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Reproductive & Sexual Health > HIV > Flashcards

HIV Flashcards

1
Q

HIV is a ____virus which causes the ______ ________ ______. ____ related conditions are the single highest predictor of mortality in HIV.

A

HIV is a retrovirus which causes the acquired immunodeficiency syndrome.

AIDS related conditions are the single highest predictor of mortality in HIV.

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2
Q

Where did HIV originate?

A

HIV-2 in west African sooty mangabey

HIV-1 in central/west African chimpanzees

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3
Q

Which HIV is responsible for the global pandemic starting in 1981

A

HIV-1 group M

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4
Q

What is the target site for HIV?

A

CD4+ receptors

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5
Q

CD4 (cluster of differentiation) is a glycoprotein found on the surface of a range of cells including:

A
  • T helper lymphocytes (CD4+ Cells)
  • dentritic cells
  • macrophages
  • microglial cells
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6
Q

CD4+ Th lymphocytes are essential for….

A

Induction of adaptive immune response

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7
Q

How is adaptive immune response induced?

A
  • recognition of MHC2 antigen-presenting cell
  • activation of B cells
  • activation of cyto-toxic T cells (CD8+)
  • cytokine release
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8
Q

What effect does HIV infection have on the immune response?

A
  • sequestration of cells in lymphoid tissues
  • reduced proliferation of CD4+ cells
  • reduction CD8+ (cytotoxic) T cell activatoin
  • reduction in antibody class switching
  • Chronic immune activation (microbial translocation)
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9
Q

Why does HIV cause Reduction CD8+ (cytotoxic) T cell activation?

A
  • Dysregulated expression of cytokines
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10
Q

Why does HIV vause reduction in antibody class switching?

A

Reduced affinity of antibodies produced

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11
Q

HIV increases susceptibility to

A

Viral infections

Fungal infections

Mycobacterial infections

Infection-induced cancersl

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12
Q

What is a normal CD4+ Th Level?

A

500-1600 cells/mm3

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13
Q

What CD4 level causes risk of opportunistic infections?

A

<200 cells/mm3

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14
Q

Describe HIV viral replication

A

Rapid in very early and very late infection

New generation every 6-12 hours

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15
Q

Describe HIV infection pathogenesis?

A

Infection of mucosal CD4 cell (langerhans and dendritic cell)

Transport to regional lymph nodes

Infection established within 3 days of entry

Dissemination of virus

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16
Q

When do symptoms begin in primary HIV infection

A

about 2-4 weeks after infection

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17
Q

What are the initial symptoms of primary HIV infection

A
  • fever
  • rash
  • myalgia
  • pharyngitis
  • headache/aseptic meningitis
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18
Q

Primary symptomatic HIV infection has what risk of transmission?

A

Very high risk

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19
Q

Describe what is happening during asymptomatic HIV infection?

A

Ongoing viral replication

Ongoing CD4 count depletion

Ongoing immune activation

RIsk of onward transmission if remains undiagnosed

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20
Q

What is an opportunistic infection?

A

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

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21
Q

What causes pneumocystic pneumonia?

A

Pneumocystic jirovecci

CD4 threshold <200

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22
Q

What are the symptoms of pneumocystis pneumonia?

A

Insidious onset;

SOB

Dry cough

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23
Q

What are the signs of pneumocystis pneumonia?

A

Exercise desaturation

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24
Q

What are the CXR findings in pneumocystis pneumonia and how is it diagnosed?

A

CXR may be normal- interstitial infiltrates, reticulonodular markings

Diagnosis: BAL and immunofluorescence +/- PCR

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25
Q

What is the treatment for pneumocystis pneumonia?

A

High dose cotrimoxazole +/- steroid

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26
Q

What is the prophylaxis for pneumocystis pneumonia?

A

Low dose co-trimoxazole

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27
Q

Which disease shows epidemiological synergy with HIV?

A

TB

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28
Q

What causes cerebral toxoplasmosis?

A

Toxoplasma gondii

CD4 threshold <150

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29
Q

Cerebral toxoplasmosis is a reactivation of latent infection (chorioretinitis). It presents with multiple cerebral abscesses.

What are the symptoms/signs;

A
  • headache
  • fever
  • focal neurology
  • seizures
  • reduced consciousness
  • raised ICP
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30
Q

What causes cytomegalovirus?

A

CD4 threshold <50

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31
Q

Cytomegalovirus is a reactivation of latent infection;

causes;

A

Retinitis

Colitis

Oesophagitis

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32
Q

How does cytomegalovirus present?

A

Reduced visual acuity

Floaters

Abdominal pain, diarrhoea, PR bleeding

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33
Q

Who should be screened for CMV?

A

All individuals CD4 <50

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34
Q

What skin infections are common in HIV

A
  • herpes zoster
    • ​multidermatomal
    • recurrent
  • ​herpes simplex
    • ​extensive
    • hypertrophic
    • aciclovir resistant
  • ​human papilloma virus
    • ​extensive
    • recalcitrant
    • dysplastic
  • ​weird/wonderful
    • ​penicliiiosis
    • histoplasmosis
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35
Q

What causes HIV-associated neurocognitive impairment?

A

HIV-1

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36
Q

What is the CD4 threshold for HIV-associated neurocognitive impairement?

A

Any increase incidence with increased immunosuppression

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37
Q

How does HIV-associated neurocognitive impairment present?

A

Reduced short term memory +/- motor dysfunction

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38
Q

What is progressive multifocal leukoencephalopathy?

A

Caused by JC virus

Reactivation of latent infection

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39
Q

What is the CD4 threshold for progressive multifocal leukoencephalopathy

A

<100

40
Q

How does progressive multifocal leukoencephalopathy present?

A

Rapidly progressing

Focal neurology

Confusion

Personality change

41
Q

What are the neurological presentations of HIV

A
  • Distal sensory polyneuropathy
  • Mononeuritis multiplex
  • Vacuolarmyelopathy
  • Aseptic meningitis
  • Guillan-Barre syndrome
  • Viral meningitis (CMV, HSV)
  • Cryptococcal meningitis
  • Neurosyphilis
42
Q

What is slim’s disease?

A

HIV associated wasting

Multiple aetiologies;

  • Metabolic (chronic immune activation)*
  • Anorexia (multifactorial)*
  • Malabsorption/diarrhoea*
  • Hypogonadism*
43
Q

What causes kaposi’s sarcoma?

A

Human herpes virus 8

44
Q

What is a kaposi’s sarcoma?

A

Vascular tumour

45
Q

What is the presentation and treatment for kaposi’s sarcoma?

A

Presentation

  • cutaenous
  • visceral- pulmonary, GI
  • mucosal

Treatment

  • Highly active antiretroviral therapy (HAART)
  • local therapies
  • systemic chemotherapy
46
Q

What causes non-hodgkins lymphoma?

A

EBV (burkitt’s lymphoma, primary CNS lymphoma)

47
Q

How does non-hodgkin’s lymphoma present?

A

More advanced

B symptoms

Bone marrow involvement

Extranodal disease

Increased CNS involvement

48
Q

How is non-hodgkins lymphoma diagnosed, treated and what is the prognosis?

A

Diagnosis: as for HIV

Treatment: as for HIV, add HAART

Prognosis: approaching HIV

49
Q

What causes AIDS related cervical cancer?

A

Persistence of HPV infection

50
Q

What are the symptoms of non-oi symptomatic HIV?

A

Mucosal candidiasis

Seborrhoeic dermatitis

Diarrhoea

Fatigue

Worsening psoriasis

Lymphadenopathy

Parotitis

Epidemiologically linked conditions

  • STIs*
  • Hepatitis B*
  • Hepatitis C*
51
Q

What causes haematologic manifestation of HIV?

A

HIV

Opportunistic infections

AIDS malignancies

HIV drugs

52
Q

What are the haematologic manifestations of HIV?

A

Anaemia

Thrombocytopenia (ITP)

53
Q

Sexual transmission accounts for __% of new HIV infections in the UK;

Sex between men __%

Sex between men and women __%

A

Sexual transmission accounts for 95% of new HIV infections in the UK;

Sex between men 53%

Sex between men and women 42%

54
Q

What factors increase the risk of sexual transmission of HIV?

A

Anoreceptive sex

Trauma

Genital ulceration

Concurrent STI

55
Q

What is parenteral transmission?

A

Transmission via injecting drugs

56
Q

Transmission of HIV by parenteral route accounts for _% of new cases in the UK

A

Transmission of HIV by parenteral route accounts for 2% of new cases in the UK

57
Q

How is HIV transmitted from mother to child?

A

In utero/trans-placental

Delivery

Breast-feeding

58
Q

There is a _ in _ risk at risk babies will become infected with HIV

_ in _ HIV+ infants will die before first birthday if untreated

A

There is a 1 in 4 risk at risk babies will become infected with HIV

1 in 3 HIV+ infants will die before first birthday if untreated

59
Q

What is the risk of MTCT in UK over all?

A

1.2%

<1% if viral load undetected at delivery

60
Q

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

(2)

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
61
Q

Where is HIV opt-out testing offered?

A

TOP services

GUM clinics

Drug dependency services

Antenatal services

Assisted conception services

62
Q

Which groups should have regular screening?

A
  • MSM
  • female partners of bisexual men
  • PWID
  • partners of HIV+ people
63
Q

What are high prevalence areas?

A

Sub-saharan africa

Caribbean

Thailand

64
Q

How is HIV testing carried out?

A
  • Document consent (or refusal)
  • Obtain venous sample for serology
  • Request via ICE (accelerate if clinically indicated)
  • Ensure pathway in place for retrieving and communicating result
65
Q

Which markers of HIV are used by labs to detect infections?

A

RNA (viral genome)- viral RNA

Capsule protein (p25)- antigen

66
Q

What is seen during seroconversion

A

3 month period

initial risk and peak of viral load and p24, which then fall as antibody begins to rise

67
Q

Describe HIV antibody tests

A

3rd generation

HIV-1 and HIV-2 antibof

Detect IgM and IgG

Very sensitive/specific in established infection

Window period: 20-25 days

68
Q

What are 4th generation HIV tests?

A

Combined antibody and antigen (p24)

Shortens window period

69
Q

What is the window period in 4th generation HIV tests?

A

13-28 days

variability beteween assays

Variabilit between labs

70
Q

A negative 4th generation test performed at 4 weeks following an exposure is highly likely to ______ HIV ______

A

A negative 4th generation test performed at 4 weeks following an exposure is highly likely to exclude HIV infection

71
Q

What are POCT?

A

Rapid HIV tests

Fingerprick or saliva

Results in 20-30 minutes

72
Q

what are the 3rd generation and 4th generation POCT?

A

3rd- Ab only

4th- Ab/ag

73
Q

Why is POCT disadvantageous?

A

Expensive ~£10

Quality control

Poor positive predictive value in low prevalence settings

Not suitable for high volume

Can’t be relied on in ?early infection

74
Q

What are the targets for anti-retroviral drugs?

A
  • reverse transcriptase
  • integrase
  • protease
  • entry
    • fusion
    • CCR5 receptor
  • Maturation
75
Q

What is highly active anti-retroviral therapy?

A

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

76
Q

What is the purpose of highly active anti-retroviral therapy?

A
  • reduce viral load to undetectable
  • restore immunocompetence
  • reduce morbidity and mortality
77
Q

How can drug resistance in HIV be prevented?

A
  • adherence!
78
Q

How does drug resistance in HIV become more likely with poor adherance?

A

When you are taking your HIV medication correctly, HIV has little chance of getting through

The less you take your medication on time everyday, the weaker the wall becomes

If the wall is too weak HIV learns how to get through.

79
Q

What are the GI side effects of HAART?

A

Protease inhibitors

Transaminitis, fulminant hepatitis (nevirapine, most others)

80
Q

What are the skin side effects of HAART?

A

Rash, hypersensitivity, stevens-johnsons (abacavir, nevirapine)

81
Q

What are the CNS side effects of HAART?

A

Mood, psychosis (efavirenz)

82
Q

What are the renal side effects of HAART?

A

Proximal renal tubulopathies (tenofovor, atazanavir)

83
Q

What are the MSK side effects of HAART?

A

Osteomalacia (tenofovir)

84
Q

What are the CVS risks of HAART?

A

Increased MI risk (abacavir, lopinavir, maraviroc)

85
Q

What are the haematological side effects of HAART?

A

Anaemia (zidovudine)

86
Q

Protease inhibitors are generally potent _____ ______ ______

NNRTIs are generally potent _____ _____ _____

Some drugs require pharmacological boosting (with potent _____ _____ ______)

A

Protease inhibitors are generally potent liver enzyme inhibitors

NNRTIs are generally potent liver enzyme inducers

Some drugs require pharmacological boosting (with potent liver enzyme inhibitors)

87
Q

What are common co-infections with HIV and what considerations must be made?

A

Hepatitis B- same treatment

Hepatitis C- drug interactions

Tuberculosis- drug interactions

88
Q

Partner notification and disclosure is a _______ process

A

Partner notification and disclosure is a voluntary process

89
Q

What are the different strategies for partner notification and disclosure?

A

Partner referral

Provider referral

Conditional referral

90
Q

What are the barriers to partner notification and disclosure?

A

Fear- rejection, isolation, violence

Confidentiality

Stigma

91
Q

How can sexual transmission of HIV be prevented?

A
  • condom use
  • HIV treatment
  • STI screening and treatment
  • Sero-adaptive sexual behaviours
  • disclosure
  • post-exposure prophylaxis
  • pre-exposure prophylaxis
92
Q

There is __ risk of transmission of HIV by casual/household contact

A

no

93
Q

What are the conception options for sero-discordant HIV + male, HIV - female?

A
  • treatment as prevention
  • (+/- timed condomless sex)
  • ? HIV PrEP for female partner
94
Q

What are the conception options for serodiscordant HIV + female and HIV- male?

A

Treatment as prevention

+/- times condomless sex

self-insemination

?HIV PrEP for male partner

95
Q

How can transmission of HIV from mother to child be prevented?

A
  • HAART during pregnancy
  • Vaginal delivery if undetected viral load
  • Caesarean section if detected viral load
  • 4/52 PEP for neonate
  • Exclusive formula feeding
96
Q

What is the PrEP eligibility criteria to determine if patient is high risk for HIV?

A
  • HIV+ partner with detectable viral load
  • MSM or transwoman
    • UPAI >2 partners in 12/12 and likely to do so again in next 3/12
    • Confirmed bacterial rectal STI in last 12/12
  • Other high risk factor agreed with another clinician
97
Q

What is the eligibility criteria for PrEP?

A
  • Aged ≥ 16
  • HIV negative
  • Can commit to 3/12’ly follow up
  • Willing to stop if eligibility criteria no longer apply
  • resident in scotland

Reproductive & Sexual Health (54 decks)

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