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Y4: Infectious Disease > HIV > Flashcards

HIV Flashcards

1
Q

Origin of HIV infection?

A
  • Zoonotic infection with simian immunodeficiency virus (SIV)
  • First infecting local hunters
  • HIV-1 is the cause of global pandemic
  • HIV-2 causes similar illness but with slower progression
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2
Q

What are the modes of transmission of HIV?

A
  • Sexual contact
  • Exposure to blood
    • IV drug use
    • Health case workers
    • Blood products
  • HIV infected mothers
    • In utero
    • Breastfeeding
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3
Q

What is the major route of transmssion?

A

Heterosexual

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4
Q

What determines the risk of contracting HIV after exposure?

A
  • Integrity of exposed site
  • Type and volume of fluid
  • Level of viraemia in source person
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5
Q

Name some factors which increase the risk of transmission of HIV?

A
  • High viral load
  • Rectal/vaginal lacerations
  • Uncircumcised male partner
  • Receptive anal intercourse
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6
Q

Describe the properties of HIV?

A
  • Enveloped RNA retrovirus
  • From lentivirus family
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7
Q

Describe the pathophysiology of HIV?

A
  • After exposure, HIV travels to lymph nodes via dendritic cells
  • Viraemia occurs
  • Dissemintation to lymphoid organs
    • Main sites of viral replication
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8
Q

What cells does HIV infect?

A
  • Cells bearing the CD4 receptor
    • T-helper lymphocytes
    • Monocyte-macrophages
    • Dendritic cells
    • Microglial cells in CNS
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9
Q

Describe the diagnosis of HIV testing?

A
  • Detecting host antibodies with:
    • Rapid point of care tests
    • Labarotory ELISA tests
  • Positive antibody test from two different immunoassays confirms infection
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10
Q

What patients should be offered HIV testing in the UK?

A
  • Patients accessing sexual health services
  • Patients accessing primary and secondary care
    • With relevant risks
  • Prison inmates
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11
Q

Name some important aspects counselling following a positive HIV result?

A
  • Explain meaning of the result
  • Assess coping strategy
  • Stress important of partner disclosure
  • Facilitate notification of sexual partners
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12
Q

Name some important baseline investigations investigating someone with HIV?

A
  • CD4 count
  • Viral load
  • Screening for other investigations
    • HBV, HCV, syphilis, TB
  • FBC, LFTs
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13
Q

What is the most important indicator of immune suppression in HIV?

How often should it be monitored?

A
  • CD4 count
  • Measured every 3-6 months
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14
Q

What is a normal CD4 count?

What CD4 count results in severe immune suppression?

A

> 500 cells/mm3

< 200 cells/mm3

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15
Q

How is the CD4 lymphocyte count determined?

A

Flow cytometry

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16
Q

Describe measurements of viral load in HIV?

A
  • Quantitative PCR of HIV RNA
    • High viral loads experience more rapid declines of CD4 count
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17
Q

What a re the clinical features of a primary HIV infection?

A
  • Fever
  • Maculopapular rash
  • Pharyngitis
  • Lymphadenopathy
  • Oral and genital ulceration
  • Bell’s palsy
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18
Q

What does the appearance of anti-HIV antibodies occur?

A

2-12 weeks after the development of symptoms

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19
Q

Describe AIDS?

A
  • Defined by development of:
    • Specific oppurtunistic infections
    • Cancers
    • Severe manifestations of HIV
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20
Q

Name some conditions which an HIV patient is at risk of when there CD4 count is . less than 500?

A
  • Tuberculosis
  • Herpes zoster
  • Kaposi’s sarcoma
  • Oropharyngeal candidiasis
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21
Q

Name some conditions which an HIV patient is at risk of when there CD4 count is . less than 200?

A
  • Pneumocystis jiroveci pneumonia
  • Chronic herpes simplex ulcers
  • HIV-associated dementia
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22
Q

Name some conditions which an HIV patient is at risk of when there CD4 count is less than 100?

A
  • Cerebral toxoplasmosis
  • Cryptococcal meningitis
  • Progressive multifocal leucoencephalopthy
23
Q

Globally, what is the most common cause of morbidity and mortality in HIV patients?

A

Tuberculosis

24
Q

What is HIV wasting syndrome?

A
  • Sign of advanced HIV infection
  • Weight loss of > 10% body weight plus 1 of:
    • Diarrhoea for over 1 month
    • Chronic weakness
    • Prolonged fever
25
Q

What is used to treat pneumocystis jiroveci pneumonia in AIDS?

A
  • Co-trimoxazole
  • Adjunctive prednisolone
26
Q

What is used to treat cerebral toxoplasmosis in AIDS?

A
  • Pyrimethamine
  • Sulphadiazine
27
Q

What is used to treat cryptococcosis in AIDS?

A
  • Amphotericin B
  • Flucytosine
28
Q

What is used to treat oesophageal candidiasis in AIDS?

A

Fluconazole

29
Q

Describe Kaposi’s sarcoma?

A
  • Spindle cell tumour
  • Due to sexually transmitted HSV-8
  • Mucocutaneous lesions and lymphoedema +/- B symptoms
30
Q

Describe primary HIV infection?

A
  • Incubation period 2-4 weeks after exposure
  • Often presents similar to glandular fever
    • Maculopapular rash can differentiate HIV
  • Lymphopenia, thrombocytopenia and elevated liver enzymes
31
Q

Differentials for primary HIV infection?

A
  • Glandular fever
  • Primary toxoplasmosis
  • Secondary syphilis
32
Q

What is the median time from infection to AIDS development in adults with asymptomatic HIV infection?

A

9 years

33
Q

Describe progressive multifocal leucoencephalopathy (PML)?

A
  • Stroke-like episodes and cognitive impairment
  • Vision impairment due to involvement of occipital cortex
  • Diagnosis:
    • Characteristic MRI appearance
    • JC virus in CSF by PCR
  • No specific treatment exists
34
Q

Co-trimoxazole prophylaxis in HIV patients?

A
  • Reduces risk of oppurtunistic infections:
    • Pneumocystis jiroveci pneumonia
    • Cerebral toxoplasmosis
    • Malaria
  • SE: hypersensitivity causing maculopapular rash
35
Q

What can be used as prophylaxis for TB in HIV patients?

A
  • Isoniazid
  • All of the following must be absent:
    • Cough
    • Fever
    • Weight loss
    • Night sweats
36
Q

What are the goals of anti-retroviral therapy in HIV?

A
  • Keep viral load low for as long as possible
  • Increase CD4 count over 200 cells/mm3
  • Improve quality of life
  • Reduce HIV transmission
37
Q

What are the different categories of anti-retroviral drugs for HIV?

A
  • Nucleoside reverse transcriptase inhibitors (NRTIs)
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • Protease inhibitors (PIs)
  • Integrase inhibitors
  • Chemokine receptor inhibitor
38
Q

Examples of NRTIs?

A
  • Abacavir
  • Tenofovir
39
Q

Examples of NNRTIs?

A
  • Efavirenz
  • Rilpivirine
40
Q

Example of PIs?

A

Atazanavir

41
Q

Example of integrase inhibitors?

A

Raltegravir

42
Q

Example of chemokine receptor inhibitor?

A

Maraviroc

43
Q

What is the standard anti-retroviral regimens?

A
  • 2 NRTIs + 1 of:
    • NNRTI
    • Protease inhibitor
    • Integrase inhibitor
44
Q

Complications of anti-retroviral therapy?

A
  • Immune reconstitution inflammatory syndrome (IRIS)
  • Lipodystrophy
  • Hypersensitivity rashes
45
Q

Anti-retroviral in pregnancy?

A
  • CD4 count falls by 25% in pregnancy due to haemodilution
  • HIV disease progession is not altered
  • Begin anti-retroviral treatment at beginning of second trimester
  • Caesarean section is associated with lower risk of transmission
46
Q

Describe PrEP?

A
  • Pre-exposure prophylaxis
  • Daily tenofovir plus emtricitabine
  • Reduces risk of HIV acquisition
47
Q

Describe PEP?

A
  • Post-exposure prophylaxis
  • First dose within 6 hours
  • HIV antibody testing at 3 months post exposure
48
Q

Describe hairy leukoplakia?

A
  • EBV-associated lesion on the side of the tongue
    • Indicative of HIV
  • Cannot be scraped off
    • Candida lesions can be scraped off the tongue
49
Q

What is the test for EBV diagnosis?

A

Monospot test

50
Q

What would you do if you come across hairy leukoplakia?

A
  • Test for HIV
  • Do not perform the monospot test
51
Q

In terms of CD4+ count, which diseases fall within the 200-500 region?

A
  • Oral thrush
  • Shingles
  • Hairy leukoplakia
  • Kaposi sarcoma
52
Q

In terms of CD4+ count, which diseases fall within the 100-200 region?

A
  • PMLE
  • HIV dementia
  • Cryptosporidiosis
  • Cerebral histoplasmosis
  • Pneumocystic jiroveci pneumoniae
53
Q

In terms of CD4+ count, which diseases fall within the 50-100 region?

A
  • Aspergillosis
  • Oesophageal candidiasis
  • Cryptococcal meningitis
  • Primary CNS lymphoma
54
Q

In terms of CD4+ count, which diseases fall within the <50 region?

A

Cytomegalovirus retinitis

Y4: Infectious Disease (18 decks)

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