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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
How does Kaposi Sarcoma present
Purple papules / plaque on skin or mucosa of GI / respiratory tract Haemoptysis Pleural effusion Commonly LN if children
26
What virus Kaposi
HHV-8
27
How do you treat Kaposi
ART RT / chemo Resection
28
How does toxoplasmosis present
``` Most common SOL Headache Confusion Drowsy Focal neuro Seizure Headache and vomiting if raised ICP Accounts for 50% of all CNS lesions ```
29
How do you Dx and Rx
CT shows single or multiple ring enhancing lesion with oedema LP Thalium spect = -ve Rx - Sulfafiazine - Pyrimethanime Ax
30
What causes CNS lymphoma
EBV
31
How do you Dx and Rx
CT shows single lesion Thalium spect = +VE in contrast to toxoplasmosis Steroid Chemo RT
32
Cerebral TB
Single ring enhancing lesion When CD4 <500 Standard TB Rx Less common
33
What viruses can cause neuro symptoms
``` CMV encephalitis - Oedematous brain - Rx = aciclovir HIV encephalitis HSV encephalitis Cryptococcus Meningiits ```
34
How does cryptococcosis meningitis present
``` Headache Fever Malaise N+V Seizure Focal neuro Meningitis ```
35
How do Dx and Rx
CSF India ink or cryptococcal antigen CT shows menial enhancement Repeat LP if raised ICP - high opening pressure IV Anphotericin B
36
What is PML and what causes | How does it present
Widespread demyelination caused by JC virus Presents like mini stroke / TIA CT / MRI shows demyelination Rx = ART
37
How does oesophageal candidiasis present
Dysphagia Odynophagia White patches which scrape of to be red Never presents in children if no HIV
38
How do you Rx
Anti-fungal
39
What are RF for HIV
``` MSM PWID Other STI High prevalence country Sexual contact ```
40
When do you test for HIV
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
Indicator disease
``` PCP Viral hepatits Lymphoma TB Oral candida Oral hairy luekoplaia Cryptospiridium HAND All stage 3+ diseases ```
42
When could it be a differential but don't always need to test
Unexplained weight loss Diarrhoea Difficult eczema Pneumonia
43
How do you Dx HIV
Antigen and antibody test - HIV PCR and 24 antigen | ELISA
44
When do you test
4 weeks if lab Can do POC but must be >3 months Offer at 12 weeks if -ve
45
What is most accurate
HIV antibody | CDT / ELISA / western blood
46
What are other tests
``` HIV resistnace Mantoux Serology - CMV / HBV / syphillis Sub type Tropism Avidity - when developed ```
47
How do you monitor
HIV viral load CD4 count Drug levels for compliance
48
When do you start Rx
As soon as Dx
49
What is given as ART
3 drugs 2x NRTI + protease inhibitor 2x NRTI + NNRTI
50
What is a NRTI
AZT | Stop conversion to DNA
51
Why is it useful in pregnancy and dementia
Cross BB
52
What are SE of NRTI
``` GI Pancreatitis Hepatic Neuropathy Marrow toxicity Insomina Weight Kidney Risk of immune reconstitution inflammation syndrome when started ```
53
What are SE of NNRTI
Rash GI p450 inhibitor
54
What are SE of protease inhibitor - end in navir
``` p450 inhibitor GI - Diarrhoea DM Hyperlipidaemia Lipodystrophy Jaundice and hepatitis ```
55
SE of integrated inhibitor - end in gravir
Rash | GI
56
If viral load undetectable
Non-transmissible
57
What are challenges of HIV
``` Osteoporosis Cognitive Malignancy CVS disease TB Hepatitis B and C Renal disease DM Neuropathy ```
58
How do you prevent HIV
``` Condoms Circumcision PREP PEP Vertical transmission.- ART by 24 weeks gestation + C-section ```
59
What are chance of developing from percutaneous (needle stick) HBV, HCV, HIV
``` HBV = 30% HCV = 3% HIV = 0.3% ```
60
What are chance from mucotaneous (blood / body fluid)
HIV <0.1% Transfusion = 100% Mother to fetus = 50% but reduced with C-section + ART
61
What do you do if exposed
``` 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
What do you do if expose to HCV
No vaccine No Ig or antiviral Early treatment Do monthly PCR and Rx
63
What do you do if exposed to HBV
Vaccine | Ig
64
What do you do to avoid
``` Hygiene Cover wounds Protective measure Protect mucous membrane Prevent puncture wounds Avoid sharps Safe disposal ```
65
What is given as PEP
3 ART for 28 days up to 72 hours after exposure | Test at 12 weeks
66
What do you do for PREP
2 ART
67
What do you do if on PREP
Monitor eGFR
68
What does CMV cause congenital
``` Growth retardation Petechiae Microcephaly Sensorineural deafness Encephalitis HSM ```
69
What does CMV monomucleosis cause
Glandular fever | Typical symptoms
70
What does CMV retinitis cause
Painless progressive visual loss in HIV+ve Haemorrhage and exudate Retinal haemorrhage Necrosis on fundoscopy
71
How do you Dx and Rx
PCR of vitreous fluid | IV Anti-viral
72
What else does CMV cause
Encephalopathy Pneumonitis Colitis
73
What causes Mononucleosis
EBV | CMV
74
What is triad seen in 98%
Sore throat Fever Lymphadenopath
75
What are other symptoms
``` Malaise Fatigue Palatal petechiae Splenomegaly Hepatitis - ALT rise Lymphocytosis Haemolytic anaemia ```
76
How long to resolve
2-4 weeks
77
How do you Dx
FBC | Monospot
78
How do you treat
Rest Fluid Avoid alcohol Simple analgesia
79
What should you avoid
Contact sport 8 weeks as predisposed to splenic rupture | Amox as maculopapular rash
80
What malignancy associated with EBV
Burkitt's Hodgkin's HIV central nervous lymphoma Hairy leukoplakia in HIV
81
What must be given to test for HIV
Consent
82
What else do you do apart for ART if Dx with HIV
CVS disease - monitor RF + lipid Yearly cervical smear in women Co-trimox for PJP Make sure vaccines are up to date
83
When do you test children for HIV
HIV +ve parent Immunodeficeincy suspected Sexually active if ask RF e.g. needle stick / sexual abuse
84
How do you delivery baby if mother +Ve
Normal if viral load undetectable C-section if not IV anti-viral during delivery
85
What is given after birth
Prophylactic anti-viral to baby
86
Can you breastfeed
No
87
What are aids defining malignancy
Kaposi sarcoma Cerebral lymphoma NHL
88
If have HIV as a doctor
No hands in body cavity so no surgery Regular CD4 If gets above a certain level then off work
89
What is target viral load
<200

Infection (14 decks)

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