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HIV Flashcards

1
Q

What kind of virus is HIV?

A

retrovirus

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2
Q

What does HIV cause?

A

Acquired Immunodeficiency Syndrome (AIDS)

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3
Q

Target sites for HIV?

A

CD4+ receptors

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4
Q

What is CD4?

A

CD4 (Cluster of Differentiation) is a glycoprotein found on the surface of a range of cells including:

T helper lymphocytes (“CD4+ cells”)
Dentritic cells
Macrophages
Microglial cells

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5
Q

What do CD4+ Th lymphocytes do?

A

Essential for induction of adaptive immune response

Recognition of MHC2 antigen-presenting cell
Activation of B-cells
Activation of cytotoxic T-cells (CD8+)
Cytokine release

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6
Q

What effect does HIV infection have on immune response?

A

Sequestration of cells in lymphoid tissues
- Reduced circulating CD4+ cells

Reduced proliferation of CD4+ cells

Reduction CD8+ (cytotoxic) T cell activation

  • Dysregulated expression of cytokines
  • Increasing susceptibility to viral infections (including HIV!)
Reduction in antibody class switching
- Reduced affinity of antibodies produced

Chronic Immune Activation (microbial translocation)

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7
Q

HIV makes you susceptible to?

A

Viral infections
Fungal infections
Mycobacterial infections
Infection-induced cancers

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8
Q

CD4+ Th cell count for risk of opportunistic infection?

A

<200 cells/mm3

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9
Q

Primary infection symptoms?

A 
Combination of 
Fever
Rash (maculopapular)
Myalgia
Pharyngitis
Headache/aseptic meningitis

Note: Up to 80% present with symptoms

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10
Q

Onset of primary infection?

A

2-4 weeks after infection

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11
Q

What happens in the asymptomatic phase of HIV infection?

A

Ongoing viral replication

Ongoing CD4 count depletion

Ongoing immune activation

Risk of onward transmission if remains undiagnosed

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12
Q

What is an opportunistic infection?

A

An infection caused by a pathogen that does not normally produce disease in a healthy individual.

It uses the “opportunity” afforded by a weakened immune system to cause disease

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13
Q

Signs and symptoms on pneumocystis jiroveci?

A

Symptoms: insidious onset
SOB
Dry cough
Signs: exercise desaturation

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14
Q

CXR for pneumocystis jiroveci?

A

May be normal

Interstitial infiltrates, reticulonodular markings

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15
Q

Diagnosis of pneumocystis jiroveci?

A

BAL and immunofluorescence +/- PCR

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16
Q

Treatment of pneumocystis jiroveci?

A

Treatment: high dose co-trimoxazole (+/- steroid)
Prophylaxis: low dose co-trimoxazole

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17
Q

Which organism causes cerebral toxoplasmosis?

A

Toxoplasma gondii

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18
Q

CD4 threshold for cerebral toxoplasmosis?

A

<150

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19
Q

What does cerebral toxoplasmosis cause?

A

Multiple cerebral abscess

Chorioretinitis

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20
Q

Signs and symptoms of cerebral toxoplasmosis?

A 
Headache
Fever
Focal neurology
Seizures
Reduced consciousness
Raised intracranial pressure
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21
Q

CD4 threshold for Cytomegalovirus?

A

<50

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22
Q

Symptoms during primary HIV infection?

A 
Fever
Rash (maculopapular)
Myalgia
Pharyngitis
Headache/aseptic meningitis
23
Q

Presentation of cytomegalovirus ?

A

Reduced visual acuity
Floaters
Abdo pain, diarrhoea, PR bleeding

24
Q

What kind of screening should all individuals with a CD4 <50 get?

A

Ophthalmic screening

25
Q

Cancers associated with HIV?

A

Kaposi’s sarcoma
Non-Hodgkins lymphoma
Cervical cancer

26
Q

Organism associated with Kaposi’s sarcoma?

A

Human herpes virus 8

27
Q

Treatment of kaposi’s sarcoma?

A

HAART
Local therapies
Systemic chemotherapy

28
Q

Organism associated with Non-Hodgkins lymphoma?

A

EBV

29
Q

Diagnosis, treatment and prognosis for Non-Hodgkins lymphoma??

A

Diagnosis: as for HIV-
Treatment: as for HIV-, add HAART
Prognosis: approaching HIV

30
Q

Organism associated with Cervical cancer?

A

human papillomavirus

31
Q

HIV testing should be offered to all individuals with complicated disease caused by this virus?

A

human papillomavirus

32
Q

Haematological manifestations of HIV?

A

Anaemia (affects up to 90%)

Thrombocytopenia (ITP)

33
Q

Modes of transmission of HIV?

A

Sexual
Parenteral transmission ( Injecting drugs, infected blood products)
Mother to child (In utero/trans-placental, breastfeeding)

34
Q

What is the risk of mother to child transmission when viral load is undetected at delivery?

A

<0.1%

35
Q

Risk group with the highest proportion of HIV in the UK?

A

MSM

36
Q

Percentage of people living with HIV in the UK that are undiagnosed?

A

7%

37
Q

What is universal testing?

A

In high prevalence areas in the UK (local prevalence >0.2%) HIV testing is recommended to

all general medical admissions
all new patients registering at general practice

38
Q

There is a higher prevalence of HIV in individuals accessing these services than in the background population ?

A

Termination of pregnancy services
GUM clinics
drug dependancy services

39
Q

The risks associated with undiagnosed HIV in these

settings are unacceptably high?

A

Antenatal services

Assisted conception services

40
Q

Which groups are screened sue to high risk of HIV?

A

MSM
Female partners of bisexual men
People who inject drugs
Partners of people living with HIV

41
Q

Markers of HIV used to detect infection?

A

Viral RNA
p24 antigen
anti-HIV antibody

42
Q

3rd generation HIV test

A

HIV antibody test

43
Q

4th generation HIV test

A

combined antibody and antigen test (p24)

44
Q

What is highly active anti-retroviral therapy (HAART)?

A

Combination of 3 drugs from two drug classes which the virus is susceptible

45
Q

Side effects of protease inhibitors?

A

GI upset

46
Q

Side effects of abacavir or nevirapine

A

Skin - rash, hypersensitivity, Stevens-Johnsons

47
Q

Side effects of efavirenz?

A

CNS - mood, psychosis

48
Q

Side effects of tenofovir or atazanavir?

A

Renal toxicity - proximal renal tubulopathies

49
Q

Side effects of tenofovir?

A

Bone - Osteomalacia

50
Q

Side effects of abacavir, lopinavir, maraviroc?

A

CVS - increased MI risk

51
Q

Side effects of zidovudine?

A

Anaemia

52
Q

Side effect of nevirapine?

A

GI - transaminitis or fulminant hepatitis

53
Q

These anti-retrovirals are potent liver enzyme inhibitors?

A

Protease inhibitors

54
Q

These anti-retrovirals are potent liver enzyme inducers?

A

Non-nucleoside reverse transcriptase inhibitors (NNRTI)

Reproduction (6 decks)

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