HIV and AIDS

Question 1

Means of spreading HIV (5)

Answer 1

1. Sexual transmission
2. IVDU
3. Blood products
4. Vertical transmission
5. Organ transplant

Question 2

What cells are destroyed in HIV

Answer 2

CD4+

Question 3

What is the normal level of CD4+ and when is the AIDS diagnosis made?

Answer 3

Normal = 500
Changes seen roughly <350 (thrush and skin changes)
AIDS = <200

Question 4

How many classification stages are there in HIV?

Answer 4

4 clinical stages

Question 5

Clinical stage 1 (2)

Answer 5

Asymptomatic

Persistent generalised lymphadenopathy

Question 6

Clinical stage 2 (4)

Answer 6

Weight loss < 10% of body weight
Minor mucocutaneous manifestations
Herpes zoster, within last 5 years
Recurrent upper resp tract infections

and/or performance scale 2: symptomatic, normal activity

Question 7

Clinical stage 3 (7)

Answer 7

Weight loss >20% of body weight
Unexplained chronic diarrhoea
Unexplained prolonged fever
Oral candidiasis
Oral hairy leukoplakia
Pulmonary TB
Severe bacterial infections

and/or performance scale 3: bed ridden <50% of the day

Question 8

Clinical stage 4 (lots)

Answer 8

too many to list

Question 9

AIDS defining conditions

Answer 9

Resp - TB, pneumocystis
Neuro - meningitis, cerebral tomoplasmosis
Derm - Kaposi sarcoma
Oncology - non-hodgekins

Question 10

How long does seroconversion take?

Answer 10

Abrupt: 2-4 weeks

Self-limiting: 1-2 weeks

Question 11

Symptoms of primary HIV (6)

Answer 11

1. Lymphadenopathy
2. Fever
3. Malaise/lethargy
4. flu-like symptoms
5. Pharyngitis
6. Toxic exanthema (wide-spread rash)

Question 12

What can primary HIV look like?

Answer 12

Glandular fever - EBV serology not in-keeping

Question 13

When to treat?

Answer 13

Encourage at DIAGNOSIS regardless of CD4+ count
<350 should art treatment
<200 treatment needs to start ASAP
Any pregnant women need to start before 3rd trimester

Question 14

What is the life expectancy dictated by?

Answer 14

Nadir CD4+ count - lowest count before medication

Question 15

What are the challenges of HIV care in 2018? (7)

Answer 15

Malignancy
Osteoporosis
Cognitive impairment
cerebrovascular disease
IHD
Diabetes
Renal disease

Question 16

HIV Prevention

Answer 16

Behaviour changes/condoms
Circumcision 
Treatment as prevention - eg pregnancy
Pre-exposure prophylaxis (PrEP)
Post-exposure prophylaxis sexual exposure (PEPSE) - taken within 72 hours each day for a month