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Clinical Microbiology > HIV > Flashcards

HIV Flashcards

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1
Q

Which type of HIV virus is responsible for the vast majority of HIV infections?

A

HIV-1

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2
Q

Which virus, found in chimpanzees and gorillas in west Africa, is closely related to HIV1?

A

Simian immunodeficiency virus

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3
Q

When are HIV viruses through to have crosses species from primaries to humans in Africa?

A

late 19th / early 20th century

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4
Q

What is the bush meat theory of how HIV transmitted to humans?

A

The theory that a hunter was bitten or cut while butchering an animal resulting in transmission of HIV to humans

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5
Q

What factors may have triggered or contributed to an epidemic of transmission of HIV when it first emerged in Africa?

A

Social changes and urbanisation
Unsterile injections
Genital ulcer diseases
Sexual promiscuity

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6
Q

How can HIV be transmitted?

A 
Sexually transmitted
IV drug use (sharing needles)
Mother to child vertical transmission
Contaminated blood products
Occupation e.g. needle stick injuries
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7
Q

How does HIV enter the body?

A 
Open cuts
Sores
Breaks in the skin
Mucous membranes (aus/vagina)
Direct injection
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8
Q

HIV contains three of its own enzymes which can each be used as drug targets. What are these enzymes?

A

Integrase
Reverse transcriptase
Protease

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9
Q

Which immune cells does HIV infect?

A

T helper cells
Macrophages
Dendritic cells

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10
Q

What receptor allows the entry of HIV into immune cells?

A

CD4+

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11
Q

How does HIV infection cause depletion of CD4+ T cells?

A

Direct viral killing of cells
Apoptosis of unaffected bystander cells
CD8+ cytotoxic T cell killing of infected CD4+ T cells

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12
Q

How can HIV infection result in inappropriate/excess immunoglobulin production?

A

By inducing abnormal B cell activation by infected CD4+ T cells

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13
Q

What is the critical level of CD4+ cells at which a person becomes at risk of opportunistic infections and some cancers?

A

<200

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14
Q

What are the six types of antiretroviral drug used to treat HIV?

A

Fusion inhibitor
R5 inhibitor
Nucleoside reverse transcriptase inhibitor
Non-nucleoside reverse transcriptase inhibitor
Integrase inhibitor
Protease inhibitors

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15
Q

What type of genetic material does HIV have?

A

Single stranded RNA

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16
Q

HIV is a non-enveloped virus. T/F?

A

False - it is an enveloped virus and some of the surface proteins in this envelope have been considered as potential drug treatments

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17
Q

What is viral latency?

A

A state of reversibly non-productive infection of individual cells

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18
Q

What does the term ‘latency’ refer to in HIV?

A

The long asymptomatic period between initial infection and advanced HIV

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19
Q

At what point in infection is there no way of curing HIV?

A

Once the HIV virus genetic material is incorporated into the host DNA as there is no way of removing this

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20
Q

What can help to reduce the risk of drug resistance in HIV?

A

Taking HIV medications very day, exactly as prescribed

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21
Q

How can drug resistant HIV develop?

A

As HIV multiplies in the body, the virus sometimes mutates and produces variations of itself. Variation of HIV that develop while a person is taking HIV medicines can lead to drug resistance

22
Q

What is the main theoretical safety concern against the development of a live attenuated HIV vaccine?

A

The possibility of reversion to a live virus through mutation

23
Q

HIV, is diagnosed early and treated appropriately, has a near normal. life expectancy. T/F?

A

True

24
Q

When is HIV universally tested for?

A

Antenatal screening
GUM clinics
IV drug users
Populations in which the prevalence fo HIV is >2/1000

25
Q

What populations are at higher risk of HIV?

A 
Patients from sub-saharan Africa
MSMs
Children of people with HIV
IV drug users
People who have transactional sex
26
Q

What does the HIV blood test look for?

A

The presence fo the p24 antigen and His antibody

27
Q

What is the window period for HIV testing?

A

4 weeks

28
Q

If a positive HIV test is done, a confirmatory test is conducted. T/F?

A

True

29
Q

What is the other name for primary HIV infection?

A

HIV seroconversion

30
Q

What are the differential diagnoses of HIV seroconversion?

A

Infectious mononucleosis
Secondary syphilis
Drug rash
Other viral infections

31
Q

What are the main symptoms of acute HIV infection?

A 
Fever
Weight loss
Malaise
Headache
Neuropathy
Pharyngitis
Sores and thrush in the mouth
Lymphadenopathy
Rash
Myalgia
Nausea
Vomiting
Enlargement of liver and spleen
32
Q

Give examples of conditions which can be indicators of HIV infection?

A 
TB
Pneumocystitis
Cerebral toxoplasmosis
Primary cerebral lymphoma
Crytococcal meningitis
Progressive multifocal leucencephalopathy
Kapsoi's sarcoma
Persistent crytosporidosis
Cervical cancer
Cytomegalovirus 
Non-hodgkin;s lymphoma
33
Q

What is the aim of treatment in HIV infection?

A

To maintain an undetectable viral load

34
Q

What is the definition of an undetectable viral load globally?

A

<200 copies per ml

35
Q

What is the definition of an undetectable viral load in Scotland?

A

<40 copies per ml

36
Q

When should antiretroviral treatment be started in HIV infection?

A

As soon as possible to reduce morbidity/mortality and reduce risk of onwards transmissions

37
Q

What drugs are used in triple therapy against HIV?

A

2 nucleoside reverse transcriptase inhibitors plus a drug from another class (usually an integrase inhibitor)

38
Q

What factors influence the choice of therapy in HIV patients?

A

Patient choice
Comorbidities
Interactions
Drug resistance

39
Q

What are the possible short term side effects of HIV treatment?

A 
Rash
Hypersensitivity
CNS side effects
GI side effects
Renal and septic effects
40
Q

What are the possible long term toxicities of HIV infection?

A 
Body shape changes (lipoatrophy, lipodystrophy)
Renal
Hepatic
Lipid
Bone
41
Q

Why does antiretroviral treatment for HIV have so many. drug interactions?

A

It effects the CYP450 enzyme resulting in reduced/increased drug levels of other medications

42
Q

Partner notification is carried out for all people following a HIV diagnosis. T/F?

A

True

43
Q

How can HIV infection be prevented?

A 
Use of condoms
Treatment as prevention
Post exposure prophylaxis
Pre exposure prophylaxis
Prevention of mother to child transmission
Harm reduction measures
44
Q

How soon after exposure does post exposure prophylaxis for HIV. need to be initiated?

A

72 hours

45
Q

For how long is post exposure prophylaxis for HIV continued?

A

28 days

46
Q

Breast-feeding should be avoided in HIV positive mothers. T/F?

A

True - there is no data on the safety of breastfeeding in HIV infection

47
Q

How is a pregnant women with HIV managed to prevent transmission of HIV to the baby?

A

Antiretrovirals given to mother during pregnancy

Post exposure prophylaxis given to baby

48
Q

P.jiroveci infection is an opportunistic infection which can occur in individuals with HIV. Give an account of the pathogenesis of this infection

A

It is an extracellular pathogen (fungus) which causes interstitial plasma cell pneumonia with foamy exudates int he alveoli

49
Q

What are the symptoms of p.jorveci infection?

A

Progressive and disproportionate shortness of breath, fever, dry cough with failure to respond to usual antibiotic regimes

50
Q

What are the possible complications of p.jiroveci infection?

A

Respiratory failure

Pneumothorax

51
Q

What is the first line treatment for p.jiroveci infection?

A

Cotrimoxazole and steroid therapy

52
Q

What signs of p.jiroveci infection may be seen on CXR?

A

Perihilar interstitial shadowing in moderate disease and white out in sever disease

Clinical Microbiology (17 decks)

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