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A - MSRA Gynaecology > HIV/AIDS > Flashcards

HIV/AIDS Flashcards

1
Q

What is HIV?

A

A single stranded RNA retrovirus

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2
Q

How dos HIV infect humans?

A

Infects and replicates within the human immune system using host CD4 cells

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3
Q

What can HIV lead to without treatment?

A

Destruction of the immune system and AIDS

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4
Q

What was the prevalence of HIV in the UK in 2015?

A

~101,000

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5
Q

What % of the population of the UK had HIV in 2015?

A

0.16%

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6
Q

What % of people infected with HIV were unaware of their status?

A

13%

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7
Q

What % of people with HIV were men?

A

69%

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8
Q

What proportion of people with HIV are MSM?

A

Just under half

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9
Q

What cells does HIV replicate within?

A

CD4

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10
Q

What are CD4 cells also known as?

A

T helper cells

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11
Q

How does HIV infect a host CD4 cell?

A

Penetrates cell and empties the contents. The viral RNA is converted to DNA and combines with the host DNA

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12
Q

What enzyme causes HIV RNA to become DNA?

A

Reverse transcriptase

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13
Q

What enzyme integrates viral DNA into the host DNA in HIV?

A

Integrase

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14
Q

What happens when the CD4 cell divides in HIV?

A

Viral DNA is read and viral protein chains are created and push out of the cell retaining some cell membrane to form an immature virus

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15
Q

How does the immature HIV virus develop?

A

Viral protein chains are cut and assemble to create a working virus

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16
Q

What enzyme cuts the viral proteins in an immature HIV virus?

A

Protease

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17
Q

What happens to the host CD4 cell when HIV replicates?

A

It is destroyed

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18
Q

What is seroconversion in HIV?

A

The process pf producing anti-HIV antibodies during primary infection

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19
Q

What happens to the levels of CD4 cells during seroconversion?

A

Fall due to initial rapid replication of HIV

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20
Q

How dos HIV infect humans?

A

Infects and replicates within the human immune system using host CD4 cells

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21
Q

What can HIV lead to without treatment?

A

Destruction of the immune system and AIDS

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22
Q

How can the clinical features of HIV be divided?

A

Into stages of infection

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23
Q

What symptoms can be experienced during HIV seroconversion?

A

Flu-like symptoms

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24
Q

What happens to the levels of CD4 cells during seroconversion?

A

Fall due to initial rapid replication of HIV

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25
Q

How infectious is the patient during seroconversion?

A

Highly infectious

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26
Q

What can happen to HIV over the months-years following seroconversion?

A

Can enter a latent phase

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27
Q

What symptoms do many patients with HIV display after seroconversion?

A

None

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28
Q

What happens to CD4 levels after seroconversion?

A

Continue to fall

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29
Q

What happens to HIV viral load after seroconversion?

A

Increases

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30
Q

What happens to the patient as CD4 levels fall and viral load rises in HIV?

A
  • Become more susceptible to infections
  • Increasingly infectious
  • Increasingly symptomatic
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31
Q

Over what period does HIV generally develop into AIDS?

A

10 years

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32
Q

How can HIV be transmitted?

A
  • Unprotected sexual contact
  • Sharing needles
  • Medical procedures
  • Vertical transmission
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33
Q

What types of sexual contact can spread HIV?

A
  • Vaginal
  • Anal
  • Oral
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34
Q

What medical procedures can transmit HIV?

A
  • Blood products
  • Skin grafts
  • Organ donation
  • Artificial insemination
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35
Q

How can HIV be spread by vertical transmission?

A
  • In-utero
  • Childbirth
  • Breast feeding
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36
Q

What factors can increase likelihood of contracting HIV when in contact with infectious components?

A
  • Higher viral level
  • Concurrent STI’s causing anogenital inflammation
  • Breaks in the skin or mucosa
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37
Q

Is HIV preventable?

A

Yeah

38
Q

What should practitioners be able to advise patients regarding HIV?

A
  • Transmission reduction

- Safe sex

39
Q

What are the risk factors for HIV?

A
  • MSM
  • IVDU
  • High prevalence areas
  • Unprotected sex with a partner who has lived or been to Africa
40
Q

What are the stages of HIV infection?

A
  • Seroconversion
  • Asymptomatic infection
  • Persistent generalised lymphadenopathy (PGL)
  • Symptomatic HIV
  • AIDS
41
Q

How long after exposure do fourth generation HIV tests give reliable results?

A

4-6 weeks

42
Q

What alternatives are available to fourth generation HIV testing?

A
  • Rapid test kits

- Home sampling kits

43
Q

What are the features of HIV seroconversion?

A
  • Fever
  • Muscle aches
  • Malaise
  • Lymphadenopathy
  • Maculopapular rash
  • Pharyngitis
44
Q

What % of patients with HIV present at seroconversion stage?

A

20-60% (this is a massive range lol)

45
Q

What is the viral load of HIV in asymptomatic infection stage?

A

Low - but continuing slow replication

46
Q

Can HIV be cured?

A

No

47
Q

How long can the asymptomatic infection stage of HIV last?

A

Many years

48
Q

What is persistent generalised lymphadenopathy (PGL) in HIV?

A

Nodes >1cm in diameter at 2-extra inguinal sites for 3 months or longer (not due to any other cause)

49
Q

What happens after the latent (asymptomatic) phase of HIV?

A

Becomes symptomatic

50
Q

What symptoms may a patient have in symptomatic HIV infection?

A
  • Weight loss
  • High temperatures
  • Diarrhoea
  • Frequent minor opportunistic infections
51
Q

What minor opportunistic infections can be present in the symptomatic phase of HIV?

A
  • Candidiasis

- Herpes zoster

52
Q

What is the symptomatic phase of HIV known as?

A

AIDS-related complex

53
Q

What is AIDS-related complex regarded as?

A

An AIDS prodrome

54
Q

What can happen to HIV infection if left untreated?

A

Can develop into AIDS

55
Q

What happens in AIDS?

A

The immune system is significantly weakened and patient develops some defining illnesses

56
Q

What are some AIDS-defining illnesses?

A
  • Pneumocystis jiroveci pneumonia
  • Non-hodgkin’s lymphoma
  • TB
  • Kaposi’s sarcoma
57
Q

What are the first line investigations for HIV?

A

Fourth generation tests

58
Q

What are fourth generation tests for HIV?

A

ELISAs that test for serum (or salivary) HIV antibodies and p24 antigen

59
Q

How long after infection do fourth generation HIV tests give reliable results?

A

4-6 weeks

60
Q

How long can rapid testing kits take to give a result on HIV infection?

A

30 minutes

61
Q

What are the disadvantages to fourth generation HIV test alternatives?

A
  • Less reliable

- Require confirmation by ELISA

62
Q

What public health management is important when managing HIV?

A

Contact tracing

63
Q

What treatment is given to manage HIV?

A

HAART (highly active anti-retroviral therapy)

64
Q

What are the regular tests required to monitor HIV?

A
  • CD4 count
  • HIV viral load
  • FBC
  • U&E
  • Urinalysis
  • ALT, AST and bilirubin
65
Q

What is the prognosis of HIV when using HAART?

A

Excellent

66
Q

What is the risk of HIV transmission from a person complying fully with HAART?

A

Low risk

67
Q

What can treatment of HIV with HAART reduce?

A

AIDS-related and non-AIDS-related mortality

68
Q

What classes of drugs can be used to treat HIV?

A
  • Nucleoside reverse transcriptase inhibitors (NRTIs)
  • Protease inhibitors (PIs)
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • Integrase strand transfer inhibitors (InSTIs)
69
Q

How are are anti-HIV drugs used?

A

In combination

70
Q

How do anti-HIV drugs reduce viral load?

A

Target enzymes involved in replication and maturation of HIV

71
Q

How are anti-HIV drugs combined?

A

Often into a once-daily single tablet

72
Q

What are some examples of single tablet HIV treatments?

A
  • Atripla
  • Stribild
  • Eviplera
  • Ttriumeq
73
Q

What is Atriplas?

A

Tenofovir + emtricitabine + efavirenz

74
Q

What is Stribild?

A

Elvitegravir + cobicistat + tenofovir + emtrictabine

75
Q

What is Eviplera?

A

Tenofovir + emtricitabine + reilpivirine

76
Q

What is Triumeq?

A

Abacavir + lamivudine + dolutegravir

77
Q

What is key to successful management of HIV?

A

Good compliance for the rest of their lives

78
Q

What can non-adherence to HARRT result in?

A

Resistance mutations making treatment difficult or impossible

79
Q

What other factors must be considered when managing HIV?

A

Psychological impact of living with or being diagnosed with HIV

80
Q

What additional tests may HIV patients require in the future?

A
  • Pregnancy testing

- Resistance testing

81
Q

What can people who believe they have been exposed to HIV be treated with?

A

Post-exposure prophylaxis (PEP)

82
Q

Within what period from HIV exposure can someone commence PEP?

A

72 hours

83
Q

What is the aim of PEP for HIV?

A

Reduce the risk of being infected

84
Q

How long does a HIV PEP course last?

A

1 month

85
Q

What is a HIV PEP regime?

A

Truvada OD + Raltegravir BD

86
Q

How can HIV be transmitted vertically?

A
  • In-utero
  • Delivery
  • Breast feeding
87
Q

How can vertical transmission of HIV be reduced?

A
  • Antenatal antiretroviral therapy during pregnancy and delivery
  • Avoidance of breastfeeding
  • Neonatal post-exposure preophylaxis
88
Q

What do the collective interventions reduce the risk of HIV vertical transmission to?

A

<1%

89
Q

What is the risk of vertical transmission of HIV with no interventions?

A

1 in 4

90
Q

Are caesarean section births indicated in HIV?

A

Not if the viral load is undetectable at delivery

A - MSRA Gynaecology (52 decks)

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