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HIV Flashcards

1
Q

What can HIV be spread by?

A
  • Sexual transmission
  • Injection drug misuse
  • Blood products
  • Vertical transmission
  • Organ transplant
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2
Q

What is the most common cause for the spread of HIV?

A

Most commonly due to sex between men

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3
Q

Can you test unconscious patients for HIV?

A

Unconscious patients can be testing if you think it is in their interest

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4
Q

How do you test someone for HIV?

A

Point of care testing is done (POC):

  • Blood sample from finger
  • Results in 60 seconds
    • Negative, positive or invalid

Standard test will then confirm results

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5
Q

What is the immunology of HIV?

A

Infects and destroys cells of immune system:

  • Especially T helper cells that are CD4+ (have a CD4 receptor on their surface)
    • CD4 receptors are not exclusive to lymphocytes, also found on macrophages and monocytes, cells in the brain, skin
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6
Q

What cells have CD4 receptors?

A

T helper cells

Macrophages

Monocytes

Cells in the brain

Cells in the skin

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7
Q

Describe the natural history of a HIV infection?

A

Over course of infection:

  • CD4 count declines and HIV viral load increases
    • Increasing risk of developing infections and tumours
    • Severity of illness is greater the lower the CD4 count (normal CD4>500)
    • Most AIDs diagnosis occur at CD4 count < 200

Symptoms increase as CD4 decreasing, as does opportunistic infections

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8
Q

What is a normal CD4 level?

A

>500

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9
Q

At what CD4 level do most AIDS diagnosis occur?

A

<200

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10
Q

Describe the classification of HIV?

A

Stage 1 - asymptomatic

Stage 2 - <10% BW lost and/or performance scale 2 (symptomatic, normal activity

Stage 3 - >10% BW lost and/or performance scale 3 (bedridden <50% of day dyring last month)

Stage 4 - HIV wasting syndrome and/or performance scale 4 (bedridden, <50% of day during last month

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11
Q

What opportunistic infections are common in HIV?

A

Thrush

PJP

TB

Cryptosporidiosis

Kaposis

Cryptococcal meningitis

CMV, MAC

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12
Q

When does HIV become AIDS?

A
  • If no symptoms then HIV
  • Certain infections and tumours that develop due to weakness in immune system are classified as AIDS illnesses
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13
Q

What are some clinical indicator diseases of HIV?

A

TB

Pneumocystits

Cerebral toxoplasmosis

Primary cerebral lymphoma

Cryptococcal meningitis

Kaposi’s sarcoma

Persistent cryptosporiosis

Cervical cancer

Cytomegalovirus retinitis

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14
Q

How does mortality in HIV change with CD4 count?

A

One year mortality increases as CD4 count decreases

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15
Q

Describe the general path of acute infection of HIV to death?

A
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16
Q
A
17
Q

What is the seroconversion illness?

A

Seroconversion illness is when HIV antibodies first develop:

  • Abrupt onset 2-4 weeks post exposure
  • Self limiting 1-2 weeks
  • Symptoms generally non-specific and differential diagnosis includes a range of common conditions, symptoms includes
    • Flu-like illness
    • Fever
    • Malaise and lethargy
    • Pharyngitis
    • Lymphadenopathy
    • Toxic exanthema
18
Q

What is the presentation of the seroconversion illness of HIV?

A
  • Abrupt onset 2-4 weeks post exposure
  • Self limiting 1-2 weeks
  • Symptoms generally non-specific and differential diagnosis includes a range of common conditions, symptoms includes
    • Flu-like illness
    • Fever
    • Malaise and lethargy
    • Pharyngitis
    • Lymphadenopathy
    • Toxic exanthema
19
Q

What is the most common late stage (AIDS) infection?

A

Most common late stage (AIDS) infection is pneumocystitis jiroveci pneumonia:

  • Opportunistic infection
  • CD cell count usually <200
  • Classical history of dry cough and increasing breathlessness over several weeks
  • Investigations
    • Chest x-ray
    • Induced sputum or broncoscopy for PCR
  • Treatment
    • Cotrimoxazole
    • Pentamine
    • Prophylaxis until CD>200
20
Q

What is the classical history of pneumocystitis juroveci pneumonia?

A
  • Classical history of dry cough and increasing breathlessness over several weeks
21
Q

What investigations are done for pneumocystitis jiroveci pneumonia?

A
  • Chest x-ray
  • Induced sputum or bronchoscopy for PCR
22
Q

What is the treatment for pneumocystitis jiroveci pneumonia?

A
  • Cotrimoxazole
  • Pentamine
  • Prophylaxis until CD>200
23
Q

What is the treatment of HIV?

A

Antiretroviral therapy is used:

  • Different classes of drugs acting on different stages in HIV lifecycle
  • Combination antiretroviral therapy (cART) means at least 3 drugs from at least 2 groups
  • Adherence needs to be over 90%
  • cART can lead to normal life but side effects can be significant
24
Q

What does combination antiretroviral therapy (cART) refer to?

A
  • Combination antiretroviral therapy (cART) means at least 3 drugs from at least 2 groups
25
Q

What does the adherence to HIV treatment need to be for it to work?

A
  • Adherence needs to be over 90%
26
Q

What are the different classes of antiretroviral therapy?

A

Entry inhibitors

Reverse transcription inhibitors

Integrase inhibitors

Protease inhibitors

27
Q

Where does each class of antiretroviral therapy act in the HIV lifecycle?

A
28
Q

What is the HIV lifecycle?

A

1) Binding and entry
2) Reverse transciption
3) Integration
4) Transcription
5) Assembly
6) Release and protease

29
Q

When should HIV treatment be started?

A
  • Start all patients at diagnosis regardless of CD4 and viral load
    • If CFD4 < 350 cells/mm3 patients at risk of developing symptoms without treatment
    • Any pregnant woman start before third trimester
    • Three drug combination with treatment adjustment if viral load not suppressed after 4-6 weeks
30
Q

What is usually the reason when HIV treatment fails?

A

When treatment fails is usually due to poor adherence leading to viral mutation and resistance

31
Q

What are side effects of each antiviral drug for HIV?

A
  • Nucleoside reverse transcriptase inhibitors
    • Marrow toxicity, neuropathy, lipodystrophy
  • Non-nucleoside reverse transcriptase inhibitors
    • Skin rashes, hypersensitivity, drug interactions, neuropsychiatric effects
  • Protease inhibitors
    • Drug interactions, diarrhoea, lipodystrophy and hyperlipidaemia
  • Integrase inhibitors
    • Rashes, disturbed sleep
32
Q

What are side effects for nucleoside reverse transcirption inhibitors?

A
  • Marrow toxicity, neuropathy, lipodystrophy
33
Q

What are side-effects for non-nucleoside reverse transcription inhibitors?

A
  • Skin rashes, hypersensitivity, drug interactions, neuropsychiatric effects
34
Q

What are side effects for protease inhibitors?

A
  • Drug interactions, diarrhoea, lipodystrophy and hyperlipidaemia
35
Q

What are side effects for integrase inhibitors?

A
  • Rashes, disturbed sleep
36
Q

What is lipodystrophy?

A

Abnormal distribution of fat

37
Q

What are some challenges of HIV care?

A
  • Osteoporosis
  • Cognitive impairment
  • Malignancy
  • Cerebrovascular disease
  • Renal disease
  • Ischaemic heart disease
  • Diabetes mellitus
38
Q

What is HIV prevention done by?

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

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