HIV and AIDS Flashcards
How is HIV spread?
- Sexual transmission
- Injection drug misuse
- Blood products
- Vertical transmission
- organ transplant
Can you test an unconscious patient for HIV?
Yes - if you think its in their best interest. Negative result doesn’t affect insurance premium
Discuss the immunology behind HIV infection?
HIV infects and destroys immune system cells, esp CD4+ T Helper cells
CD4 receptors also present on macrophages and monocytes, brain cells, skin, and more
What is the natural history of HIV as it progresses?
> CD4 count declines and HIV viral load inc.
Inc risk of infections and tumours
severity of illnesses is greater the lower the CD4 count (normal >500)
most AIDS diagnoses (severe infections) at CD4 count <200
How many clinical stages of HIV is there?
4
Discuss clinical stage I of HIV?
-Asymptomatic, persistent generalised lymphadenopathy (PGL)
|»_space;Performance scale 1: Asymptomatic, normal activity
Discuss clinical stage II symptoms of HIV?
-weight loss (<10%)
-Minor mucocutaneous manifestations (seborrhoeic dermatitis, prurigo, fungal nail infections, recurrent oral ulcerations, angular cheritis)
-Herpes Zoster (in last 5y)
-Recurrent URTI
»and/or performance scale 2: symptomatic, normal activity
Discuss clinical stage III symptoms of HIV?
-Weight loss (>10%)
-Unexplained chronic diarrhoea (>1m)
-unexplained prolonged fever (intermittent or prolonged) >1m
-oral candidiasis
-oral hairy leukoplakia
-Pulmonary TB in last yr
-severe bacterial infections
»and/or performance scale 3: bedridden <50% of day in last month
Discuss clinical stage IV symptoms of HIV?
- HIV toxoplasmosis
- CMV disease of organ other than liver/spleen/LN
- HSV infection
- PML
- Candidiasis incl. oesophague/trachea/bronchii/lungs
- HIV encephalopathy
HIV and AIDS are directly linked in infection. When someone gets a certain infection or tumour is it classified as AIDS illness or HIV illness?
AIDS illness. If no symptoms you have HIV infection only
Name some AIDS-defining conditions
- TB
- Cerebral toxoplasmosis
- PML
- Cryptococcal meningitis
- Kaposi’s sarcoma
- Non-Hodgkins lymphoma
- Cervical cancer
- CMV retinitis
Name conditions when HIV testing should be offered?
- aseptic meningitis/encephalitis
- GBS
- transverse myelitis
- dementia
- leucoencephalopathy
- oral candidiasis
- unknown weight loss
- hep b/c infection
- lung cancer
- seminoma
- hodgkins lymphoma
What is the progression of HIV from initial infection?
>acute infection (seroconversion) >Asymptomatic >HIV related illnesses >AIDS defining illness >death
What are the symptoms of seroconversion (when HIV antibodies first develop)?
- flu-like illness
- fever
- malaise and lethargy
- pharyngitis
- lymphadenopathy
- toxic exanthema
may look like glandular fever but EBV serology negative
How soon does seroconversion present?
2-4 weeks post exposure. 1-2 weeks is self limiting
What is the treatment for HIV?
Combination antiretroviral therapy - cART (at least 3 drugs from at least 2 groups)
Side effects of cART?
- metabolic problems
- lipodystrophy
What are the 3 drugs combined in HIV therapy? What other drug is also available?
- Reverse transcriptase inhibitors
- Integrase inhibitors
- Protease inhibitors
-Entry inhibitors
When should you consider commencing treatment for HIV?
> consider all patients at diagnosis regardless of CD4 count
if CD4<350 cells/mm3 encourage treatment
if CD4 <200cells/mm3 start asap
any pregnant woman - start before 3rd trimester
Is HIV treatment lifelong?
yes
What does life expectancy depend on in HIV sufferers?
how early treatment is started from point patient is infected
Why do treatments fail?
- inadequate potency
- inadequate drug levels
- inadequate adherence (leads to viral mutation and resistance)
- pre-existing resistance
List the 4 antiviral drugs and one side effect of each:
- Nucleoside reverse transcriptase inhibitors
- non-nucleoside reverse transcriptase inhibitors
- protease inhibitors
- integrase inhibitors
> NRT inhibitors: lipodystrophy
NNRT inhibitors: skin rashes
Protease inhibitors: lipodystrophy
Integrase inhibitors: rashes
Cosmetic procedures to treat lipodystrophy?
- facelift
- liposuction
- fillers
