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YEAR 3 REPRO > HIV > Flashcards

HIV Flashcards

1
Q

what kind of virus is HIV

A

retrovirus

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2
Q

is HIV 1 or 2 more virulent

A

HIV 1 more virulent

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3
Q

what is the target site for HIV

A

CD4+ receptors

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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
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5
Q

how long is it between HIV infection and establishment

A

72 hours

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6
Q

CD4+ T helper lymphocytes are essential for the ____ of the ____ immune response

A

induction of adaptive immune response

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7
Q

CD4+ T helper cells recognise MHC class _ APCs

A

II

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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

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9
Q

what is a normal CD4+ Th cell count

A

500-1600 cells/mm3

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10
Q

at what count of CD4+ Th cells is there a risk of opportunistic infections

A

< 200

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11
Q

in HIV CD4 count will be ___ and CD8 count will be ____

A

CD4 low

CD8 high

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12
Q

why can psoriasis get worse in HIV

A

overproduction of CD8

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13
Q

when is the most rapid replication of the HIV virus

A

very early and very late

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14
Q

what is the average time to death without treatment of HIV

A

9-11 years

baby - 1 year

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15
Q

what are the 3 stages of HIV infection

A

acute HIV syndrome
clinical latency
symptoms of aids

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16
Q

what happens after the infection of mucosal CD4 cells (langerhans and dendritic cells)

A

transport to regional lymph nodes

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17
Q

when is the onset of symptoms after primary infection

A

2-4 weeks

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18
Q

give 5 symptoms of primary HIV infection

A 
fever
maculopapular rash
myalgia
pharyngitis 
headache
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19
Q

during the primary infection, there is a very low/high risk of transmission

A

very high

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20
Q

when does the clinical latency period last between

A

4 weeks - 9+ years

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21
Q

describe what goes on in the clinical latency period

A

ongoing viral replication, CD4 count depletion and immune activation

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22
Q

is there a risk of transmission during the clinical latency phase

A

yes

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23
Q

what is an opportunistic infection

A

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

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24
Q

what type of pneumonia is common in HIV

A

pneumocystis pneumonia

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25
Q

what is the causative organism in pneumocystis pneumonia

A

pneumocystis jiroveci

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26
Q

what is the CD4 threshold for pneumocystis jiroveci

A

< 200

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27
Q

what are the symptoms of pneumocystis pneumonia

A

shortness of breath
dry cough
exercise desaturation

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28
Q

what may a CXR show of pneumocystis pneumonia

A

may be normal
may be interstitial infiltrates
may be reticulo-nodular markings

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29
Q

how is pneumocystis pneumonia diagnosed

A

BAL and immunofluorescence +/- PCR

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30
Q

what is the treatment for pneumocystis pneumonia

A

high dose co-trimoxazole (+/- steroid)

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31
Q

what is the prophylactic treatment of pneumocystis pneumonia

A

low dose co-trimoxazole

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32
Q

what is the prophylactic treatment of pneumocystis pneumonia

A

low dose co-trimoxazole

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33
Q

chronic productive cough +/- haemoptysis
fever
night sweats

A

pulmonary tuberculosis

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34
Q

what is the treatment for tuberculosis

A

2 RIPE 4 RI

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35
Q

what is the causative organism in cerebral toxoplasmosis

A

toxoplasma gondii

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36
Q

what is the CD4 threshold for cerebral toxoplasmosis

A

< 150

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37
Q

what would show on a brain scan of cerebral toxoplasmosis

A

multiple cerebral abscess

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38
Q

what are some signs/symptoms of cerebral toxoplasmosis

A 
headache
fever
focal neurology 
seizures
reduced consciousness
raised ICP
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39
Q

if you took a brain biopsy and found it to be a toxoplasmic abscess what would your next step be

A

HIV test

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40
Q

what is a problem in the eye caused by toxoplasma gondii

A

toxoplasmic chorioretinitis

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41
Q

give 3 things CMV can cause

A

retinitis
colitis
oesophagitis

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42
Q

how can CMV retinitis present

A

reduced visual acuity

floaters

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43
Q

how can CMV colitis present

A

abdominal pain, diarrhoea, PR bleeding

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44
Q

what is the CD4 threshold for CMV

A

< 150

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45
Q

what should all patients with a CD4 < 150 be offered

A

ophthalmic screening

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46
Q

give 5 skin infections that occur with HIV

A 
herpes zoster
herpes simplex
HPV
penicilliosis
histoplasmosis
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47
Q

state whether the following infections can be reactivated

  • tuberculosis
  • toxoplasma gondii
  • CMV
  • JC virus
A

all yes

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48
Q

what strain of HIV causes HIV associated neurocognitive impairment

A

HIV-1

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49
Q

what is the CD4 threshold for HIV associated neurocognitive impairment

A

any - increase in immunosuppression increases incidence

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50
Q

how does HIV associated neurocognitive impairment present

A

reduced short term memory +/- motor dysfunction

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51
Q

what organism causes progressive multifocal leukoencephalopathy

A

JC virus

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52
Q

what is the CD4 threshold for JC virus

A

< 100

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53
Q

how does progressive multifocal leukoencephalopathy present

A

rapidly progressive focal neurology
confusion
personality change

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54
Q

what might you see in the MRI T2 weighted imaging of progressive multifocal leukoencephalopathy

A

hyperintensities in the white matter which later spreads to the internal capsule and the other hemisphere

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55
Q

what might you see in the MRI T1 weighted imaging of progressive multifocal leukoencephalopathy

A

extensive hypodensities corresponding to loss of myelin

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56
Q

what is slim’s disease

A

HIV associated wasting

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57
Q

what causes HIV associated wasting

A

severe weight loss/metabolic
chronic diarrhoea/malabsorption
hypogonadism

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58
Q

what causes kaposi sarcoma

A

human herpes virus 8 (HHV8)

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59
Q

what is the pathology of kaposi sarcoma

A

vascular tumour

60
Q

what is the CD4 threshold for HHV8

A

any - increase incidence with increased immunosuppression

61
Q

how does kaposi sarcoma present

A

lesions:

  • cutaneous
  • mucosal
  • visceral (pulmonary, GI)
62
Q

give 3 treatments of kaposi sarcoma

A

HAART
local therapies
systemic chemo

63
Q

what other kinds of cancer are common in HIV

A

non-hodgkin lymphoma

cervical cancer

64
Q

what is the causative organism of non-hodgkin lymphoma

A

EBV (Burkitt’s lymphoma, primary CNS lymphoma)

65
Q

what is the CD4 threshold for EBV

A

any - increased incidence with increased immunosuppression

66
Q

how often are women with HIV screening for cervical cancer

A

every year

67
Q

what is the organism causative of cervical cancer

68
Q

HPV infection rapidly progresses to severe ______ and ______ disease

A

severe dysplasia and invasive disease

69
Q

what should patients with complicated HPV disease be offered?
(recalcitrant warts, High grade CIN VIN AIN PIN)

A

HIV testing

70
Q

what are some symptomatic non-opportunistic infection problems people with HIV can have

A 
mucosal candidiasis
seborrheic dermatitis
diarrhoea
fatigue
worsening psoriasis
lymphadenopathy
parotitis
STIs
hep B/hep C
71
Q

what are some haematological manifestations of HIV

A

anaemia

thrombocytopenia (immune thrombocytopenic purpura)

72
Q

what is the CD4 threshold for ITP

73
Q

give an opportunistic infection that can cause haematological manifestations

A

mycobacterium avium-intracellulare

74
Q

what is the main form of transmission of HIV

A

sexual transmission

75
Q

HIV can only be transferred man to man

true/false

A

false
men-men 53%
men-women 42%

76
Q

give 4 factors that would increase transmission risk by sex

A

ano-receptive sex
trauma
genital ulceration
concurrent STI

77
Q

give 3 other ways HIV can be transmitted

A

IV drug use - sharing needles
infected blood products
mother to child

78
Q

what 3 ways can HIV be transmitted mother to child

A

in utero/transplacental
during delivery
breast feeding

79
Q

if a mother has HIV what is the risk of her transmitting it to her baby

80
Q

what is the highest risk group for HIV

81
Q

what are 2 other high risk groups for HIV

A

black africans

PWID

82
Q

what group of people are most likely to be undiagnosed with HIV and therefore present late

A

heterosexual men

83
Q

how many people /1000 does HIV affect in the uk

84
Q

what high risk groups should be screened for HIV

A

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
Q

what are some high prevalence areas

A

sub-saharan africa, carribean, thailand

86
Q

where might people get tested for HIV as an opt-out service

A

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
Q

can you test for HIV if patient is incapacitated?

A

yes, if in their best interest

if safe wait until they regain capacity

88
Q

what 2 tests can be done for HIV

A

HIV-1 and HIV-2 antibody (3rd gen)

combined antibody and antigen (p24) (4th gen)

89
Q

which test detects the virus itself

A

combined antibody and antigen

90
Q

what is a window period

A

period in which HIV is not detectable on tests because levels of viral antibody/antigen haven’t risen yet

91
Q

what is an advantage to the combined antibody antigen test

A

shorter window period

92
Q

what Ig does the antibody test detect

A

IgM and IgG

93
Q

a negative 4th generation test performed at 4 weeks would mean what

A

highly likely to exclude HIV infection

94
Q

what are the capsule proteins of HIV

95
Q

what are the envelope proteins of HIV

96
Q

what is a POCT

A

point of care test

97
Q

what would a HIV POCT involve

A

finger prick blood specimen or saliva

98
Q

what are the advantages to rapid HIV testing

A

simple, no lab required, no venepuncture, no wait, reduce follow up, good sensitivity

99
Q

what are the disadvantages to rapid HIV testing

A

expensive, poor positive predictive value in low prevalence settings, not suitable for high volume, cant be relied on in early infection

100
Q

what enzyme converts viral RNA to DNA

A

reverse transcriptase

101
Q

what enzyme inserts viral DNA into host DNA

102
Q

what drugs are used in the treatment of HIV

A

anti-retrovirals

103
Q

what is HAART

A

highly active anti-retroviral therapy

104
Q

what does HAART entail

A

a combination of 3 drugs from at least 2 drug classes to which the virus is susceptible

105
Q

what would a typical HAART consist of

A

2 NRTIs

+ PI or NNRTI

106
Q

what is an NRTI and give 4 examples

A 
Nucleoside Reverse Transcriptase Inhibitor
Tenofovir
Emtricitabine 
Zidovudine
abacavir
107
Q

what is the mechanism of action of NRTIs

A

block reverse transcriptase

108
Q

what is the main side effect of NRTIs

A

peripheral neuropathy

109
Q

what kind of drug is Efavirenz

A

NNRTI - non-nucleoside reverse transcriptase inhibitor

110
Q

what is the mechanism of action of NNRTI

A

bind to and block HIV reverse transcriptase

111
Q

how is HAART administered

A

one tablet once daily
single tablet co-formulation
- tenofovir, emtricitabine, efavirenz

112
Q

what is the key to preventing drug resistance

113
Q

give 2 examples of entry inhibitors

A

maraviroc

enfuvirtide

114
Q

what is the mechanism of action of maraviroc

A

binds to CCR5, preventing an interaction with gp41

115
Q

what is the mechanism of action of enfuvirtide

A

binds to gp41, also known as a ‘fusion inhibitor’

116
Q

what HIV drug causes anaemia, myopathy, black nails

A

zidovudine

117
Q

what kind of drug is nevirapine

118
Q

what is the mechanism of action of protease inhibitors

A

by blocking the action of protease, they prevent the immature HIV from becoming a mature virus that can infect other CD4 cells

119
Q

give 4 examples of protease inhibitors

A

indinavir, nelfinavir, ritonavir, saquinavir

120
Q

what other inhibitors are used in HIV treatment

A

integrase inhibitors

121
Q

what are the main side effects of protease inhibitors

A

GI side effects

122
Q

PIs are generally potent liver enzyme _______

A

inhibitors

123
Q

NNRTIs are generally potent liver enzyme ______

124
Q

what HIV drug causes anaemia, black nails and myopathy

A

zidovudine

125
Q

abacavir, lopinavir, maraviroc all increase the risk of —

126
Q

tenofovir causes side effects such as

A

osteomalacia

proximal renal tubulopathies

127
Q

skin side effects such as rash, hypersensitivity, stevens johnsons are caused by

A

abacavir

nevirapine

128
Q

what are 3 common co infections with HIV

A

Hep B
Hep C
TB

129
Q

give 5 prevention medicine points for someone with HIV

A 
Hep A/B vaccine
flu vaccine
HPV vaccine
STI screening
stop smoking, exercise - CVS risk
130
Q

partner notification is mandatory/voluntary

131
Q

what is stigma

A

the shame or disgrace attached to something regarded as socially unacceptable

132
Q

what should be screened for at HIV dx

A

Hep B + C
chlamydia
Gonorrhoea
Syphilis

133
Q

Post-exposure prophylaxis is available until how long after exposure

134
Q

condom use reduces risk of HIV spread

true/false

135
Q

you can get HIV from house hold items

true/false

136
Q

what would you say to a couple who came in one of whom was HIV + and one who was HIV - about preventing transmission

A

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
Q

HIV+ women should not be put on HAART during pregnancy

true/false

A

false - HAART during pregnancy

138
Q

if the +ve HIV pregnant female has an undetected viral load how should she deliver her baby

139
Q

if the +ve HIV pregnant female has a detected viral load how should she deliver her baby

140
Q

how many weeks should the baby get PEP

141
Q

can HIV + women breast feed

A

no - exclusively formula feeding

142
Q

PrEP reduces the risk of HIV transmission by around 50%

true/false

A

false

around 100% if taken daily

143
Q

what is the eligibility criteria for PrEP (5)

A 
16 +
HIV negative
can commit to 3 monthly follow up
willing to stop if eligibility criteria no longer applies
resident in scotland
144
Q

what high risk factors make someone eligible for PrEP

A

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
Q

mutation in what can make you immune to HIV

A

mutation in CXCR4 or CCR5

YEAR 3 REPRO (11 decks)

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