HIV and AIDS

Question 1

How is HIV spread?

Answer 1

Sexual transmission
Injection drug misuse
Blood products
Vertical transmission
Organ transplant

Question 2

How is HIV tested?

Answer 2

Point of Care Testing (POC)
Blood sample from individuals finger
Takes 60 seconds
Standard test will confirm result

Question 3

Describe the immunology of HIV

Answer 3

Infects and destroys cells of the immune system especially the T-Helper cells that are CD4+
CD4 receptors are non-exclusive to lymphocytes - present on surface of monocytes and macrophages, cells in brain and skin, and other sites

Question 4

Describe the natural history of HIV

Answer 4

CD4 count declines and HIV viral load increases
Increasing risk of developing infections and tumours
Severity of illness is greater if CD4 count is lower
Most AIDS diagnosis occurs when CD4 <200

Question 5

What are some symptoms of clinical stage 1 HIV?

Answer 5

Asymptomatic
Persistent generalised lymphadenopathy

Question 6

What are some symptoms of clinical stage 2 HIV?

Answer 6

Weight loss
Minor mucocutaneous manifestations
Herpes zoster
Recurrent upper resp tract infections

Question 7

What are some symptoms of clinical stage 3 HIV?

Answer 7

Weight loss
Unexplained chronic diarrhoea
Unexplained prolonged fever
Oral candidiasis
Oral hairy leucoplakia
Pulmonary tuberculosis
Severe bacterial infections

Question 8

What are some symptoms of clinical stage 4 HIV?

Answer 8

HIV wasting syndrome
Pneumocystis pneumonia
Toxoplasmosis
Cryptococcosis
HSV
Progressive multifocal leukoencephalopathy

Question 9

What is the difference between AIDS and HIV?

Answer 9

HIV - no symptoms
AIDS - certain infections and tumours which develop to a weakness in immune system
If AIDS then put on antivirals

Question 10

What are some AIDS defining conditions?

Answer 10

Tuberculosis
Pneumocystis
Toxoplasmosis
Kaposi’s sarcoma
Cervical cancer
Persistent cryptosporidiosis

Question 11

What is the progression of HIV?

Answer 11

Acute infection - seroconversion
Asymptomatic
HIV related illnesses
AIDS defining illness
Death

Question 12

Describe primary HIV/ seroconversion

Answer 12

Approx. 30-60% of patients have seroconversion illness when HIV antibodies first develop
Abrupt onset after 2-4 weeks after exposure
Self limiting 1-2 weeks
Symptoms non-specific

Question 13

What are the symptoms of primary HIV?

Answer 13

Flu-like illness, fever, malaise, lethargy, pharyngitis, lymphadenopathy and toxic exanthema
Looks like glandular fever but no EBV serology

Question 14

Describe pneumocystis jiroveci pneumonia

Answer 14

Commonest late stage AIDS infection
Opportunistic infection
CD4 cell count usually less than 200
Classification is dry cough and increasing breathlessness over several weeks

Question 15

What investigations are used for pneumocystis jiroveci pneumonia?

Answer 15

Chest X-ray
Induced sputum or bronchoscopy for PCR

Question 16

What is the treatment for pneumocystis jiroveci pneumonia?

Answer 16

Cotrimoxazole
Pentamidine
Prophylaxis until CD4 is under 200

Question 17

Describe antiviral therapy for HIV

Answer 17

Different classes of drugs acting on different stages of HIV lifecycles
Combination antiviral therapy means 3 drugs of at least 2 groups
Adherence need to be over 90%

Question 18

Where does the antiviral treatment act?

Answer 18

Reverse transcription inhibitors
Integrase inhibitor
Protease inhibitors

Question 19

When should antiviral therapy start?

Answer 19

All patients at diagnosis regardless of CD4 count and viral load
If CD4 less than 350 then risk of symptoms without treatment
If CD4 under 200 then need to start as soon as possible
Any pregnant women before 3rd trimester

Question 20

When is combination therapy adjusted?

Answer 20

If viral load is not adequately suppressed after 4-6 weeks

Question 21

What is the current life expectancy for HIV and AIDS?

Answer 21

If CD4 under 100 - 52%
If 100-200 - 62%
If over 200 - 70% +

Question 22

How long does treatment last?

Answer 22

Life long
May need to changed but always need to on some form of antiviral medication

Question 23

Why do treatments fail?

Answer 23

Poor adherence levels to viral mutation and resistance
Incomplete suppression - inadequate potency, drug levels, adherence and pre-existing resistance

Question 24

What are some antiviral drugs used?

Answer 24

Nucleoside inhibitors
Non-nucleoside reverse transcription inhibitors
Protease inhibitors
Integrase inhibitors

Question 25

What are some side effects of nucleoside reverse transcriptase inhibitors?

Answer 25

Marrow toxicity, neuropathy and lipodystrophy

Question 26

What are some side effects of non-nucleoside reverse transcriptase inhibitors?

Answer 26

Skin rashes, hypersensitivity, drug interactions and neuropsychiatric effects

Question 27

What are the side effects of protease inhibitors?

Answer 27

Drug interactions, diarrhoea, lipodystrophy and hyperlipidaemia

Question 28

What are the side effects of integrase inhibitors?

Answer 28

Rashes and disturbed sleep

Question 29

What is the treatment for lipodystrophy?

Answer 29

Change drugs
Cosmetic - facelift, liposuction and fillers

Question 30

What are some challenges of HIV care?

Answer 30

Osteoporosis, cognitive impairment, malignancy, cerebrovascular disease, renal disease, ischaemic heart disease and DM

Question 31

What is used for prevention of HIV?

Answer 31

Behaviour change and condoms
Circumcision
Treatment as prevention
Pre-exposure prophylaxis
Post-exposure prophylaxis for sexual exposure