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Infection > HIV/AIDS > Flashcards

HIV/AIDS Flashcards

1
Q

How is HIV transmitted?

A 
Sexual transmission
Injection drug misuse
Blood products
Vertical transmission
Organ transplant
Needlestick injury/sharing needles
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2
Q

When can you test an unconscious patient for HIV?

A

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

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3
Q

What is the POC testing for HIV?

A

Blood sample from individual’s finger

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4
Q

How long does the POC testing for HIV take?

A

60 seconds

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5
Q

How does HIV infection affect the immune system?

A

HIV infects and destroys cells of the immune system especially the T-helper cells that are CD4+

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6
Q

What cells in particular dos HIV infect and destroy?

A

T-helper cells that are CD4+

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7
Q

Where are CD4+ receptors present?

A

Lymphocytes, surface of macrophages and monocytes, cells in the brain, skin and other sites

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8
Q

What happens to the CD4+ count over the course of the HIV infection ?

A

CD4+ count declines

HIV viral load increases

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9
Q

What is there an increased risk of as HIV infection develops?

A

Developing infections and tumours

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10
Q

What is normal CD4+?

A

> 500

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11
Q

As the severity of the illnesses caused by HIV increases what happens to the CD4 count?

A

Lower the CD4+ count

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12
Q

At what CD4+ count do most AIDS diagnoses occur?

A

CD4+ count <200

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13
Q

What increases as CD4+ count decreases?

A

HIV RNA

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14
Q

How many clinical stages of HIV are there?

A

4 stages

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15
Q

What are the symptoms of HIV at Clinical Stage I?

A

Asymptomatic

Persistant generalised lymphadenopathy (PGL)

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16
Q

What are the symptoms of HIV at Clinical Stage II?

A

Weight loss (<10% of body weight)
Minor mucocutanous manifestations
Herpes zoster within last 5 years
Recurrent URTI

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17
Q

What are examples of minor mucocutaneous manifestations of HIV at Clinical Stage II?

A

Seborrheic dermatitis, prurigo, fungal nail infections, recurrent oral ulcerations, angular chelitis

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18
Q

What are the symptoms of HIV at Clinical Stage III?

A 
Weight loss (>10% of body weight)
Unexplained chronic diarrhoea >1 month
Unexplained prolonged fever >1 month
Oral candidiasis
Oral hairy leukoplakia
Pulmonary TB within past year
Severe bacterial infections
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19
Q

What are the symptoms of HIV at Clinical Stage IV?

A 
HIV wasting syndrome
Pneumocystic pneumonia
Toxoplasmosis of brain
Cryptosporidiosis with diarrhoea >1mo
Cytomegalovirus (MCV) disease of an organ other than liver, spleen or lymph nodes
HSV infection
Progressive multifocal leukoenephalopathy (PML)
Candidiasis (widespread)
HIV encephalopathy
Atypical mycobacteriosis
Extrapulmonary TB
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20
Q

How else can HIV be assessed other than Clincal stages?

A

Performance scale

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21
Q

What are the 4 performance scales for HIV?

A

Performance scale 1: asymptomatic, normal activity
Performance scale 2: symptomatic, normal activity
Performance scale 3: bedridden, <50% of the day during last month
Performance scale 4: bedridden, >50% of the day during the last month

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22
Q

What is the difference between HIV and AIDS?

A

HIV infection = no symptoms

AIDS = weakness in immune system causing infections and tumours to develop

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23
Q

What is the natural history of HIV/AIDS?

A

Acute infection - seroconversation -> asymptomatic -> HIV related illnesses -> AIDS defining illness -> death

24
Q

What percentage of patients have a seroconversion illness (when HIV antibodies first develop)?

A

30-60% of patients

25
Q

How long post-exposure is the onset of a seroconversion illness?

A

2-4wks

26
Q

How long does a seroconversion illness usually last?

A

1-2wks (self-limiting)

27
Q

What are the symptoms for a seroconversion illness?

A 
Flu-like illness
Fever
Malaise and lethargy
Pharyngitis
Lymphadenopathy
Toxic exanthema
28
Q

What does a seroconversion illness often look like?

A

Glandular fever

29
Q

What is seroconversion illness?

A

After a person contracts HIV, their immune system begins to develop HIV antibodies. Seroconversion is the period during which these antibodies first become detectable.

30
Q

What is the commonest late stage (AIDS) infection?

A

Pneumocystis jiroveci pneumonia

31
Q

What is the CD4 cell count normally in pneumocystis jiroveci pneumonia?

A

<200

32
Q

What is the classical history for pneumocystis jiroveci pneumonia?

A

Dry cough

Increasing breathlessness over several weeks

33
Q

What are the investigations for pneumocystis jiroveci pneumonia?

A

CXR

Induced sputum or bronchoscopy for PCR

34
Q

What is the treatment for pneumocystis jiroveci pneumonia?

A

Cotrimoxazole
Pentamidine
Prophylaxis until CD4 >200

35
Q

What is ART?

A

Antiretroviral treatment

36
Q

What is combination ART?

A

At least 3 drugs from at least 2 groups of HIV class drugs

37
Q

What does adherence to ART have to be to support the patient?

A

90%

38
Q

What are the different types of inhibitors (ARTs)?

A

Reverse transcription inhibitors
Integrase inhibitors
Protease inhibitors

39
Q

When should you start patients on ARTs?

A

At diagnosis, regardless of CD4 and viral load

40
Q

With what CD4 count are patients at risk of developing symptoms if they are not on treatment?

A

<350

41
Q

When should ART be started with pregnant women?

A

Start before third trimester

42
Q

What is the treatment if viral load not adequately suppressed after 4-6wks?

A

Three drug combination with treatment adjustment - if viral load not adequately suppressed after 4-6wks

43
Q

What does a CD4 nadir mean?

A

The lowest CD4 cell count recorded

44
Q

How long is the treatment for HIV?

A

Life-long

45
Q

Why might HIV treatment fail?

A

Incomplete suppression: inadequate potency, inadequate drug levels, inadequate adherence, pre-existing resistance

46
Q

What are side effects of NUCLEOSIDE reverse transcriptase inhibitors?

A

Marrow toxicity
Neuropathy
Lipodystrophy

47
Q

What are side effects of NON-NUCLEOSIDE reverse transcriptase inhibitors?

A

Skin rashes
Hypersensitivity
Drug interactions
Neuropyschiatric effects

48
Q

What are side effects of protease inhibitors?

A

Drug interactions
Diarrhoea
Lipodstrophy
Hyperlipidaemia

49
Q

What are side effects of integrase inhibitors?

A

Rashes

Disturbed sleep

50
Q

What is lipodystrophy?

A

Abnormal distribution of fat in the body

51
Q

What are ways of HIV prevention?

A 
Behaviour change/condoms
Circumcision
Treatment as prevention
Pre-exposure prophylaxis (PrEP)
Post-exposure prophylaxis for sexual exposure (PEPSE)
52
Q

What is the most common type of HIV?

A

HIV-1

53
Q

What is the HIV group responsible for the epidemic?

A

HIV-1-M

54
Q

What type of virus is HIV?

A

Lentivirus (retrovirus)

55
Q

What drugs are for post-exposure prophylaxis?

A

Truvada and Raltegravir

56
Q

How long should Truvada and Raltegravir be taken as PEP?

A

28 days

57
Q

How long after exposure should PEP be started?

A

Within 72hrs

Infection (13 decks)

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