HIV/AIDS

Question 1

Define HIV?

Answer 1

Human immunodeficiency virus, retrovirus - virus insert RNA into DNA, changing cell genome, attached to CD4 cell receptors

Question 2

Prevalance?

Answer 2

38 mil worldwide, over 100k UK

Question 3

Transmission?

Answer 3

4 ways. Unprotected sex. Blood products. Vertical transmission - mother to child (womb, birth, breastfeeding). Contaminated needles/equiptment.

Question 4

Diagnosis?

Answer 4

HIV bloodtests. 4th gen can detect 1 month. Detects both antigen p24 and antobodies

Question 5

CD4 count? levels

Answer 5

> 500 infection, 500 early, 500-200 middle, 200-50 advanced, <50 late

Question 6

Levels explained?

Answer 6

1. Normally asymptomatic. 2. Often asymptomatic, flu like symptoms, enlarged lymph nodes (lymphadenopathy), skin disorders. 3. Often asymptomatic, +, recurrent herpes/shingles infections, TB/pneumonia, diarrhoea, weight loss, cancers 4. wasting, Pneumocystis carinni pneumonia (PCP)
   MAC (mycobacterium aviun complex), PML (progressive multifocal leukoencephalopathy, other neurological issues 5. Neurological issues, MAC, wasting

Question 7

PCP?

Answer 7

Most common opportunistic infection, HAART works well to prevent. Symptoms: cough, fever, shortness of breath, chest discomfort. Treatment with combination antibiotics

Question 8

PML?

Answer 8

Progressive Multifocal Leukoencephalopathy, brains white matter disease

Question 9

HIV and oncology?

Answer 9

3 main AIDS defining cancers, Kaposi Sarcoma (KS)
High B-cell non-hodgkin’s lymphoma
Invasive cervical cancer

Question 10

What is AIDS?

Answer 10

Acquired Immuno-deficiency syndrome, late stage HIV

Question 11

HAART?

Answer 11

Highly active anti retroviral therapy, combination of at least 3 different ARVs

Question 12

Aims of treatment? individual vs population

Answer 12

1. Reduce viral load + raice CD4 (T cells)
2. Reduce incidence of opportunistic infections
3. Increase life expectancy
4. Reduce vertical transmission
5. Reduce sexual transmission rates

Question 13

Types of ARVs?

Answer 13

Entry inhibitors, NRTI, NNRTI, protease inhibitors (PI), integrase inhibitors (INI)

Question 14

Names of some co-formulation

Answer 14

Kivexa, Eviplera, Truvada

Question 15

NNRTI?

Answer 15

Non-nucleoside reverse transcriptase inhibitors

Question 16

NRTI?

Answer 16

Nucleoside reverse transcriptase inhibitors, latch onto the new DNA strand getting build

Question 17

PIs?

Answer 17

Protease inhibitors. Prevent final assembly and completion of new HIV viruses within the cell

Question 18

Treatment plan?

Answer 18

Patient centered. When to start? what to start? patient involved and seen by specialist. Normally Truvada or Kivexa

Question 19

PrEP and PeP?

Answer 19

Pre exposure prophylaxis (daily or event based), post exposure prophylaxis (within 72 hours, for 4 weeks)

Question 20

Side effects to HAART

Answer 20

Diarrhoea common, treatment: pancreatic enzyme supplements, diet changes, imodium. Nausea and vomiting less common now, Treatment: dietary advice, anti-emetics. Fatigue, many causes. CNS (anxiety, dizziness, moods) associated drugs - vibrant dreams. System complication (liver-related, kidney/renal, skin problems, peripheral neuropathy, lactic acidosis and pancreatitis. Metabolic changes (lipodystrophy), diabetes, dyslipideamia, osteoporosis

Question 21

HIV and ageing

Answer 21

Increasing rate of new infections
Higher rates of common health complications
Life-expectancy however similar