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Stage 2: Inflammation > HIV/AIDS > Flashcards

HIV/AIDS Flashcards

1
Q

What is HAART?

A

Highly active anti-retroviral therapy

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2
Q

What are the units of viral load?

A

RNA copies/ml

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3
Q

What are the aims for viral load with treatment?

A

To be undetectable < 50 cpm bc lower viral load means less transmission

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4
Q

What does the CD4 count show and determine?

A
  • It shows the degree of immune damage

- It determines when to start anti-retroviral therapy

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5
Q

What is the natural course of of HIV/AIDS over 5-20 years?

A

1) Acute infection and seroconversion
2) Asymptomatic (transmission occurs)
3) HIV related illness e.g. weight loss, night sweats
4) AIDS defining illness
5) Death

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6
Q

What is a normal CD4 count?

A

> 350

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7
Q

At what CD4 count do most AIDS diagnoses occur?

A

< 200

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8
Q

What is seroconversion?

A

When the body makes antibodies against the virus

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9
Q

How does the virus enter CD4 cells?

A

Via CD4 receptors

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10
Q

How can you reduce perinatal HIV transmission?

A
  • Early HIV diagnosis
  • Treatment for mother to reduce viral load
  • Appropriate delivery method
  • Avoid breastfeeding
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11
Q

What prophylaxis treatment can be given for HIV?

A

PrEP (pre-exposure prophylaxis)

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12
Q

What are clinical features of primary HIV infection (acute seroconversion)?

A
  • Fever, rash, sore throat
  • Glandular fever-like illness
  • Lymphadenopathy
  • Malaise, myalgia, arthralgia, diarrhoea
  • Neurological symptoms e.g. meningitis, encephalitis, neuropathy, myelopathy
  • Ulceration (oral, ano-genital)
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13
Q

Does everyone with primary HIV infection have symptoms and why?

A

No, viral replication rate may be slow or CD4 count is steady or falls slowly

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14
Q

What are viral differential diagnoses of HIV seroconversion?

A
  • Infectious mononucleosis
  • CMV
  • Rubella
  • HSV
  • Adenovirus
  • Hep B/C
  • Flu
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15
Q

What are bacterial differential diagnoses of HIV seroconversion?

A
  • Secondary syphilis

- Streptococcal pharyngitis

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16
Q

What are protozoal differential diagnoses of HIV seroconversion?

A

Toxoplasmosis

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17
Q

What are neoplastic differential diagnoses of HIV seroconversion?

A
  • Lymphoma

- Leukaemia

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18
Q

What are 4 basic ‘non-specific’ HIV related symptoms?

A

1) Fevers
2) Night sweats
3) Weight loss
4) Diarrhoea

19
Q

What else might happen in symptomatic HIV disease?

A

Simple conditions e.g. skin conditions, chest infections, HSV become recurrent or harder to treat

20
Q

What are examples of AIDS defining illnesses where there is advanced disease with severe immunosuppression?

A
  • Candidiasis
  • Cervical cancer
  • CMV
  • Kaposi’s sarcoma
  • Lymphoma
  • TB
  • PCP (pneumocystis jiroveci) pneumonia
  • Cerebral toxoplasmosis
  • Mycobacterium avium complex
  • PML
  • Cryptococcosis
21
Q

What would a CXR look like in PCP pneumonia?

A

Lots of white shading everywhere, foggy

22
Q

What might you see in a head scan in toxoplasmosis?

A

Abscess

23
Q

How is PrEP used?

A

It is taken by someone when they might do something that would put them at risk of HIV

24
Q

What are differentials of HIV + cough?

A
  • Bacterial (pneumococcus) pneumonia
  • TB
  • PJP
  • Other causes rare
25
Q

What CD4 counts would indicate unlikely PJP?

A

CD4 > 200 OR CD4 < 200 but taking prophylaxis

26
Q

What investigations would you do for suspected pneumonia?

A
  • History and examination
  • CXR
  • Arterial sats
  • Exercise oximetry (5 mins)
  • Induced sputum ± bronchoalveolar lavage
  • Consider CT-CAP
  • Screen for TB
27
Q

What is a typical presentation of PJP?

A
  • Gradual onset (weeks)
  • Fever, dyspnoea, cough, chest discomfort
  • Desaturation on exercise
  • CXR can be normal, or interstitial infiltrates, nodular lesions, PTX or pleural disease
  • Hypoxia
  • LDH elevated
28
Q

What is the first choice treatment in PJP that can also be used for prophylaxis?

A

Co-trimoxazole

29
Q

What is TB-IRIS?

A

TB-immune reconstitution inflammatory syndrome - occurs in HIV patients

30
Q

What CNS diseases can occur in HIV?

A
  • Cerebral toxoplasmosis
  • HIV encephalitis
  • HIV neurocognitive disorder (HAND)
  • Primary cerebral lymphoma
  • Cryptococcal meningitis
  • PML
  • Syphilis
31
Q

What are symptoms of CNS diseases in HIV?

A
  • Headache
  • Seizure
  • Focal signs
  • Altered consciousness/confusion
  • Signs of meningism
  • Fever
32
Q

What is first line treatment for toxoplasmosis?

A

Sulphadiazine or clindamycin + pyrimethamine + folinic acid

33
Q

How do you manage cryptococcal meningitis?

A
  • Exclude pulmonary infection
  • Test for serum cryptococcal antigen
  • Blood cultures
  • CSF incl. opening pressure
  • Treat with IV amphotericin (ambisome) and flucytosine following by fluconazole
34
Q

What are late complications of cryptococcal meningitis?

A

Fits, raised ICP, hydrocephalus, cranial nerve palsies

35
Q

What are the 4 ways of HIV transmission and their respective risks?

A 
1) Sexual transmission (0.05-0.
5%)
2) IV drug use (0.67%)
3) Blood transfusion (90%)
4) Mother-to-child at birth or via breast milk (25%)
36
Q

How is HIV-1 transmitted sexually?

A

It breaches mucosal barriers

37
Q

What type of CD4 cells are the main target in acute infection prior to adaptive immune response?

A

Memory CD4 cells in the mucosa esp. in gut associated lymphoid tissue (GALT) which never really recovers

38
Q

What is the immune response to HIV?

A

First CD8 T cells then neutralising antibodies

39
Q

What are the 4 types of responders to HIV?

A

1) Normal progressors - AIDS in 8-10 years
2) Rapid progressors - AIDS 1-3 years
3) Long-term non-progressors - low level detectable viral RNA but AIDS-free indefinitely
4) Elite controller - < 50 cpm, AIDs-free, genetic association with MHC haplotype

40
Q

How is HIV infection diagnosed?

A
  • ELISA test for presence of anti-p24 serum antibodies (detects those who have seroconverted approx. 3 months post infection)
  • Positive test is retested using diff ELISA or Western Blot
  • Negative test may just mean that haven’t seroconverted yet
  • Confirmation via RT-PCR to detect level of HIV RNA in blood
  • Only RT-PCR can diagnose HIV before seroconversion
41
Q

What are different types of HIV anti-retroviral therapy?

A

1) RT inhibitors (N)NRTI e.g. tenofovir, efavirenz
2) CCR5 inhibitors
3) Fusion inhibitor
4) Integrase inhibitors
5) Protease inhibitors

42
Q

How many antiretrovirals are used in HAART combination therapy and why and what is the most common combination?

A

3 in order to avoid mutations

- 2 NRTI + 1 NNRTI/1 protease inhibitor

43
Q

What does HAART do?

A

It controls HIV replication to below detectable levels in blood but virus is never eradicated and stopping treatment leads to rebound of HIV replication

44
Q

What drugs is PrEP?

A

Tenofovir + emtricitabine

Stage 2: Inflammation (39 decks)

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