HIV and AIDS

Question 1

State the modes of transmission of HIV

Answer 1

Sexual tranmission, IUD, Blood products, vertical transmission and organ transplantation

Question 2

Describe the immunological mechanism of HIV

Answer 2

HIV infects and destroys cells of the immune system, especially the T-helper cells that are CD4+

Question 3

Where are CD4 receptors present

Answer 3

Lymphocytes, macrophages, monocytes, brain, skin

Question 4

Describe the natural history of HIV

Answer 4

CD4 count declines and HIV viral load increases over time.

Question 5

Increased HIV viral load increases the risk of

Answer 5

Developing infections and tumours

Question 6

The lower the CD4 count

Answer 6

The greater the severity of the disease

Question 7

State the normal CD4 count

Answer 7

above 500

Question 8

State when AIDS diagnosed

Answer 8

CD4<200

Question 9

Clinical stage 1 HIV

Answer 9

Asymptomatic with persistent generalised lymphadenopathy

Question 10

Clinical stage 2 HIV

Answer 10

Weight loss (<10% of body weight), minor muscocutaneous manifestations, HZV within the last 5 years, recurrent upper respiratory tract infections

Question 11

Clinical stage 3 HIV

Answer 11

Weight loss >10% body weight, unexplained chronic diarrhoea >1mnth, unexplained fever >1mnth, oral candidiasis, oral hairy leukoplakia, pulmonary TB, severe bacterial infections and/or performance scale 3

Question 12

Define performance scale 3

Answer 12

Bedridden, <50% of the day during the last month

Question 13

Define clinical stage 4 HIV

Answer 13

HIV wasting syndrome, pneumonia, toxoplasmosis of the brain, CMV disease of any organ other than liver, spleen or lymph nodes, HSV, PML

Question 14

State the natural history of progression of HIV

Answer 14

Acute infection (seroconversion), asymptomatic HIV, HIV related illness, AIDS defining illness and death

Question 15

State the percentage of patients who get seroconversion illness

Answer 15

30-60%

Question 16

State the symptoms of primary HIV

Answer 16

Flu, fever, malaise and lethargy, pharyngitis, lymphadenopathy, toxic exanthema

Question 17

When is anti-retro-viral therapy started

Answer 17

CD4 350

Question 18

What does combination antiretroviral therapy mean

Answer 18

At least 3 drugs from at least 2 groups

Question 19

State the main side effect of cART

Answer 19

Lipodystrophy

Question 20

State the side effects of nuceloside reverse transcriptase inhibitors

Answer 20

Marrow toxicity, neuropathy, lipodystrophy

Question 21

State the side effects of non-nuceloside reverse transcriptase inhibitors

Answer 21

Skin rashes, hypersensitivity, drug interactions

Question 22

State the side effects of protease inhibitors

Answer 22

Drug interactions, diarrhoea, lipodystrophy, hyperlipidaemia

Question 23

State the side effects of integrase inhibitors

Answer 23

rashes

Question 24

What type of virus is HIV

Answer 24

Retrovirus

Question 25

State the number of people estimated to be living with HIV worldwide

Answer 25

37 million

Question 26

How does HIV destroy CD4 cells

Answer 26

It binds via GP120 envelope glycoprotein and these CD4 cell migrate to lymphoid tissue wher the virus replicates, producing millions of new virions

Question 27

What is the result of infection of CD4 cells

Answer 27

Leads to decreased immune function

Question 28

Describe post-exposure prophylaxis of HIV

Answer 28

Antiretroviral treatment given up to 72 hours after exposure. The first line is Truvada (tenofovir/emtricitabine) and raltegravir for 28 days

Question 29

What should all pregnant women infected with HIV be commenced on by 24 weeks gestation

Answer 29

ART

Question 30

How is the neonate treated

Answer 30

PEP given from birth to 4 weeks old with formula feeding

Question 31

State the use of ELISA for HIV antibody and antigen

Answer 31

test for HIV antibody and p24 antigen. This is confirmed by confirmatroy assay

Question 32

State the use of rapid point-of-care testing

Answer 32

Immunoassay kit which gives a rapid result from a finger prick or mouth swab but still needs serological confirmation

Question 33

Describe the use of viral load testing in HIV

Answer 33

Used to monitor the response of ART.

Question 34

When is nucleic acid testing/viral PCR used for the diagnosis of HIV

Answer 34

Neonates as placental transfer of maternal antibodies can affect ELISA antibody testing up to 18 months of age

Question 35

List some opportunistic infections patients with HIV may get

Answer 35

Pneumocystis jirovecii, candidiasis, cryptococcus neoformas, toxoplasma gondii, CMV, cryptosporidium, kaposis sarcoma, lymphoma

Question 36

State the aims of ART in the treatment of HIV

Answer 36

The reduction of the HIV viral load to a level undetectable by standard la techniques leading to recovery, reduced clinical progression, and reduced mortality

Question 37

State the mechanism of CCR5 antagonists

Answer 37

Inhibit the entry of the virus into the cell by blocking the CCR5 co-receptor

Question 38

State the mechanism of NRTIS

Answer 38

Inhibit reverse transcriptase and the conversion of viral RNA into DNa

Question 39

State the mechanism of Integrase Stand Transfer Inhibitors

Answer 39

Inhibit integrase and prevent HIV DNA integrating into the nucleus

Question 40

State the mechanism of protease inhibitors

Answer 40

Inhibit protease, an enzyme involved in the maturation of virus particles

Question 41

State the mechanism of pharmacokinetic enhancers

Answer 41

Increase the effectiveness of antiretroviral drugs allowing lower doses

Question 42

What should be started in the treatment of HIV

Answer 42

2 nucleoside reverse transcriptase inhibitors plus one of ritonavir-boosted protease inhibitor, non-nucleoside reverse transcriptase inhibitor or integrase inhibitor

Question 43

State the main NRTI backbone drugs used in HIV treatment

Answer 43

Tenofovir and emtricitabine

Question 44

State the main protease inhibitors used in HIV treatment

Answer 44

Atazanavir and darunavir

Question 45

State the main NNTRIs used in HIV treatment

Answer 45

Rilpivirine

Question 46

State the main Integrase inhibitors used in the treatment of HIV

Answer 46

Dolutegravir, elvitegravir, raltegravir