HIV Flashcards
(145 cards)
1
Q
what kind of virus is HIV
A
retrovirus
2
Q
is HIV 1 or 2 more virulent
A
HIV 1 more virulent
3
Q
what is the target site for HIV
A
CD4+ receptors
4
Q
what is CD4 and give 4 types of cells it is found on
A
glycoprotein found on surface of
- T helper lymphocytes (CD4 cells)
- dentritic cells
- macrophages
- microglial cells
5
Q
how long is it between HIV infection and establishment
A
72 hours
6
Q
CD4+ T helper lymphocytes are essential for the ____ of the ____ immune response
A
induction of adaptive immune response
7
Q
CD4+ T helper cells recognise MHC class _ APCs
A
II
8
Q
give 4 functions of CD4+ T helper cells
A
recognition of MHC-II antigen presenting cells
activation of B-cells
Activation of cytotoxic T cells (CD8+)
cytokine release
9
Q
what is a normal CD4+ Th cell count
A
500-1600 cells/mm3
10
Q
at what count of CD4+ Th cells is there a risk of opportunistic infections
A
< 200
11
Q
in HIV CD4 count will be ___ and CD8 count will be ____
A
CD4 low
CD8 high
12
Q
why can psoriasis get worse in HIV
A
overproduction of CD8
13
Q
when is the most rapid replication of the HIV virus
A
very early and very late
14
Q
what is the average time to death without treatment of HIV
A
9-11 years
baby - 1 year
15
Q
what are the 3 stages of HIV infection
A
acute HIV syndrome
clinical latency
symptoms of aids
16
Q
what happens after the infection of mucosal CD4 cells (langerhans and dendritic cells)
A
transport to regional lymph nodes
17
Q
when is the onset of symptoms after primary infection
A
2-4 weeks
18
Q
give 5 symptoms of primary HIV infection
A
fever maculopapular rash myalgia pharyngitis headache
19
Q
during the primary infection, there is a very low/high risk of transmission
A
very high
20
Q
when does the clinical latency period last between
A
4 weeks - 9+ years
21
Q
describe what goes on in the clinical latency period
A
ongoing viral replication, CD4 count depletion and immune activation
22
Q
is there a risk of transmission during the clinical latency phase
A
yes
23
Q
what is an opportunistic infection
A
an infection caused by a pathogen that does not normally produce disease in a healthy individual
24
Q
what type of pneumonia is common in HIV
A
pneumocystis pneumonia
25
what is the causative organism in pneumocystis pneumonia
pneumocystis jiroveci
26
what is the CD4 threshold for pneumocystis jiroveci
< 200
27
what are the symptoms of pneumocystis pneumonia
shortness of breath
dry cough
exercise desaturation
28
what may a CXR show of pneumocystis pneumonia
may be normal
may be interstitial infiltrates
may be reticulo-nodular markings
29
how is pneumocystis pneumonia diagnosed
BAL and immunofluorescence +/- PCR
30
what is the treatment for pneumocystis pneumonia
high dose co-trimoxazole (+/- steroid)
31
what is the prophylactic treatment of pneumocystis pneumonia
low dose co-trimoxazole
32
what is the prophylactic treatment of pneumocystis pneumonia
low dose co-trimoxazole
33
chronic productive cough +/- haemoptysis
fever
night sweats
pulmonary tuberculosis
34
what is the treatment for tuberculosis
2 RIPE 4 RI
35
what is the causative organism in cerebral toxoplasmosis
toxoplasma gondii
36
what is the CD4 threshold for cerebral toxoplasmosis
< 150
37
what would show on a brain scan of cerebral toxoplasmosis
multiple cerebral abscess
38
what are some signs/symptoms of cerebral toxoplasmosis
```
headache
fever
focal neurology
seizures
reduced consciousness
raised ICP
```
39
if you took a brain biopsy and found it to be a toxoplasmic abscess what would your next step be
HIV test
40
what is a problem in the eye caused by toxoplasma gondii
toxoplasmic chorioretinitis
41
give 3 things CMV can cause
retinitis
colitis
oesophagitis
42
how can CMV retinitis present
reduced visual acuity
| floaters
43
how can CMV colitis present
abdominal pain, diarrhoea, PR bleeding
44
what is the CD4 threshold for CMV
< 150
45
what should all patients with a CD4 < 150 be offered
ophthalmic screening
46
give 5 skin infections that occur with HIV
```
herpes zoster
herpes simplex
HPV
penicilliosis
histoplasmosis
```
47
state whether the following infections can be reactivated
- tuberculosis
- toxoplasma gondii
- CMV
- JC virus
all yes
48
what strain of HIV causes HIV associated neurocognitive impairment
HIV-1
49
what is the CD4 threshold for HIV associated neurocognitive impairment
any - increase in immunosuppression increases incidence
50
how does HIV associated neurocognitive impairment present
reduced short term memory +/- motor dysfunction
51
what organism causes progressive multifocal leukoencephalopathy
JC virus
52
what is the CD4 threshold for JC virus
< 100
53
how does progressive multifocal leukoencephalopathy present
rapidly progressive focal neurology
confusion
personality change
54
what might you see in the MRI T2 weighted imaging of progressive multifocal leukoencephalopathy
hyperintensities in the white matter which later spreads to the internal capsule and the other hemisphere
55
what might you see in the MRI T1 weighted imaging of progressive multifocal leukoencephalopathy
extensive hypodensities corresponding to loss of myelin
56
what is slim's disease
HIV associated wasting
57
what causes HIV associated wasting
severe weight loss/metabolic
chronic diarrhoea/malabsorption
hypogonadism
58
what causes kaposi sarcoma
human herpes virus 8 (HHV8)
59
what is the pathology of kaposi sarcoma
vascular tumour
60
what is the CD4 threshold for HHV8
any - increase incidence with increased immunosuppression
61
how does kaposi sarcoma present
lesions:
- cutaneous
- mucosal
- visceral (pulmonary, GI)
62
give 3 treatments of kaposi sarcoma
HAART
local therapies
systemic chemo
63
what other kinds of cancer are common in HIV
non-hodgkin lymphoma
| cervical cancer
64
what is the causative organism of non-hodgkin lymphoma
EBV (Burkitt's lymphoma, primary CNS lymphoma)
65
what is the CD4 threshold for EBV
any - increased incidence with increased immunosuppression
66
how often are women with HIV screening for cervical cancer
every year
67
what is the organism causative of cervical cancer
HPV
68
HPV infection rapidly progresses to severe ______ and ______ disease
severe dysplasia and invasive disease
69
what should patients with complicated HPV disease be offered?
(recalcitrant warts, High grade CIN VIN AIN PIN)
HIV testing
70
what are some symptomatic non-opportunistic infection problems people with HIV can have
```
mucosal candidiasis
seborrheic dermatitis
diarrhoea
fatigue
worsening psoriasis
lymphadenopathy
parotitis
STIs
hep B/hep C
```
71
what are some haematological manifestations of HIV
anaemia
| thrombocytopenia (immune thrombocytopenic purpura)
72
what is the CD4 threshold for ITP
300-600
73
give an opportunistic infection that can cause haematological manifestations
mycobacterium avium-intracellulare
74
what is the main form of transmission of HIV
sexual transmission
75
HIV can only be transferred man to man
| true/false
false
men-men 53%
men-women 42%
76
give 4 factors that would increase transmission risk by sex
ano-receptive sex
trauma
genital ulceration
concurrent STI
77
give 3 other ways HIV can be transmitted
IV drug use - sharing needles
infected blood products
mother to child
78
what 3 ways can HIV be transmitted mother to child
in utero/transplacental
during delivery
breast feeding
79
if a mother has HIV what is the risk of her transmitting it to her baby
1 in 4
80
what is the highest risk group for HIV
MSM
81
what are 2 other high risk groups for HIV
black africans
| PWID
82
what group of people are most likely to be undiagnosed with HIV and therefore present late
heterosexual men
83
how many people /1000 does HIV affect in the uk
1.6/1000
84
what high risk groups should be screened for HIV
MSM, females with bisexual male partners, PWID, partners of HIV+, children of HIV+
people/children from endemic areas, sexual partners from endemic area, history of iatrogenic exposure in endemic area, children of parent from endemic area
85
what are some high prevalence areas
sub-saharan africa, carribean, thailand
86
where might people get tested for HIV as an opt-out service
abortion services, GUM clinics, drug dependency services
- higher prevalence among people that access these services
antenatal services, assisted conception services
- risk assoc with undiagnosed HIV
87
can you test for HIV if patient is incapacitated?
yes, if in their best interest
| if safe wait until they regain capacity
88
what 2 tests can be done for HIV
HIV-1 and HIV-2 antibody (3rd gen)
| combined antibody and antigen (p24) (4th gen)
89
which test detects the virus itself
combined antibody and antigen
90
what is a window period
period in which HIV is not detectable on tests because levels of viral antibody/antigen haven't risen yet
91
what is an advantage to the combined antibody antigen test
shorter window period
92
what Ig does the antibody test detect
IgM and IgG
93
a negative 4th generation test performed at 4 weeks would mean what
highly likely to exclude HIV infection
94
what are the capsule proteins of HIV
p24
95
what are the envelope proteins of HIV
gp120
96
what is a POCT
point of care test
97
what would a HIV POCT involve
finger prick blood specimen or saliva
98
what are the advantages to rapid HIV testing
simple, no lab required, no venepuncture, no wait, reduce follow up, good sensitivity
99
what are the disadvantages to rapid HIV testing
expensive, poor positive predictive value in low prevalence settings, not suitable for high volume, cant be relied on in early infection
100
what enzyme converts viral RNA to DNA
reverse transcriptase
101
what enzyme inserts viral DNA into host DNA
integrase
102
what drugs are used in the treatment of HIV
anti-retrovirals
103
what is HAART
highly active anti-retroviral therapy
104
what does HAART entail
a combination of 3 drugs from at least 2 drug classes to which the virus is susceptible
105
what would a typical HAART consist of
2 NRTIs
| + PI or NNRTI
106
what is an NRTI and give 4 examples
```
Nucleoside Reverse Transcriptase Inhibitor
Tenofovir
Emtricitabine
Zidovudine
abacavir
```
107
what is the mechanism of action of NRTIs
block reverse transcriptase
108
what is the main side effect of NRTIs
peripheral neuropathy
109
what kind of drug is Efavirenz
NNRTI - non-nucleoside reverse transcriptase inhibitor
110
what is the mechanism of action of NNRTI
bind to and block HIV reverse transcriptase
111
how is HAART administered
one tablet once daily
single tablet co-formulation
- tenofovir, emtricitabine, efavirenz
112
what is the key to preventing drug resistance
adherence
113
give 2 examples of entry inhibitors
maraviroc
| enfuvirtide
114
what is the mechanism of action of maraviroc
binds to CCR5, preventing an interaction with gp41
115
what is the mechanism of action of enfuvirtide
binds to gp41, also known as a 'fusion inhibitor'
116
what HIV drug causes anaemia, myopathy, black nails
zidovudine
117
what kind of drug is nevirapine
NNRTI
118
what is the mechanism of action of protease inhibitors
by blocking the action of protease, they prevent the immature HIV from becoming a mature virus that can infect other CD4 cells
119
give 4 examples of protease inhibitors
indinavir, nelfinavir, ritonavir, saquinavir
120
what other inhibitors are used in HIV treatment
integrase inhibitors
121
what are the main side effects of protease inhibitors
GI side effects
122
PIs are generally potent liver enzyme _______
inhibitors
123
NNRTIs are generally potent liver enzyme ______
inducers
124
what HIV drug causes anaemia, black nails and myopathy
zidovudine
125
abacavir, lopinavir, maraviroc all increase the risk of ---
MI
126
tenofovir causes side effects such as
osteomalacia
| proximal renal tubulopathies
127
skin side effects such as rash, hypersensitivity, stevens johnsons are caused by
abacavir
| nevirapine
128
what are 3 common co infections with HIV
Hep B
Hep C
TB
129
give 5 prevention medicine points for someone with HIV
```
Hep A/B vaccine
flu vaccine
HPV vaccine
STI screening
stop smoking, exercise - CVS risk
```
130
partner notification is mandatory/voluntary
voluntary
131
what is stigma
the shame or disgrace attached to something regarded as socially unacceptable
132
what should be screened for at HIV dx
Hep B + C
chlamydia
Gonorrhoea
Syphilis
133
Post-exposure prophylaxis is available until how long after exposure
72 hours
134
condom use reduces risk of HIV spread
| true/false
true
135
you can get HIV from house hold items
| true/false
false
136
what would you say to a couple who came in one of whom was HIV + and one who was HIV - about preventing transmission
treatment as prevention - if the +ve partner is being treated and keeping an undetectable viral load, there is a very very low risk of transmission
condom (+/- timed condomless sex)
PrEP for -ve partner
137
HIV+ women should not be put on HAART during pregnancy
| true/false
false - HAART during pregnancy
138
if the +ve HIV pregnant female has an undetected viral load how should she deliver her baby
vaginal
139
if the +ve HIV pregnant female has a detected viral load how should she deliver her baby
c section
140
how many weeks should the baby get PEP
4
141
can HIV + women breast feed
no - exclusively formula feeding
142
PrEP reduces the risk of HIV transmission by around 50%
| true/false
false
| around 100% if taken daily
143
what is the eligibility criteria for PrEP (5)
```
16 +
HIV negative
can commit to 3 monthly follow up
willing to stop if eligibility criteria no longer applies
resident in scotland
```
144
what high risk factors make someone eligible for PrEP
HIV + partner with detectable viral load
MSM or transwoman with 2 or more partners in 1 year and likely to do so again in next 3 months or confirmed bacterial STI in last year
or another high risk factor
145
mutation in what can make you immune to HIV
mutation in CXCR4 or CCR5
