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HIV (CMV / EBV) Flashcards

1
Q

What HIV virus is most common

A

HIV 1

RNA

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2
Q

What does HIV bind too

A

CD4 receptors present on T helper cells - most important

Also on monocytes / macrophage / neural

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3
Q

What type of virus is HIV

A

Retrovirus

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4
Q

What happens to HIV when inside CD4

A

Infects and destroys them so impairs immune
Reverse transcriptase makes DNA and incorporated into genome
Integrase integrates this to produce core viral proteins
Protease cleaves proteins

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5
Q

What is the natural Hx of HIV

A

CD4 declines

HIV viral load increases

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6
Q

What is normal CD4 level

A

> 500

If no symptoms = HIV infection

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7
Q

When does AIDS occur

A

CD4 <200
Takes about 7-8 years
Opportunistic infections
Increased risk of infection / tumour

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8
Q

How is HIV spread

A

Sexual - MSM / multiple partners
Blood - products, PWID, transplant
Vertical from mother to baby
Breast feeding

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9
Q

What is a seroconversion illness

A

When HIV Ab first develop 2-4 weeks post exposure
Viral load peaks
Very infectious in this time
Early Rx will reduce transmission and enhance immune recovery

Fever + rash think HIV and test

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10
Q

What are the symptoms of HIV seroconversion

A 
Flu 
Fever
Malaise 
Persistent generalised LN 
Maculopapular rash 
Toxic exanthema (rash)
Headache
Arthralgia 
Pharyngitis
Mouth ulcer
Liver dysfunction 
Diarrhoea
Meningitis/ neuropathy = rare
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11
Q

When do you think HIV

A

EBV with -ve serology

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12
Q

How do you Dx

A

HIV Ab test = used in hospital
HIV PCR + p24 antigen
Antibodies might not be +Ve

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13
Q

How does stage 1 present

What must you exclude

A 
Asymptomatic
Persistent generalised lymphadenopathy 
Occurs when immune system has got more control
Lasts a few years
Exclude
- TB
- Infection
- Malignancy
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14
Q

What are stage 2+3

A

HIV related illness where CD4 declining and viral load increasing
Not quite aids

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15
Q

How does stage 2 present

A 
Weight loss <10% 
Minor mucocutaneous infection
HZV = shingles
HSV = herpes 
Recurrent upper tract infections
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16
Q

What are the symptoms of stage 3

A 
Weight loss >10%
Unexplained diarrhoea >1 month 
Unexplained fever >1 month 
Oral thrush (candidiasis) - can scrape off 
Oral hairy leukoplakia 
Pulmonary TB
Hepatitis 
HAND - HIV associated neurological disorder 
Peripheral neuropathy
Increased MI risk 
Seborrheic dermatitis

Malignancy

  • Kaposi sarcoma
  • NHL
  • Invasive cervical cancer
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17
Q

What is oral hairy leukoplakia

A

Can’t scrape off
EBV if immunocompromised
HIV defining so always test

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18
Q

What can cause diarrhoea

A 
HIV enteritis itself 
Crptosporidium = most common and HIV defining so test 
- ZN stain 
CMV
Mycobacterium avium
Giardia
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19
Q

Is oral thrush common

A

Never in the young

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20
Q

What are symptoms of stage 4 CD4 <200

What are symptoms when CD4 <100

A 
PCP 
Cerebral toxoplasmosis
HIV dementia
- Rx = ART
TB - tuberculoma=. single enhancing lesion (not common) 
PML
Kaposi Sarcoma 
HSV / CMV encephaliits 
Salmonella septicaemia
HIV encephalopathy 
<100
Oesophageal candidiasis 
- Diff from oral (pre-aids) 
Cryptococcal meningitis 
Primary CNS lymphoma 
Mycobacterium avium
CMV retinitis 
Immune reconstitution inflammation syndrome 
- Opportunistic brain infection when started on ART
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21
Q

What is given as prophylaixis in patients with CD4 <200

A

PCP prophylaxis

Co-trimoxazole

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22
Q

How does it present and how do you treat PCP

A 
SOBOE
Dry cough
Fever
Pneumothorax 
\+Ve BAL with silver stain

Co-trimoxazole
Steroids if hypoxic as reduce resp failure
May need IV pentamidine if severe

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23
Q

How does mycobacterium avium

A 
CD4 <50
Fever
Abdominal pain
Sweating
Diarrhoea
LFT
LN 
HSM
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24
Q

How do you Dx and Rx

A

Blood - deranged LFT
Blood culture
Bone marrow

Rx = TB + Ax

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25
Q

How does Kaposi Sarcoma present

A

Purple papules / plaque on skin or mucosa of GI / respiratory tract
Haemoptysis
Pleural effusion
Commonly LN if children

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26
Q

What virus Kaposi

A

HHV-8

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27
Q

How do you treat Kaposi

A

ART
RT / chemo
Resection

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28
Q

How does toxoplasmosis present

A 
Most common SOL 
Headache
Confusion 
Drowsy 
Focal neuro 
Seizure 
Headache and vomiting if raised ICP 
Accounts for 50% of all CNS lesions
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29
Q

How do you Dx and Rx

A

CT shows single or multiple ring enhancing lesion with oedema
LP
Thalium spect = -ve

Rx
- Sulfafiazine
- Pyrimethanime
Ax

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30
Q

What causes CNS lymphoma

A

EBV

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31
Q

How do you Dx and Rx

A

CT shows single lesion
Thalium spect = +VE in contrast to toxoplasmosis

Steroid
Chemo
RT

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32
Q

Cerebral TB

A

Single ring enhancing lesion
When CD4 <500
Standard TB Rx
Less common

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33
Q

What viruses can cause neuro symptoms

A 
CMV encephalitis 
- Oedematous brain
- Rx = aciclovir 
HIV encephalitis 
HSV encephalitis
Cryptococcus Meningiits
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34
Q

How does cryptococcosis meningitis present

A 
Headache
Fever
Malaise
N+V
Seizure
Focal neuro
Meningitis
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35
Q

How do Dx and Rx

A

CSF India ink or cryptococcal antigen
CT shows menial enhancement
Repeat LP if raised ICP - high opening pressure

IV Anphotericin B

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36
Q

What is PML and what causes

How does it present

A

Widespread demyelination caused by JC virus
Presents like mini stroke / TIA
CT / MRI shows demyelination
Rx = ART

37
Q

How does oesophageal candidiasis present

A

Dysphagia
Odynophagia
White patches which scrape of to be red
Never presents in children if no HIV

38
Q

How do you Rx

A

Anti-fungal

39
Q

What are RF for HIV

A 
MSM
PWID
Other STI
High prevalence country 
Sexual contact
40
Q

When do you test for HIV

A

Anyone who requests
Universal screen - Ante-natal / TOP / prisoner / healthcare
At risk groups - IVDU
Anyone with hep B or C or TB
Indicator disease
All patients presenting where HIV is a differential
If high prevalence area

41
Q

Indicator disease

A 
PCP
Viral hepatits
Lymphoma
TB
Oral candida
Oral hairy luekoplaia
Cryptospiridium 
HAND 
All stage 3+ diseases
42
Q

When could it be a differential but don’t always need to test

A

Unexplained weight loss
Diarrhoea
Difficult eczema
Pneumonia

43
Q

How do you Dx HIV

A

Antigen and antibody test - HIV PCR and 24 antigen

ELISA

44
Q

When do you test

A

4 weeks if lab
Can do POC but must be >3 months
Offer at 12 weeks if -ve

45
Q

What is most accurate

A

HIV antibody

CDT / ELISA / western blood

46
Q

What are other tests

A 
HIV resistnace
Mantoux
Serology - CMV / HBV / syphillis
Sub type
Tropism
Avidity - when developed
47
Q

How do you monitor

A

HIV viral load
CD4 count
Drug levels for compliance

48
Q

When do you start Rx

A

As soon as Dx

49
Q

What is given as ART

A

3 drugs
2x NRTI + protease inhibitor
2x NRTI + NNRTI

50
Q

What is a NRTI

A

AZT

Stop conversion to DNA

51
Q

Why is it useful in pregnancy and dementia

A

Cross BB

52
Q

What are SE of NRTI

A 
GI
Pancreatitis
Hepatic 
Neuropathy 
Marrow toxicity
Insomina
Weight 
Kidney
Risk of immune reconstitution inflammation syndrome when started
53
Q

What are SE of NNRTI

A

Rash
GI
p450 inhibitor

54
Q

What are SE of protease inhibitor

  • end in navir
A 
p450 inhibitor 
GI - Diarrhoea 
DM
Hyperlipidaemia
Lipodystrophy
Jaundice and hepatitis
55
Q

SE of integrated inhibitor

  • end in gravir
A

Rash

GI

56
Q

If viral load undetectable

A

Non-transmissible

57
Q

What are challenges of HIV

A 
Osteoporosis
Cognitive
Malignancy
CVS disease
TB
Hepatitis B and C
Renal disease
DM
Neuropathy
58
Q

How do you prevent HIV

A 
Condoms
Circumcision
PREP
PEP 
Vertical transmission.- ART by 24 weeks gestation + C-section
59
Q

What are chance of developing from percutaneous (needle stick) HBV, HCV, HIV

A 
HBV = 30%
HCV = 3%
HIV = 0.3%
60
Q

What are chance from mucotaneous (blood / body fluid)

A

HIV <0.1%

Transfusion = 100%
Mother to fetus = 50% but reduced with C-section + ART

61
Q

What do you do if exposed

A 
Wash 
Encourage bleed
Report to OHS or A+E 
Risk assessment 
- type of injury
- patient details 
Combination ART 28 days
Vaccine against hep B / booster 
Test source - patient
Stop PEP if source -ve
If +Ve continue for 4 weeks 
Test in 12 weeks
62
Q

What do you do if expose to HCV

A

No vaccine
No Ig or antiviral
Early treatment
Do monthly PCR and Rx

63
Q

What do you do if exposed to HBV

A

Vaccine

Ig

64
Q

What do you do to avoid

A 
Hygiene
Cover wounds
Protective measure
Protect mucous membrane
Prevent puncture wounds
Avoid sharps
Safe disposal
65
Q

What is given as PEP

A

3 ART for 28 days up to 72 hours after exposure

Test at 12 weeks

66
Q

What do you do for PREP

A

2 ART

67
Q

What do you do if on PREP

A

Monitor eGFR

68
Q

What does CMV cause congenital

A 
Growth retardation
Petechiae
Microcephaly
Sensorineural deafness
Encephalitis 
HSM
69
Q

What does CMV monomucleosis cause

A

Glandular fever

Typical symptoms

70
Q

What does CMV retinitis cause

A

Painless progressive visual loss in HIV+ve
Haemorrhage and exudate
Retinal haemorrhage
Necrosis on fundoscopy

71
Q

How do you Dx and Rx

A

PCR of vitreous fluid

IV Anti-viral

72
Q

What else does CMV cause

A

Encephalopathy
Pneumonitis
Colitis

73
Q

What causes Mononucleosis

A

EBV

CMV

74
Q

What is triad seen in 98%

A

Sore throat
Fever
Lymphadenopath

75
Q

What are other symptoms

A 
Malaise
Fatigue
Palatal petechiae
Splenomegaly
Hepatitis - ALT rise
Lymphocytosis
Haemolytic anaemia
76
Q

How long to resolve

A

2-4 weeks

77
Q

How do you Dx

A

FBC

Monospot

78
Q

How do you treat

A

Rest
Fluid
Avoid alcohol
Simple analgesia

79
Q

What should you avoid

A

Contact sport 8 weeks as predisposed to splenic rupture

Amox as maculopapular rash

80
Q

What malignancy associated with EBV

A

Burkitt’s
Hodgkin’s
HIV central nervous lymphoma
Hairy leukoplakia in HIV

81
Q

What must be given to test for HIV

A

Consent

82
Q

What else do you do apart for ART if Dx with HIV

A

CVS disease - monitor RF + lipid
Yearly cervical smear in women
Co-trimox for PJP
Make sure vaccines are up to date

83
Q

When do you test children for HIV

A

HIV +ve parent
Immunodeficeincy suspected
Sexually active if ask
RF e.g. needle stick / sexual abuse

84
Q

How do you delivery baby if mother +Ve

A

Normal if viral load undetectable
C-section if not
IV anti-viral during delivery

85
Q

What is given after birth

A

Prophylactic anti-viral to baby

86
Q

Can you breastfeed

A

No

87
Q

What are aids defining malignancy

A

Kaposi sarcoma
Cerebral lymphoma
NHL

88
Q

If have HIV as a doctor

A

No hands in body cavity so no surgery
Regular CD4
If gets above a certain level then off work

89
Q

What is target viral load

A

<200

infection (14 decks)

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