HIV (CMV / EBV) Flashcards
(89 cards)
1
Q
What HIV virus is most common
A
HIV 1
RNA
2
Q
What does HIV bind too
A
CD4 receptors present on T helper cells - most important
Also on monocytes / macrophage / neural
3
Q
What type of virus is HIV
A
Retrovirus
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
5
Q
What is the natural Hx of HIV
A
CD4 declines
HIV viral load increases
6
Q
What is normal CD4 level
A
> 500
If no symptoms = HIV infection
7
Q
When does AIDS occur
A
CD4 <200
Takes about 7-8 years
Opportunistic infections
Increased risk of infection / tumour
8
Q
How is HIV spread
A
Sexual - MSM / multiple partners
Blood - products, PWID, transplant
Vertical from mother to baby
Breast feeding
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
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
11
Q
When do you think HIV
A
EBV with -ve serology
12
Q
How do you Dx
A
HIV Ab test = used in hospital
HIV PCR + p24 antigen
Antibodies might not be +Ve
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
14
Q
What are stage 2+3
A
HIV related illness where CD4 declining and viral load increasing
Not quite aids
15
Q
How does stage 2 present
A
Weight loss <10% Minor mucocutaneous infection HZV = shingles HSV = herpes Recurrent upper tract infections
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
17
Q
What is oral hairy leukoplakia
A
Can’t scrape off
EBV if immunocompromised
HIV defining so always test
18
Q
What can cause diarrhoea
A
HIV enteritis itself Crptosporidium = most common and HIV defining so test - ZN stain CMV Mycobacterium avium Giardia
19
Q
Is oral thrush common
A
Never in the young
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
21
Q
What is given as prophylaixis in patients with CD4 <200
A
PCP prophylaxis
Co-trimoxazole
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
23
Q
How does mycobacterium avium
A
CD4 <50 Fever Abdominal pain Sweating Diarrhoea LFT LN HSM
24
Q
How do you Dx and Rx
A
Blood - deranged LFT
Blood culture
Bone marrow
Rx = TB + Ax
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
