HIV

Question 1

What are the main ways that HIV is spread?

Answer 1

Sexual transmission
Injection drug misuse
Blood products
Vertical transmission
Organ transplant

Question 2

Can unconscious patients be tested for HIV?

Answer 2

Yes

If you think it is in the patient’s interest to test

Question 3

Does a negative HIV test affect insurance premiums?

Answer 3

No

Question 4

What is Point of Care Testing?

Answer 4

Blood sample from an individual’s finger
Takes 60 seconds
Standard test will confirm the results

Question 5

How does HIV infection work?

Answer 5

Infects and destroys immune cells, especially CD4+ T-helper cells

Question 6

Are CD4 receptors exclusive to lymphocytes?

Answer 6

No

They are also present on the surface of macrophages, monocytes, brain cells and skin, and others

Question 7

How is CD4 count related to HIV viral load?

Answer 7

CD4 count declines and viral load increases
Increased risk of developing infections and tumours
Severity of these illnesses is greater the lower the CD4 count
Most AIDS cases diagnose at CD4<200

Question 8

At what CD4 count do most AIDS diagnoses occur?

Answer 8

<200

Question 9

What are some of the more common opportunistic infections in HIV?

Answer 9

Thrush/skin changes among the earliest
TB
Cryptosporidiosis
Toxoplasmosis
Cryptococcal meningitis
Kaposi's sarcoma

Question 10

What is a dermatological indicator disease for adult HIV infection?

Answer 10

Kaposi’s sarcoma

Question 11

What is a common natural history of HIV?

Answer 11

Acute infection - Seroconversion
Asymptomatic
HIV related illness
AIDS defining illness
Death

Question 12

What is pneumocystis jiroveci pneumonia?

Answer 12

Opportunistic infection usually in AIDS (CD4<200)

Dry cough and progressive breathlessness over several weeks

Question 13

How is pneumocystis jiroveci pneumonia investigated?

Answer 13

CXR

Induced sputum or broncoscopy for PCR

Question 14

How is pneumocystis jiroveci pneumonia treated?

Answer 14

Cotrimoxazole
Pentamidine
Prophylaxis until CD4>200

Question 15

What is combination antiretroviral therapy?

Answer 15

cART
At least 3 drugs from at least 2 groups
Adherence needs to be over 90%

Question 16

Should all patients be treated on diagnosis regardless of CD4 and viral load?

Answer 16

Yes

Question 17

How long does HIV treatment last?

Answer 17

Lifelong

Question 18

What are some common reasons for HIV treatment failing?

Answer 18

Inadequate potency
Inadequate drug levels
Inadequate adherence

Question 19

What do Nucleoside Reverse Transcriptase Inhibitors treat?

Answer 19

Marrow toxicity
Neuropathy
Lipodystrophy

Question 20

What do non-nucleoside reverse transcriptase inhibitors treat?

Answer 20

Skin rashes
Hypersensitivity
Drug reactions
Neuropsychiatric

Question 21

What do protease inhibitors treat?

Answer 21

Drug interactions
Diarrhoea
Lipodystrophy
Hyperlipidaemia

Question 22

What do integrase inhibitors treat?

Answer 22

Rashes

Disturbed sleep

Question 23

How can lipodystrophy be treated?

Answer 23

Change drugs

Facelift
Liposuction
Fillers

Question 24

What are some ways HIV is prevented?

Answer 24

Behaviour change and condoms
Circumcision
Treatment as prevention
Pre-exposure prophylaxis (PrEP)
Post-exposure prophylaxis for sexual exposure (PEPSE)