HIV and AIDS Flashcards
how can HIV be spread?
Sexual transmission
Injection drug misuse
Blood products
Vertical transmission
Organ transplant
when can a patient be tested for HIV?
Unconscious patients can be tested if you think it is in the patient’s interest to have the test
what is good to mention to patients when having negative hiv test?
Having had a negative HIV test does not affect insurance premiums
point of care testing?
blood sample from finger
60 seconds
confirmation of results
describe the immunology of HIV
HIV infects and destroys cells of the immune system especially the T-Helper cells that are CD4+ (have a CD4 receptor on their surface)
CD4 receptors are not exclusive to lymphocytes – they are also present on the surface of macrophages and monocytes, cells in the brain, skin, and probably many other sites.
over the course of infection what will happen to CD4?
CD4 count declines & HIV viral load increases
Increasing risk of developing infections and tumours
The severity of these illnesses is greater the lower the CD4 count (normal CD4 > 500)
Most AIDS diagnoses (severe infections) occur at CD4 count <200
what symptoms are associated with symptomatic HIV?
what classifies an HIV infections versus AIDS?
Certain infections and tumours that develop due to a weakness in the immune system are classified as AIDS illnesses. If you have no symptoms then you have HIV infection only.
Virtually everyone with an AIDS illness should recover from it and then be put on antivirals to keep them free from any future illness.
what is primary HIV/seroconversion?
Approximately 30 - 60% of patients have a seroconversion illness (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
what are symptoms of primary HIV?
Flu-like illness
Fever
Malaise and lethargy
Pharyngitis
Lymphadenopathy
Toxic exanthema
“looks like glandular fever but EBV serology not in keeping”
what is Pneumocystis jiroveci pneumonia?
Commonest late stage (AIDS) infection
Formerly known as PCP (pneumocystis carinii pneumonia)
Opportunistic infection
CD4 cell count usually <200
what I the classic history of Pneumocystis jiroveci pneumonia?
Classical history of dry cough and increasing breathlessness over seveal weeks
what investigations should be done for Pneumocystis jiroveci pneumonia?
Chest X-Ray
Induced sputum or
broncoscopy for PCR
how is Pneumocystis jiroveci pneumonia treated?
Cotrimoxazole
Pentamidine
Prophylaxis until CD4 > 200
what is the antiviral therapy for HIV?
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% - support patient
cART can lead to a normal life but side effects can be significant eg metabolic, lipodystrophy,
when should treatment be started in individuals with HIV?
Nowadays start all patients at diagnosis regardless of CD4 and viral load
If CD4 < 350 cells/mm3 patients at risk fo developing symptoms without being on treatment
If CD4 < 200 need to start as soon as possible
Any pregnant woman – start before third trimester
Three drug combination with treatment adjustment if viral load not adequately suppressed after 4-6 weeks
how long is a patient required to be on treatment?
Once you start treatment you need to continue it for the rest of your life. The treatment may need to be changed from time to time but you will always need to be taking some form of antiviral medication.
In many ways, the treatment of HIV is similar to that of a chronic condition (like hypertension) rather than to the treatment of an infection.
list the different antiviral drugs available?
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
what are side effects of Nucleoside reverse transcriptase inhibitors?
marrow toxicity, neuropathy, lipodystrophy
what are side effects of Non-nucleoside reverse transcriptase inhibitors?
skin rashes, hypersensitivity, drug interactions, neuropsychiatric effects
what are side effects of Protease inhibitors?
drug interactions, diarrhoea, lipodystrophy and hyperlipidaemia.
what are side effects of Integrase inhibitors?
Rashes, disturbed sleep
what is lipodystrophy, how is it treated?
Change drugs
Less likely with newer
agents
Cosmetic procedures
-facelift
-liposuction
-fillers
how can HIV be prevented?
Behaviour change and condoms
Circumcision
Treatment as prevention
VL undetectable = untransmissable
Pre-exposure prophylaxis (PrEP)
Post-exposure prophylaxis for sexual exposure (PEPSE)
