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Immunology Path Year 5 > HIV and secondary immunodeficiency > Flashcards

HIV and secondary immunodeficiency Flashcards

1
Q

Whats more common, Primary or secondary immunodeficiencies?

A

Secondary are more common

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2
Q

What are common causes of secondary immune deficiencies?

A
  1. Malnutrition (most common)
  2. Infection - HIV, TB
  3. Age extremes
  4. Immuno suppressive drugs
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3
Q

What kind of clinical features can be exhibited in a patient with an immune deficiency?

A
  1. Infections
    - Severe, persistent, recurrent, unusual
  2. Autoimmune conditions
  3. Persistent inflammation
  4. Cancer (associated with EBV)
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4
Q

What are some common drugs that can cause immune deficiency?

A
  1. Small molecules
    - Glucocorticoids and mineralcorticoids
    - cytotoxic agents (methotrexate)
  2. JAK inhibitors
    - Tofacitinib
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5
Q

What are some haematological cancers associated with immune deficiency?

A
  1. B cell lymphoproliferative disorders
    - Multiple myeloma
    - CLL
    - NHL
  2. Goods’ syndrome
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6
Q

How do you evaluate a possible secondary immune deficiency?

A
  1. clinical history of infection
  2. History of other illnesses (autoimmune)
  3. FHx
  4. Medication Hx
  5. Vaccine Hx
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7
Q

How do you investigate for a possible immune deficiency?

A

FISH for an immunodeficiency

  1. Full blood count
    - Anaemia
    - neutrophil count
    - lymphocyte count
    - platelet count
  2. Immunoglobulins
  3. Serum complement

4 HIV test

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8
Q

How do you manage someone with a secondary immune deficiency?

A
  1. Treat underlying cause
  2. Advice on measures to reduce exposure
  3. Offer vaccines to patient + household contacts
  4. Prophylactic antibiotics
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9
Q

What is the structure of HIV?

A

Retrovirus (RNA virus that uses reverse transcriptase)

Double stranded RNA

Slow evolution of disease

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10
Q

What is the life cycle of HIV?

A
  1. Attachment
    CD4
  2. Reverse transcription and DNA Synthesis
    Reverse Transcriptase Inhibitors (Nucleoside&Non-Nucleoside)
  3. Integration
    Integrase Inhibitors
  4. Viral Transcription
5. Viral Translation
Protease Inhibitors (Here, the proteins are cleaved to form mature proteins)
  1. Assembly and release of Virus
  2. Maturation
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11
Q

What are the 3 markers measured for the clinical course of HIV?

A
  1. Plasma Viral Load,
  2. CD4+ Lymphocytes,
  3. CD8+ Lymphocytes.
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12
Q

What are the two predominant ways of diagnosing HIV?

A

i) Viral Load (PCR)
- > This is very sensitive and can identify HIV in patients who are yet to seroconvert
- > Steps involved include; reagent preparation, specimen preparation, amplification and detection

ii) anti-HIV antibodies (ELISA)
- > in the UK, 3 ELISA’s are used with three different formats to avoid false positives
- > It is then confirmed using a Western Blot.

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13
Q

What are the 5 characteristics features of the immunology of HIV infection?

A
  1. CD4 T cell depletion
  2. Chronic immune activation
  3. Impairement of CD4 and CD8 T cell function
  4. Disruption of lymph node architecture
  5. Loss of antigen specific humoral immune responses
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14
Q

What are the characteristics of an acute HIV infection?

A
  1. Significant increase in HIV viral load
  2. “Flu like” symptoms
  3. Significant risk of viral transmission
  4. Reduction in CD4+ T cells
  5. Increase in CD8 T cell = results in drop in VL
  6. Induction of HIV specific antibodies
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15
Q

A viral load of how much is considered undetectable?

A

-> A HIV Viral Load of <40copies/mL is considered undetectable

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16
Q

What are some baseline investigation for a patient with HIV?

A
  1. FBC
  2. Renal, liver, bone, lipid and HbA1c (for drugs)
  3. Sexual health screen
  4. ECG and CXR
  5. Toxoplasma serology
17
Q

What are some HIV specific tests?

A
  1. HIV viral load
  2. HIV genotype (drug resistance)
  3. T cell counts
18
Q

Why do you check CD4 T cell count?

A

To stratify the risk of different infections

19
Q

What is the treatment for HIV?

A
  1. Test and trace
  2. HAART to treat patients
  3. PReP and PeP
20
Q

What are the limitations and complications of HAART?

A
  • > Effective HAART does NOT eradicate latent HIV-1 in the host
  • > Fails to restore HIV-specific T-cell responses
  • > Threat of drug resistance
  • > Significant toxicities
  • > High pill burden
  • > Adherence problems
  • > Quality of life issues
  • > Cost: >40% infected do not have access to drugs
  • > STIGMA
21
Q

What is HAART?

A

Highly active antiretroviral therapy, combination of 3 drugs (2 NRTIs and one other)

Used to:

  • > Suppresses the Viral Load
  • > Rise in CD4 especially memory T Cells
22
Q

How do you monitor patients on HAART?

A
  1. Compliance
  2. HIV viral Load
  3. Liver, renal, bone, lipid toxicity
  4. CD4 count
  5. Assess cardiovascular and osteoporosis risk

Immunology Path Year 5 (2 decks)

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