What is the most common cause of diarrhoea in HIV and how do u treat it?

A

cryptosporidium

rx w supportive therapy

39
Q

What is the cause of kaposi’s sarcoma?

A

HHV-8

40
Q

How does Kaposi’s sarcoma present?

A

purple papule or plaques on the skin or mucosa

resp involvement: haemoptysis or pleural effusion

41
Q

how would you confirm kaposis sarcoma?

A

histologicaly

42
Q

What is the treatment of kaposi’s sarcoma?

A

ART
Intralesional retinoids or vinblastine
radiotherapy for cosmoses/pain
chemo+ ART in advanced disease

43
Q

How does CMV present?

A 
retinitis (blurred then loss of vision)
encephalitis
oesophagitis, colitis
hepatitis
BM suppression
pneumonia
44
Q

What investigations would you do to diagnose CMV

A

serial CMV viral laod
retinal lesions
GI ulceration
‘Owls eye’ inclusions on biopsy

45
Q

What is the treatment of CMV and what are their side effects

A

ganciclovir/valganciclovir
SE:
rash, diarrhoea, bone myelosuppression

46
Q

What is the commonest systemic fungal infection in HIV?How does it present?

A

cryptococcus neoformans

Presentation: meningitis, headache, fever, meningism variable

47
Q

How would you investigate a cryptococcus neoformans infection

A

LP

CSF stain

48
Q

How would you treat cryptococcus neoformans infection

A

induction w liposomal amphotericin

49
Q

What is the commonest cause of intracranial mass lesions when CD4 <200? How would it present?

A

toxoplasma abscesses due to toxoplasma gondii
Presentation:
- Focal euro signs +/- seizures
- signs of raised ICP

50
Q

What investigations would you do for toxoplasma gondii infection?

A

MRI - ring enhancing lesions + oedema

CSF PCR

51
Q

What is the treatment of toxoplasma gondii infection

A

pyrimethamine
sulfadiazine
folinic acid

52
Q

What are the causes of diarrhoea in HIV patients?

A
  1. HIV enteritis (effects of virus itself)
  2. Cryptosporidium
  3. CMV
  4. MAI
  5. Giarda
53
Q

What are the causes of focal neurological lesions in HIV?

How would you differentiate between them?

A
  1. Toxoplasmosis: multiple lesions, ring enhancement, thallium SPECT -ve
  2. primary CNS lymphoma (EBV): single lesion, solid enhancement, thallium SPECT +ve
54
Q

What are the causes of generalised neurological disease in HIV?

A
  1. encephalitis - due to CMV or HIV itself
  2. Cryptococcus
  3. progressive multifocal leukoencephalopathy
  4. AIDS dementia complex
55
Q

What does HAART involve?

Generally how does it work?

A

Combo of 3 drugs, typically 2 NRTIs + NNRTI/PI

works by reducing replication and therefore reducing risk of viral resistance

56
Q

What are NRTIs? Give examples and SEs

A 
Nucleoside reverse transcriptase inhibitors 
- Abacavir + lamivudine 
- Tenofovir + emtricitabine 
SE:
- GI disturbance
- anorexia
- pancreatitis 
- hepatic dysfunction 
- ↓bone-mineral density.
57
Q

When should you avoid abacavir?

A

high risk of CVD

58
Q

When should you avoid tenofovir?

A

egfr<30

59
Q

What are protease inhibitors? Give examples and SE

A 
atazanavir, darunavir
SE:
hyperglycaemia
insulin resistance 
dyslipidaemia
jaundice
hepatitis
60
Q

What are NNRTIs? Give examples and SEs

A

Non-nucleoside reverse transcriptase inhibitors
Rilpivirine
Efavirenz - CNS toxicity, assoc w suicidality
Other SE: rash + GI disturbance

61
Q

Give examples of integrase inhibitors and their SEs

A

dolutegravir
elvitagravir
SE: rash, GI disturbance, insomnia

62
Q

How can HIV via sexual transmission be prevented?

A

condom

63
Q

What is PEP? What does it involve?

A

Post-exposure prophylaxis

Short term use of ART after potential HIV exposure

64
Q

How soon after exposure should PEP be given?

A

up to 72hrs, ideally <24hr

65
Q

What is 1st line PEP?

A

truvada - tenofovir/emtricitabine
+
raltegravir

66
Q

How soon after exposure should HIV be tested for ?

A

8-12 weeks

67
Q

What does PREP involve? Who is it recommended in?

A

ART in high risk of acquiring HIV
serodifferent relationships w/o suppression of viral load
condomless anal sex in MSM

68
Q

How is vertical transmission prevented?

A
  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
Q

What factors reduce vertical transmission?

A
  1. maternal ART
  2. mode of delivery - CS
  3. Neonatal ART
  4. Bottle feeding
70
Q

When is HIV tested for in pregnancy and alongside which other infections?

A

10 weeks alongside hep B and syphilis

71
Q

When is vaginal delivery indicated?

A

viral load <50 at 36 weeks

72
Q

What should be started alongside CS in delivery?

A

zidovudine IV 4 hours before

73
Q

What is the regimen for neonatal antiretroviral therapy?

A

triple ART for 4-6 weeks

Zidovudine oral if maternal viral load <50

Infectious diseases (8 decks)

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