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1. Reproduction > HIV > Flashcards

HIV Flashcards

1
Q

What type of virus is HIV?

A

retrovirus

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2
Q

What is a retrovirus?

A

when it makes DNA it uses an enzyme called reverse transcriptase

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3
Q

Out of HIV 1 and 2, what is the most common?

A

HIV 1

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4
Q

What is the pathophysiology of HIV?

A

HIV infects CD4 cells
CD4 t helper cells are vital for the induction of the active immune response
therefore there is a disregulated cell response

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5
Q

What effects does HIV have on the immune system?

A

SUPPRESSION
reduced proliferation of CD4 cells
sequestration of cells in lymphoid tissue leading to reduced circulating CD4 cells
reduction of CD8 cell activation causing dyregulation of cytokine expression and increased susceptibility to viral infections
reduction in antibody class switching
chronic immune activation

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6
Q

What is a normal CD4 count?

A

500-1600

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7
Q

How does the infection spread in HIV?

A

infection of the mucosal CD4 cells which is then transported to regional lymph nodes and infection is established within 72 hours

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8
Q

How long do you have to give post exposure prophylaxis for HIV?

A

72 hours

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9
Q

How does a primary HIV infection present?

A 
2-4 weeks after infection - HIGH RISK OF TRANSMISSION
fever 
maculopapular rash
myalgia
pharyngitis
headache
aseptic meningitis
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10
Q

What are some opportunistic infections that are associated with HIV?

A 
pneumocystis pneumonia
tuberculosis
cerebral toxoplasmosis
cytomegalovirus 
neurocognitive impairment
PML - progressive multifocal leukoencephalopathy
Skin infections
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11
Q

What organism causes pneumocystis pneumonia?

A

pneumocystis jiroveci

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12
Q

What is the CD4 threshold in pneumocystis pneumonia?

A

<200

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13
Q

What is the presentation of pneumocystis pneumonia?

A

SOB
cough
exercise desaturation - sats go down after 5 mins of exercise

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14
Q

What can be seen on a CXR of pneumocystis pneumonia?

A

OFTEN NORMAL
interstitial infiltrates
reticulonodular markings

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15
Q

How is pneumocystis pneumonia diagnosed?

A

bronchioalveolar lavage +/- PCR

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16
Q

How is pneumocystis pneumonia treated?

A

high dose co-trimoxazole

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17
Q

How is pneumocystis pneumonia prevented?

A

low dose co-trimoxazole

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18
Q

When does TB occur in those with HIV?

A

if they are HIV positive when you start anti retrovirals - immune system wakes up and causes TB flare up

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19
Q

What organism causes cerebral toxoplasmosis?

A

toxoplasma gondii

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20
Q

What is the CD4 threshold in cerebral toxoplasmosis?

A

<150

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21
Q

What is the pathology of cerebral toxoplasmosis?

A

reactivation of latent infection
chorioretinitis
multiple cerebral abscesses

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22
Q

What is the presentation of cerebral toxoplasmosis?

A 
headache
fever
focal neurology
seizures 
reduced conciousness
rasied ICP
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23
Q

What is the CD4 threshold for cytomegalovirus?

A

<50

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24
Q

What does the cytomegalovirus cause?

A

retinitis
colitis
oesophagitis

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25
Q

What symptoms does cytomegalovirus present with?

A 
reduced visual acuity
floaters due to retinitis
abdo pain
diarrhoea
PR bleeding
26
Q

What must you do for all patients with a CD4 <50?

A

opthalmic screening

27
Q

What skin problems are common in those with HIV? How are they different in HIV?

A

herpes zoster - multidermal and recurrent
herpes simplex - extensive, hypertrophic and aciclovir resistant
HPV - extensive, dysplastic
Penicilliosis
Histoplasmosis

28
Q

How does HIV associated neurogcognitive impairment present?

A

HIV 1

reduced short term memory +/- motor dysfunction

29
Q

What organism causes PML?

A

JC virus - reactivation of latent infection

30
Q

What CD4 threshold for PML?

A

<100

31
Q

How does PML present?

A

rapidly progressing focal neurology, confusion and personality change

32
Q

What is Slims disease?

A

HIV associated wasting
anorexia
due to malabsorption - gut gets disseminated so is leaky
hypogonadism

33
Q

What are AIDS related cancers?

A

Kaposi sarcoma
Non Hodgkins lymphoma
Cervical cancer

34
Q

What is kaposi sarcoma?

A

vascular tumour - purply tinge

purple lesions on cutaneous, mucosal or visceral surfaces (GI or pulmonary)

35
Q

What organism causes kaposi sarcoma?

A

human herpes virus 8

36
Q

What treatment can be given for kaposi sarcoma?

A

HAART

systemic chemo

37
Q

What organism causes non hodgkins lymphoma?

A

EBV

38
Q

How does non hodgkins lymphoma present?

A

B symptoms - weight loss, fever, night sweats
bone marrow involvement
extra nodal disease
increased CNS involvement

39
Q

What does every patient with lymphoma get?

A

HIV test

40
Q

How is non hodgkins lymphoma treated?

A

HAART

41
Q

How is HIV transmitted?

A

sexual - 95% of infections
parenteral - PWID
mother to baby - 1 in 4 babies get infected

42
Q

What % of MSM have HIV in the UK?

A

1 in 17

43
Q

Who gets tested for HIV?

A

any medical admission or new patient in a GP in a high prevelance area - subsaharan africa, carribean and Thailand
opt out in clinical settings - TOP, GUM clinics, drug dependency services
screening in high risk groups - PWID, MSM, sex workers, partners of those with HIV or bisexual men

44
Q

What is an HIV test?

A

rapid HIV test - finger prick sample, results within 20-30 mins
can do 3rd gen (antibody) or 4th gen (antigen and antibody)

45
Q

What is the other HIV test?

A

take a venous sample and look for p24 antigen

46
Q

How is HIV treated?

A

HAART - highly active anti-retroviral therapy

47
Q

What is HAART?

A

combination of 3 drugs from at least 2 different drug classes from which the virus is susceptible
eg 2 NRTIs and a NNRTI or protease inhibitor

48
Q

How do antiretrovirals work?

A

reduce the replication of HIV-1 by targeting = reverse transcriptase, protease, integrase and entry and maturation

49
Q

How is resistance to antiretrovirals prevented?

A

adherence
stop-start method of taking them leads to viral breakthrough
if they are going to stop - give them a protease inhibitor

50
Q

What interactions do HAART have?

A

Hep C and TB drug regimes
increase cholesterol
affect liver enzymes

51
Q

How are HIV comorbidities prevented?

A 
HPV vaccinations for women and more regular cervical smears 
flu vaccine
Hep A/B vaccine
smoking cessation
STI screening
52
Q

What are the methods of partner notification?

A

partner referral - partner tells them
provider referral - doctor tells them
conditional referral - doctor tells them if the person doesnt within a certain time etc

53
Q

At what viral load can HIV not be transmitted?

A

<200

54
Q

How can HIV transmission be prevented?

A 
post exposure prophylaxis - PEP
pre exposure prophylaxis - PrEP
condom use
circumcision - reduces by 60%
HIV treatment
55
Q

How can HIV transmission from partner to partner be prevented?

A

treatment as prevention to the HIV neg partner
PrEP for neg partner
self insemination if male -ve and female +ve = want a baby

56
Q

How can HIV transmission from mother to baby be prevented?

A 
HAART during pregnancy
undetectable load = vaginal delivery
detectable load = c/section
4 weeks of PEP for neonate
formula feeding only
57
Q

Where is PrEP avaliable?

A

only scotland, not england

58
Q

What is the elidibility criteria for PrEP?

A 
high risk for HIV
HIV +ve partner
MSM or transwoman 
>/=16 years
HIV negative
can commit to 3 monthly follow up
reside in scotland
59
Q

What medication is used in PrEP?

A

Tenoforir disoproxil/emtricitabine

60
Q

What is the average effectiveness of PrEP?

A

86% HIV incidence reduced

61
Q

How is PEP used for HIV?

A

3 antiretrovirals
80% effective
start within 72 hours
28 days total

62
Q

How is PEP used for Hep B?

A

HBV vaccine up to 7 days later

immunoglobulin if doesnt respond to vaccine

1. Reproduction (50 decks)

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