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Infection > HIV and AIDS > Flashcards

HIV and AIDS Flashcards

1
Q

What is HIV?

A

Human immunodeficiency virus, a virus that targets cells within the immune system causing it to fail

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2
Q

What is AIDS?

A

Acquired immunodeficiency syndrome, describes the complications that occur when an immune system fails

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3
Q

Where is the highest prevalence of HIV/AIDS?

A

Sub-Saharan Africa contains 2/3 of all people in the world living with HIV/AIDS

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4
Q

What is the main route of HIV infection in the UK?

A

homosexual sexual transmission is main route and injecting drug use is low route

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5
Q

What sex is HIV more common in in the UK?

A

M>F

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6
Q

What sex is HIV more common in in Africa?

A

F>M

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7
Q

Name the routes of infection for HIV

A

Main route of spread varies geographically

Sexual transmission

Intravenous drug misuse

Organ transplant

Vertical transmission/Mother-to-child

Unscreened blood/blood products

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8
Q

Which of the two types of HIV virus is most predominant?

A

HIV-1

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9
Q

What type of virus is HIV?

A

Single stranded RNA retrovirus

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10
Q

Describe the basic virology of HIV?

A

Virus targets cells with CD4 molecule, such as lymphocytes/T helper cells, dendritic cells and macrophages

HIV attaches to CD4 molecule and then a co-receptor via GP120 protein to gain access into cell

Once HIV is in the cell, RNA is converted to DNA using reverse transcriptase

The lack of accuracy during replication leads to virus diversity which leads to persistent infection of the cell and the ongoing opportunity to transmit

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11
Q

What are the 5 steps of HIV/AIDS (natural history of HIV)?

A

Acute infection/seroconversion

Asymptomatic

HIV related illness

AIDS defining illness

Death

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12
Q

What is the diagnostic window?

A

The window period is the time during which markers of infection are not detectable.

Testing during this period for antibody/antigen can result in false negative results

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13
Q

What viral labartory tests are used in HIV diagnosis?

A

Antigen and antibody tests

  • ELISA allows simultaneous detection of antibody and antigen

RNA/DNA test

  • Confirmatory test
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14
Q

What investigations, except diagnostic lab tests, are used in HIV diagnosis and monitoring?

A

Viral load/HIV genome Detection

CD4 Count

HIV Resistance Testing

Avidity testing

Subtype determination

Tropism testing, determinswhich co-receptor the virus used to enter CD4 cells

Drug levels, to determine compliance

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15
Q

When should HIV testing for asymptomatic patients be done?

A

4 weeks post possible exposure

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16
Q

When should HIV testing for asymptomatic patients be repeated?

A

12 weeks

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17
Q

What happens to viral loads and CD4 count when treatment is initiated?

A

When a patient initiates antiretroviral treatment, their viral load will fall and their CD4 count will rise

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18
Q

What is a normal CD4 count?

A

>500

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19
Q

What CD4 count is diagnostic of AIDS?

A

<200

20
Q

How does acute HIV/seroconversion illness present?

A

Flu-like illness

Fever

Malaise and lethargy

Pharyngitis

Lymphadenopathy

Toxic exanthema (widespread rash)

21
Q

When does seroconversion illness occur?

A

Occurs when antibodies first develop at 2-4 weeks post-exposure

22
Q

How long does seroconversion illness last?

A

lasting for 1-2 weeks

23
Q

What percentage of patients experience seroconversion illness?

A

30-60% of patients

24
Q

Give examples of HIV related illness

A

Oral Thrush/candida Albicans

Unexplained weight loss

Unexplained lymphadenopathy

Guillain-Barre

Dementia

Aspergillosis

Anal or lung Cancer

25
Q

Give examples of AIDS defining illness

A

TB

Kaposi’s Sarcoma, caused by HHV8

Pneumocystis jirovecii pneumonia

Progressive multifocal leukoencephalopathy (PML)

Cryptococcal Meningitis

Persistent Cryptosporidiosis

Non-Hodgkin’s lymphoma

Cervical cancer

CMV (Cytomegalovirus) retinitis

26
Q

What is the most common late stage/AIDS infection?

A

Pneumocystis Jiroveci Pneumonia, occuring at CD4 count of less than 200

27
Q

Give features of pneumocystis jiroveci pneumonia

A

Desaturation on exercise

Patchy opacities in the right apex and bilateral hilar enlargement on xray

Few chest signs

28
Q

How is pneumocystis jirovecii pneumonia managed?

A

Co-trimoxazole

IV pentamidine in severe cases

29
Q

What is the most common neurological infection seen in HIV?

A

Cerebral toxoplasmosis

30
Q

Give features of cerebral toxoplasmosis

A

Multiple brain lesions with ring enhancement

31
Q

Give features of progressive multifocal leukoencephalopathy

A

Multifocal non enhancing lesions

Ataxia/coordination difficulties

32
Q

Give features of cryptococcus neoformans

A

CSF contains organisms stained with india ink

Meningitis/headache

33
Q

What is the most common cause of diarrhoea in HIV?

A

Cryptosporidium

34
Q

How is HIV managed?

A

Combination antiretroviral therapy (cART)

  • 3 drugs from at least 2 groups in 1 pill
  • Initiated on diagnosis, regardless of CD4 and viral count
35
Q

When should antiretroviral therapy be adjusted?

A

Adjust if VL is not low enough after 4-6 weeks of starting treatment

36
Q

What are the 4 classes of antiviral drugs?

A

Nucleoside reverse transcriptase inhibitors

Non-nucleoside reverse transcriptase inhibitors

Protease inhibitors

Integrase inhibitors

37
Q

Name the side effects of nucleoside reverse transcriptase inhibitors

A

Marrow toxicity

Neuropathy

Lipodystrophy

38
Q

Name the side effects of non-nucleoside reverse transcriptase inhibitors

A

Skin rashes

Hypersensitivity

Drug interactions

Neuropsychiatric effects

39
Q

Name the side effects of protease inhibitors

A

Drug interactions

Diarrhoea

Lipodystrophy

Hyperlipidaemia

40
Q

Name the side effects of Integrase inhibitors

A

Rashes

Disturbed sleep

41
Q

What is the preventative management of HIV?

A

Behaviour change and condoms

Circumcision

Treatment: Undetectable means it is untransmissible

Pre exposure prophylaxis (PrEP)

Post exposure prophylaxis (PEP)

42
Q

When is PEP given?

A

When someone has sex with an HIV patient or gets a needlestick injury potentially contaminated with HIV

43
Q

When does PEP have to be given by?

A

Within 72 hours

44
Q

What medication is given for PEP?

A

Truvada

Kaltetra

45
Q

What should patients with a CD4 count lower than 200 be prescribed?

A

Co-trimoxazole for prophylaxis against pneumocystis jiroveci pneumonia

Infection (9 decks)

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