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Year 3: Block 1: Infection > HIV and AIDS > Flashcards

HIV and AIDS Flashcards

1
Q

Spread of HIV? (5)

A 
Sexual transmission
Injection drug misuse
Blood products
Vertical transmission
Organ transplant
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2
Q

HIV testing

A

Unconscious patients can be tested if you think it is in the patient’s interest to have the test

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3
Q

What is point of care testing (POC)

A

blood sample from finger
60 seconds
standard test confirms result

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4
Q

HIV infection - Immunology

A
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5
Q

Where are CD4 receptors also found

A

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.

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6
Q

Natural history of infection

A

CD4 count declines & HIV viral load increases and tumour risk increase

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7
Q

Most AIDS diagnoses (severe infections) occur at CD4 account of

A

<200

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8
Q

normal CD4 is

A

> 500

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9
Q

HIV infection - classification

A

Original classification was clinical

Pragmatic approach is to consider symptomatic vs asymptomatic disease

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10
Q

Clinical staging of HIV 1

A

ASYMPTOMATIC

swollen lymph nodes

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11
Q

Clinical staging of HIV 2

A

weight loss, oral thrush, herpes, recurrent URTI

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12
Q

Clinical staging of HIV 3

A

more weight loss, unexplained chronic diarrhoea, prolonged fever, worsening oral candidiasis
oral hairy leukoplakia

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13
Q

Clinical staging of HIV 4

A

HIV wasting syndrome, HSV, HIV encephlaopathy, extrapulmonary tuberculosis

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14
Q

Do I have HIV or AIDS?

A

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.

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15
Q

give some examples of aids defining conditions

A

tuberculosis, pneumocystis, primary cerebral lymphoma, kaposi’s sarcoma

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16
Q

Conditions where HIV testing should be offered?

A

bact pneumonia, aspergillosis, guilliane-barr syndrome, cerebral abscess, dementia, peripheral neuropathy , oral candidiasis

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17
Q

most common tumour with HIV

A

B cell lymhomas - hodgkin’s

18
Q

Those who die from HIV

A

CD4< 100 , very late presentation

19
Q

Natural history

A 
Acute infection – seroconversion
Asymptomatic
HIV related illnesses
AIDS defining illness
Death
20
Q

Primary HIV / seroconversion? what is this similar to as well?

A

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

21
Q

Primary HIV / seroconversion symptoms include

A 
Lymphadenopathy 
fevers - over a couple of weeks
Toxic exanthema
Malaise and lethargy 
Pharyngitis

blood tests - high lymphocyte counts

22
Q

Pneumocystis jiroveci pneumonia is (PCP)
cd4 cell count?
classical history?

A

Commonest late stage (AIDS) infection
Opportunistic infection
CD4 cell count usually <200

dry cough and increasing breathlessness over several

23
Q

Investigations of Pneumocystis jiroveci pneumonia

A

Chest X-Ray

Induced sputum orbroncoscopy for PCR

24
Q

Treatment of Pneumocystis jiroveci pneumonia

A

Treatment
Cotrimoxazole
Pentamidine
Prophylaxis until CD4 > 200

25
Q

When should you start anti-viral treatment?

A

modern drugs are effective - when they present they will be started right away

26
Q

Antivirals treatments - 2019 there is a?

A

combining drugs helps to control the infection

combination pill

27
Q

Antiretroviral therapy

A

at least 2 or 3 drugs that act on different targets (different groups)
- Different classes of drugs acting on different stages in HIV lifecycle

28
Q

cART is? common side effects

A

combination Antiretroviral therapy

- can lead to a normal life but side effects can be significant eg metabolic, lipodystrophy,

29
Q

protease inhibitors prevent

A

maturation of the virus

30
Q

integrase inhibitors

A

prevent viral dna integrated to genome

31
Q

reverse transcriptase inhibitors

A

prevent RNA TO DNA

32
Q

When and what to start

ideally start once?

A

Start all patients on diagnosis unless concerned about immune reconsititution illness

  • genomic resistance testing is known -look at dominant viral strain
33
Q

If CD4 < 350 cells/mm3 patients at risk of

A

developing symptoms without being on treatment

34
Q

If CD4 < 200 need to ?

A

start as soon as possible

35
Q

Any pregnant woman

A

– start before third trimester

36
Q

If viral load is not adequately suppressed after 4-6 weeks?

A

Three drug combination with treatment adjustment

37
Q

How long will I need to be on treatment?

A

HIV patients - LIFE LONG
treatment may need to be changed from time to time but you will always need to be taking some form of antiviral medication.

treatment similar to that of a chronic condition

38
Q

Why do HIV treatments fail?

A

Poor adherence leads to viral mutation and resistance

39
Q

Antiviral drugs side effects of drugs (4)

A

Nucleoside reverse transcriptase inhibitors
marrow toxicity, neuropathy, lipodystrophy

Non-nucleoside reverse transcriptase inhibitors - skin rashes, hypersensitivity, drug interactions, neuropsychiatric effects

Protease inhibitors
drug interactions, diarrhoea, lipodystrophy and hyperlipidaemia.

Integrase inhibitors
Rashes, disturbed sleep

40
Q

Lipodystrophy - side effect, treatment?

A

reverse transcriptase inhibitors
- change drugs

Cosmetic procedures

  • facelift
  • liposuction
  • fillers

fat redistribution like cushings- rounded stomach , thin limbs

41
Q

Challenges of HIV care ? (7)

A

age related degenerative conditions

  • more likely to get:
Cerebrovascular disease
Renal disease
Ischaemic heart disease
Diabetes mellitus
malignancy
Cognitive impairment
osteoporosis
42
Q

HIV prevention (5)

A

Behaviour change and condoms
Circumcision

Treatment as prevention Viral Load undetectable = untransmissable

  • Pre-exposure prophylaxis (PrEP) - combination pill daily if at risk of sexual exposure
  • Post-exposure prophylaxis for sexual exposure (PEPSE) - EFFECTIVE

vl can be undetectable in blood but can be in semen

Year 3: Block 1: Infection (14 decks)

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