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Reproduction and sexual health > HIV > Flashcards

HIV Flashcards

1
Q

What types of virus is HIV

A

retrovirus

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2
Q

What disease can HIV cause

A

Acquired Immunodeficiency Syndrome AIDS

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3
Q

what are the 2 types of HIV

A

HIV 1 - responsible for global pandemic

HIV 2 - less virulent, West Africa

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4
Q

What does HIV target molecularly

A

CD4+ receptors

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5
Q

Which cells contain CD4+ receptors

A

T helper lymphocytes (CD4+ cells)
microglia
dendritic cells
macrophages

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6
Q

What are the functions of CD4+ cells

A

activate CD8+ cells
activate B cells
recognise MHC II APCs
cytokine release

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7
Q

What is the normal CD4+ cell count

A

500-1600 cells/mm3

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8
Q

below which level of CD4+ cell count is opportunistic infection a risk?

A

CD4+ < 200 cells/mm3

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9
Q

How long is the window of opportunity to prevent HIV after exposure

A

72 hours

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10
Q

when is the onset of primary HIV

A

2-4 weeks after infection

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11
Q

How can primary HIV present

A 
fever 
myalgia 
rash 
pharyngitis 
headaches
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12
Q

Is viral replication still occurring in asymptomatic HIV

A

Yes, despite having no symptoms, virus continues to replicate and there is CD4+ cell count depletion

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13
Q

Define opportunistic infection

A

an infection caused by a pathogen that does not normally cause disease in a healthy individual

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14
Q

What is the most common opportunistic infection in HIV

A

Pneumocytis pneumonia

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15
Q

What organism causes pneumocystis pneumonia

A

Pneumocystis jirovecii / PCP

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16
Q

At what CD4+ cell count does pneumocystis pneumonia occur

A

<200

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17
Q

Prophylaxis for PCP is given to those with CD4+ <200, true or false

A

TRUE

With low dose co-trimoxazole

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18
Q

How does pneumocytsis pneumonia present

A

insidious onset
SOB
dry cough

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19
Q

How can the CXR appear in PCP

A

normal

may look like CCF, infiltrative rather than lobular pathology

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20
Q

What investigations can be done for PCP

A

Exercise desaturation - exercising causes tachycardia and reduced O2 saturation
CXR
Bronchoalveolar lavage + immunofluorescence
+- PCR

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21
Q

What is the management of pneumocystis pneumonia

A

High dose co-trimoxazole (+steroid if hypoxic)

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22
Q

Latent TB can reactivate with co-existing HIV, true or false

A

TRUE

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23
Q

What organism causes cerebral toxoplasmosis

A

toxoplasmosis gondii

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24
Q

levels below which CD4+ cell level puts you at risk of cerebral toxoplasmosis

A

CD4+ <150 cells/mm3

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25
Q

How does cerebral toxoplasmosis appear on imaging

A

Ring enhancing lesions

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26
Q

What are symptoms of cerebral toxoplasmosis

A 
headaches 
fever 
^ICP 
focal neurology 
seizures 
reduced consciousness
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27
Q

Below which level of CD4+ cell count is CMV a risk?

A

< 50 cell/mm3

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28
Q

What screening occurs in those with CD4+ < 50

A

ophthalmic screening

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29
Q

What are symptoms of CMV infection

A 
retinitis
colitis - abdominal pain, PR bleeding, diarrhoea 
oesophagitis 
reduced visual acuity 
floaters in vision
30
Q

Features of Herpes Zoster viral infection in those with HIV

A

multidermatomal rashes

recurrent

31
Q

Features of Herpes simplex viral infection in those with HIV

A

extensive and hypertrophic

aciclovir resistant

32
Q

What other weird skin infections can occur in HIV

A

penicillosis

histoplasmosis

33
Q

What is HIV associated neurocognitive impairment

A

reduced short term memory with motor dysfunction
brain atrophy
can occur at any CD4+ cell level

34
Q

What is progressive multifocal leukoencephalopathy

A

PML is a rapidly progressing disease with focal neurology and confusion and personality change

35
Q

What causes PML

A

JC virus

36
Q

below which CD4+ cell level does PML occur

A

<100 cells/mm3

37
Q

What other conditions may be associated with HIV

A 
distal sensory polyneuropathy 
Guillain barre syndrome 
mononeuritis multiplex 
vascular myelopathy 
aseptic meningitis 
cryptococcal meningitis 
neurosyphilis
38
Q

What is Slim’s disease

A

HIV associated wasting - cachectic appearance

39
Q

Give examples of AIDS related cancers

A

Kaposi’s sarcoma
Cervical cancer
Non-Hodgkins lymphoma

40
Q

What virus causes Kaposi’s sarcoma

A

human herpes virus 8 (HHV 8)

41
Q

Describe Kaposi’s sarcoma

A 
Spongy, purple tumours
vascular tumours 
occur at any CD4+ cell count 
cutaneous, mucosal, visceral 
eg skin, nails, palate, lungs, guts
42
Q

Which virus causes Non-Hodgkins lymphoma

A

Eptein Barr virus EBV

43
Q

Describe Non-Hodgkins lymphoma

A

Can occur at any CD4+ count
bone marrow involvement
B symptoms

44
Q

Which virus causes cervical cancer

A

Human papilloma virus HPV

45
Q

List some non-opportunistic HIV features

A 
mucosal candidiasis (Oral, oesophageal)
seborrhoeic dermatitis (eczema and fungal)
diarrhoea 
fatigue 
worsening psoriasis 
lymphadenopathy 
parotitis 
epidemiologically linked STIs
46
Q

List some haematological diseases in HIV

A

Anaemia of chronic disease
thrombocytopaenia
can occur at any CD4+ level

47
Q

Describe modes of transmission of HIV

A

Sexually transmitted - MSM, W+M
Parenterally transmitted - PWID, infected blood products, iatrogenic
Mother to child transmission - in utero, delivery, breast feeding

48
Q

List methods of identifying those with HIV

A

Universal screening - high prevalence areas
Opt out testing - certain clinical settings
Screening - high risk groups
Clinical indicative testing - HIV is a differential

49
Q

What are the markers of HIV

A

Antibody testing
Antigen p24
Viral RNA

50
Q

What is 3rd generation testing

A

HIV 1+2 antibody testing
detects IgM and IgG
3 months window period

51
Q

What is 4th generation testing

A

combined antibody and antigen p24 testing

shorter window period

52
Q

A negative 4th generation test performed at 4 weeks post exposure is highly unlikely to exclude HIV, true or false

A

FALSE, it is likely to exclude HIV

53
Q

What is the rapid HIV test

A

POCT
fingerprick blood test
results in 20-30 minutes

54
Q

Describe the life cycle of HIV

A

HIV infects CD4+ cells via CCR5 receptor
HIV membrane fuses with CD4+ cell membrane
Reverse transcriptase converts viral RNA to DNA
Integrase incorporates viral genome into the host cells
Replication of genetic material occurs
Assembly
Protease cleaves DNA which then buds off to make new vesicles

55
Q

Give types of reverse transcriptase target medications

A

Nucleoside Reverse Transcriptase Inhibitors NRTIs
Non-Nucleoside Reverse Transcriptase Inhibitors NNRTIs
Nucleotide Reverse Transcriptase Inhibitors NtRTIs

56
Q

What other medications are used in HIV

A

Protease inhibitors
Integrase inhibitors
Fusion inhibitors
CCR5 inhibitors

57
Q

Mono and dual therapy is effective, true or false

A

FALSE

they are ineffective due to increasing resistance

58
Q

Define HAART

A

Highly Active Anti Retroviral Therapy

combination of a minimum of 3 drugs from at least 2 drug classes that HIV is susceptible to

59
Q

What are the aims of HAART

A

Reduce viral load to undetectable
Restore immunocompetence
Reduce morbidity and mortality

60
Q

What is the single most important factor in taking HIV treatment

A

Adherence

61
Q

What are some toxic effects of HAART

A 
GI - transaminitis, fulminant hepatitis 
CNS - sleep disorders, psychosis, mood 
Skin - rash, hypersensitivity 
Renal - stones, proximal tubulopathies 
Bone - osteomalacia 
CVS - MI risk 
Haematology - anaemia
62
Q

Protease inhibitors are potent liver enzyme inducers/inhibitors?

A

inhibitors

63
Q

NNRTIs are potent liver enzyme inducers/inhibitors?

A

Inducers

64
Q

Partner notification is a voluntary process, true or false

A

TRUE

65
Q

List methods of preventing transmission

A 
Condoms
HIV treatment 
STI screening and treatment 
partner disclosure 
PEP - Post exposure prophylaxis 
PrEP - Pre exposure prophylaxis
66
Q

Can couples with HIV conceive normally

A

Yes as long as they are on HAART

67
Q

explain reasons for different delivery methods in pregnant mothers with HIV

A

undetectable load –> vaginal birth

detectable load –> c-section

68
Q

How long does a neonate get PEP for

A

4 weeks

69
Q

Breast feeding is allowed in HIV mothers, true or false

A

FALSE, breast feeding is absolutely contraindicated

70
Q

What are the eligibility criteria for PrEP

A 
>= 16yo 
HIV negative 
commits to 3 monthly appointments 
willing to stop if eligibility criteria no longer apply 
Scottish resident
71
Q

What are the high risk factors for getting HIV

A

HIV + partner with detectable load
MSM
UPAI >=2 partners in last year and likely to do so again in next 3 months
confirmed bacterial rectal STI in last year
other high risk factors

Reproduction and sexual health (46 decks)

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