HIV

Question 1

Spread

Answer 1

Sexual transmission
Injection drug misuse
Blood products
Mother to child in developing countries
Organ transplant (vertical transmission)

Question 2

Virology

Answer 2

HIV-1 and HIV-2
1 more common
attaches to cells with CD4 on surface and cells with chemokine receptors

Question 3

Diagnosis

Answer 3

Antigen/antibody tests
4th generation ELISA assay allows simultaneous detection of antibody and antigen
Window period is 1 month- dont do straight after as false negs
HIV genome detection for HIV RNA used to monitor effectiveness of treatment and maternal antibody

Question 4

Manage HIV (labs)

Answer 4

Monitor viral load
HIV resistance testing
Avidity testing
Subtype determination
Tropism testing
Drug levels/compliance

Question 5

Clinical stage 1

Answer 5

asymp
persistent generalised lymphadenopathy
normal activity

Question 6

Clinical stage 2

Answer 6

weight loss <10% body weight
minor mucocutaneous manifestations- seborrheic dermatitis, prurigo, fungal nail, oral ulcers
herpes zoster within last 5 years
recurrent resp tract infections
normal activity

Question 7

Clinical stage 3

Answer 7

weight loss >10% weight
inexplained chronic diarrhoea >1 mnth
unexplained prolonged fever >1 mnth
oral thrush
oral hairy leukoplakia
pulm tuberculosis within past year
severe bacterial inf
bedriffen <50% day during last month

Question 8

Clinical stage 4

Answer 8

pneumocystic pneumonia
toxoplasmosis brain
cryptosporidiosis w diarrhoea >1 mnth
cytomegalovirus disease of an organ other than liver, spleen or lymph nodes
herpes simplex mucocutaneous >1 month or visceral any duration
progressive multifocal leukoencephalopathy
candidiasis resp tract
atypical mucobacterosis
extrapulmonary TB lymphoma
HIV encephalopathy
bedridden <50% day during last month

Question 9

Symptoms

Answer 9

generally non sepcific
looks like glandular fever but EBV serology not keeping
flu like
fever
malaise
lethargy
pharyngitis
lymphadenopathy
toxic exanthema (widespread rash)

Question 10

Treatment

Answer 10

Anti-rertoviral therapy (cART) (HAART)
adherance needs to be over 90%
cART SE large
CD4<350 risk symptoms so encourage start
CD4<200 needs start asap
pregnant- start before 3rd trimester

3 drug combo w adjustment if not treated 4-6 weeks

Question 11

Anti viral drugs and SEs

Answer 11

nucleoside reverse transcriptase inhib- marrow toxicity, neuropathy, lipodystrophy
non-nucleoside reverse transcriptase inhib- skin rash, hypersensitivtiy, drug interactions
protease inhib- drug interactions, diarrhoea, lipodystrophy, hyperlipidemia
integrase inhib- rashes

Question 12

Prevention

Answer 12

PrEP- pre exposure prophylaxis

PEPSE- post exposure prophylaxis for sexual exposure