HIV

Question 1

when do you start treatment for HIV?

Answer 1

as soon as diagnosis is made regardless of CD 4 count

Question 2

1st line treatment for HIV ?

Answer 2

anti-retroviral therapy (ART)

• 2 nucleoside reverse transcriptase inhibitors
• 1 non-nucleoside reverse transcriptase inhibitor or protease inhibitor

Question 3

opportunistic infections in HIV and CD 4 count they occur at ?

Answer 3

CD4 200-500 cell/mm(3)

• oral thrush
• shingles
• hairy leukoplakia
• kaposki sarcoma

CD4 100-200

• cryptosporidosis
• cerebral toxoplasmosis
• primary multifocal leukoencephalopathy
• pneumocystitis jiroveci pneumonia

CD4 50-100

• oesophageal candidiasis
• aspergillosis
• CNS lymphoma
• cryptococcal meningitis

CD < 50

• CMV retinitis
• mycobacterium avium

Question 4

1st line treatment for pneumocystis jiroveci ?

Answer 4

co-trimoxazole

steroids if hypoxic (Pa02 < 9.3kPa)

Question 5

1st line treatment for severe PJP ?

Answer 5

IV pentamidine

steroids if hypoxic (Pa02 < 9.3 kPa)

Question 6

feature of PJP on CXR ?

Answer 6

bilateral interstitial pulmonary infiltrates

Question 7

complication of PJP ?

Answer 7

pnuemothorax

Question 8

how long after infection does seroconversion occur ?

Answer 8

3-12 weeks post infection

Question 9

describe post exposure prophylaxis in a patient who has been exposed to HIV .

Answer 9

if low risk such as human bite - then don’t require PEP

combination of oral antiretrovirals for 4 weeks

must be started within 72 hours (ideally within 24 hours)

serological testing at 12 weeks following completing of PEP

Question 10

after exposure to HIV, within how long should post exposure prophylaxis be taken ?

Answer 10

within 72 hours (ideally 24 hours)

taken for 4 weeks

serological test at 12 weeks following PEP to identify if infected

Question 11

side effects of Zidovudine (NRTI) ?

Answer 11

peripheral neuropathy
myopathy
black nails
anaemia

Question 12

virus responsible for kaposkis sarcoma ?

Answer 12

human herpes virus - 8 (HHV-8)

Question 13

what is JC virus responsible for at at what CD 4 count ?

Answer 13

primary multifocal leukocencephalopthy

CD4 count 100-200 cells/mm(3)

Question 14

1st line treatment for oesophageal candiasis ? at what DC4 count can this occur ?

Answer 14

fluconazole + itraconazole

CD4 50-100

Question 15

how to confirm diagnosis of HIV during seroconversion stage ?

Answer 15

HIV antibodies may not be present, so have to do HIV PCR and P24 antigen test