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
When should you start anti-viral treatment?
modern drugs are effective - when they present they will be started right away
Antivirals treatments - 2019 there is a?
combining drugs helps to control the infection
combination pill
Antiretroviral therapy
at least 2 or 3 drugs that act on different targets (different groups)
- Different classes of drugs acting on different stages in HIV lifecycle
cART is? common side effects
combination Antiretroviral therapy
- can lead to a normal life but side effects can be significant eg metabolic, lipodystrophy,
protease inhibitors prevent
maturation of the virus
integrase inhibitors
prevent viral dna integrated to genome
reverse transcriptase inhibitors
prevent RNA TO DNA
When and what to start
ideally start once?
Start all patients on diagnosis unless concerned about immune reconsititution illness
- genomic resistance testing is known -look at dominant viral strain
If CD4 < 350 cells/mm3 patients at risk of
developing symptoms without being on treatment
If CD4 < 200 need to ?
start as soon as possible
Any pregnant woman
– start before third trimester
If viral load is not adequately suppressed after 4-6 weeks?
Three drug combination with treatment adjustment
How long will I need to be on treatment?
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
Why do HIV treatments fail?
Poor adherence leads to viral mutation and resistance
Antiviral drugs side effects of drugs (4)
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
Lipodystrophy - side effect, treatment?
reverse transcriptase inhibitors
- change drugs
Cosmetic procedures
- facelift
- liposuction
- fillers
fat redistribution like cushings- rounded stomach , thin limbs
Challenges of HIV care ? (7)
age related degenerative conditions
- more likely to get:
Cerebrovascular disease Renal disease Ischaemic heart disease Diabetes mellitus malignancy Cognitive impairment osteoporosis
HIV prevention (5)
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
