HIV and AIDS Flashcards
Spread of HIV? (5)
Sexual transmission Injection drug misuse Blood products Vertical transmission Organ transplant
HIV testing
Unconscious patients can be tested if you think it is in the patient’s interest to have the test
What is point of care testing (POC)
blood sample from finger
60 seconds
standard test confirms result
HIV infection - Immunology
Where are CD4 receptors also found
CD4 receptors are not exclusive to lymphocytes – they are also present on the surface of macrophages and monocytes, cells in the brain, skin, and probably many other sites.
Natural history of infection
CD4 count declines & HIV viral load increases and tumour risk increase
Most AIDS diagnoses (severe infections) occur at CD4 account of
<200
normal CD4 is
> 500
HIV infection - classification
Original classification was clinical
Pragmatic approach is to consider symptomatic vs asymptomatic disease
Clinical staging of HIV 1
ASYMPTOMATIC
swollen lymph nodes
Clinical staging of HIV 2
weight loss, oral thrush, herpes, recurrent URTI
Clinical staging of HIV 3
more weight loss, unexplained chronic diarrhoea, prolonged fever, worsening oral candidiasis
oral hairy leukoplakia
Clinical staging of HIV 4
HIV wasting syndrome, HSV, HIV encephlaopathy, extrapulmonary tuberculosis
Do I have HIV or AIDS?
Certain infections and tumours that develop due to a weakness in the immune system are classified as AIDS illnesses. If you have no symptoms then you have HIV infection only.
give some examples of aids defining conditions
tuberculosis, pneumocystis, primary cerebral lymphoma, kaposi’s sarcoma
Conditions where HIV testing should be offered?
bact pneumonia, aspergillosis, guilliane-barr syndrome, cerebral abscess, dementia, peripheral neuropathy , oral candidiasis
most common tumour with HIV
B cell lymhomas - hodgkin’s
Those who die from HIV
CD4< 100 , very late presentation
Natural history
Acute infection – seroconversion Asymptomatic HIV related illnesses AIDS defining illness Death
Primary HIV / seroconversion? what is this similar to as well?
Abrupt onset illness 2 – 4 weeks post exposure, self limiting 1 – 2 weeks
Approximately 30 - 60% of patients have a seroconversion illness (when HIV antibodies first develop)
glandular fever - differential diagnosis includes a range of common conditions
Primary HIV / seroconversion symptoms include
Lymphadenopathy fevers - over a couple of weeks Toxic exanthema Malaise and lethargy Pharyngitis
blood tests - high lymphocyte counts
Pneumocystis jiroveci pneumonia is (PCP)
cd4 cell count?
classical history?
Commonest late stage (AIDS) infection
Opportunistic infection
CD4 cell count usually <200
dry cough and increasing breathlessness over several
Investigations of Pneumocystis jiroveci pneumonia
Chest X-Ray
Induced sputum orbroncoscopy for PCR
Treatment of Pneumocystis jiroveci pneumonia
Treatment
Cotrimoxazole
Pentamidine
Prophylaxis until CD4 > 200
