HIV Flashcards
What type of virus is HIV?
RNA retrovirus
What is the mechanism of HIV?
Enters and destroys CD4 T helper cells
How is HIV transmitted?
Unprotected oral, vaginal or anal sex
Vertical transmission
Open wounds, mucous membrane or blood exposure to infected blood/bodily fluids e.g. needle stick, blood in eye
What is the progression of HIV?
Initial seroconversion illness
Becomes asymptomatic until progression
HIV suggesting conditions
AIDS defining conditions
What is the presentation of the initial seroconversion in HIV?
Flu/glandular fever like illness for several weeks
What are some conditions suggestive of HIV?
Oral hairy leukoplakia Extensive seborrheic dermatitis or psoriasis Very early onset dementia Shingles, esp recurrent Hep B/C Invasive cervical cancer Unusual meningitis/encephalitis Cerebral abscess
What are sone AIDS definition conditions?
PJP Cerebral toxoplasmosis, cryptococcal meningitis, progressive multifocal leukoencephalopathy TB Kaposi's sarcoma CMV Lymphoma Oesophageal/bronchial candidiasis Aspergillosis
What is the Diagnostic test for HIV?
HIV antibody test- ELISA and Western Blot assay
What investigations are done if HV test comes back +?
PCR for viral load
CD4 count
Resistance assay
FBC, LFTs, U&Es, lipid profile for underlying health and complications
What investigations are done to screen for opportunistic infections at the time of diagnosis?
CXR for TB
Hep B and C
STI screen
Toxoplasmosis
What is the principle of management of HIV?
Combination antiretroviral therapy- At east 3 drugs from at least 2 classes
What are the antiretroviral options?
Nucleoside reverse transcriptase inhibitors
Non nucleoside reverse transcriptase inhibitors
Protease inhibitor
Integrase inhibitor
What is the standard combination antiretroviral therapy?
Normally 2 NRTAs as “backbone” and 1 other “active”
How is HIV monitored?
Viral load
CD4
CV health
Cervical smear
What is the vaccination protocol with HIV?
Up to date vaccines
Flu, pneumococcal, hepatitis
Avoid live vaccines if very immunosuppressed
What is the management of HIV in pregnancy?
Start antiretroviral therapy before 3rd trimester
Deliver via C section unless viral load undetectable
Treat baby with antiretrovirals for 4 weeks
Do not breastfeed
How is PJP treated?
Cotrimoxazole +/- prednisolone
What is the post exposure prophylaxis for HIV?
Combination antiretroviral for 28 days
Test at 3 months
Why is diarrhoea common in HIV?
Due to virus itself and opportunistic infections
What is the most common cause of cerebral lesions in HIV patients?
Toxoplasmosis
What is the appearance of cerebral toxoplasmosis?
Multiple lesions with ring enhancement
What are some common neuro complications with HIV?
Toxoplasmosis Primary CNS lymphoma Encephalitis Cryptococcal meningitis AIDS dementia complex Progressive multifocal leukoencephalopathy
What is progressive multifocal leukencephalopathy?
Widespread demyelination due to JC virus
Causes behavioural changes, and speech, motor and visual impairment
What causes Kaposi’s sarcoma?
HPV 8
What is the presentation of Kaposi’s sarcoma?
Purple papules/plaques on skin and mucosa
May ulcerate
Resp involvement can cause massive haemoptysis
What is PJP pneumocystis jirovecii pneumonia?
Fungal infection
Most common opportunistic infection in AIDS
What is the presentation of PJP?
Dyspnoea Dry cough Fever Few chest signs Rare= lymphadenopathy, hepatosplenomegaly
What investigations are done for PJP?
CXR= bilateral interstitial pulmonary infiltrates, not a classic pneumonia XR
Exercise induced desaturation
Sputum/bronchoalveolar lavage PCR
What is the management of PJP?
Co-trimozaxole
Severe= + prednisone
What is the presentation of oesophageal candidiasis?
Dysphagia
Odynophagia
What is the management of oesophageal candidiasis?
Fluconazole
Itraconazole
