HIV and AIDS Flashcards
5 ways HIV can be spread
sexual transmission vertical transmission infection drug misuse blood products organ transplant
Can unconscious patients be tested for HIV?
if you think it is in their best interests
What cells of the immune system does HIV particularly infect and destroy?
T helper cells with CD4 surface receptors (CD4+)
Apart from lymphocytes where else are CD4 receptors found in the body?
brain
skin
surface of macrophages and monocytes
What happens to the CD4 count and viral load over the course of the infection?
CD4 count decreases and viral load increases
Relationship between severity of disease and CD4 count
severity of illness is greater the lower the CD4 count
normal CD4 count
> 500
Most AIDS diagnoses CD4 count
<200
What was the original classification of HIV and why?
clinical
estimate incidence in developing world where GIV testing less readily available
Clinical stage 1 findings
asymptomatic
persistent general lymphadenopathy
Clinical stage 2 findings
weight loss
minor mucocutaneous
HZV - shingles
URTI recurrent
Clinical stage 3 findings
weight loss chronic diarrhoea fever thrush TB
Clinical stage 4 findings
pneumonia
CMV
mucocutaneous
encephalopathy
Define AIDS illnesses
certain infections and tumours that develop due to weakness in the immune system
No symptoms usually means HIV or AIDS?
HIV only
List some clinical indicator diseases for HIV
TB, pneumonia, cryptococcal meningitis, HZV, non Hodgkin lymphoma, cervical cancer, psoriasis
What is the 1 year mortality based on?
CD4 count
Describe the primary HIV and seroconversion illness
30-60% g=have illness when HIV antibodies first develop
abrupt onset 2-4 weeks post exposure and self limiting 1-2 weeks
Symptoms of seroconversion illness
flu like illness fever lymphadenopathy pharyngitis malaise and lethargy
Seroconversion illness and glandular fever link
look the same but EBV serology not in keeping with glandular fever
What type of virus is HIV?
retrovirus
Combination ART
atleast 3 drugs from atleast 2 groups
Basis of ART
different classes of drugs acting on different parts of the HIV lifecycle
Where do ART treatments act?
reverse transcriptase inhibitor
integrase inhibitor
protease inhibitor
When should a pregnant woman with HIV start ART?
Before 3rd trimester
3 reasons why treatment fails
poor adherence - viral mutation and resistance
pre existing resistance
inadequate potency or drug levels
Side effects of nucleoside reverse transcriptase inhibitors
marrow toxicity
neuropathy
LIPODYSTROPHY
Side effects of nucleoside reverse transcriptase inhibitors
skin rashes
hypersensitivity
drug interactions
Side effects of protease inhibitors
drug interactions
diarrhoea
LIPODYSTROPHY
hyerlipidaemia
Side effects of integrase inhibitors
rashes
What Is lipodystrophy?
lose fat in certain places and redistribute it
change drugs as less likely with newer agents
cosmetic procedures - facelift and filers etc
7 challenges of HIV care in 2018
osteoporosis malignancy IHD DM cerebrovascular disease cognitive impairment renal disease
5 ways to prevent HIV
behaviour change and condoms circumcision PrEP PEPSE treatment as prevention for pregnancy
The future for HIV care
therapeutic vaccines
cure - kick kill method
long acting injectable drug treatments
Spread of HIV in Africa
heterosexual
mother to child
contaminated blood products
Strain of HIV causing worldwide epidemic
HIV1 group M
How do we diagnose HIV?
antigen antibody test
What is the window period?
time during which markers of infection are not detectable - can vary
When do you have to tell your work about HIV diagnoses?
do they require a test for your work? - no then they do not need to know
yes - visa or exposure prone procedures
Risk of transmission with percutaneous exposure of Hep B,C and HIV
Hep b - 30%
Hep C - 3%
HIV - 0.3%
risk of HIV transmission by mucocutaneous exposure?
<0.1%
List some fluids which should be handled with same precaution as blood
synovial fluid, amniotic fluid, saliva, breast milk, CSF
Actions taken after blood or body fluid exposure
wash skin with running water and soap
encourage bleeding
wash off splashes
report to doctor and OHS
How is the risk of transmission assessed?
vaccinations, source of contamination, likelihood of B/C/HIV, extent of injury, ideally test source with informed consent
Does Hep B or C not have a vaccine?
C
Ways to avoid exposure
hygiene safe disposal cleaning up blood protect mucous membranes cover wounds
