HIV Disease Flashcards
How is HIV transmitted?
Sexual transmission Injection drug misuse Blood products Vertical transmission Organ transplant
What is the most common route of HIV transmission?
MSM
What is the pathophysiology of HIV?
HIV attacks T-helper cells that are CD4+
CD4 receptors are present where?
Macrophages
Monocytes
Cells in brain
Skin
Worsening HIV is described as what?
↑viral load
↓CD4
When does AIDS occur?
CD4 <200
What is stage 1 HIV?
Asymptomatic
Persistent generalised lymphadenopathy
What is stage 2 HIV?
Weight loss (<10%)
Minor mucocutaneous manifestations
Herpes zoster
Recurrent URTI
What Minor mucocutaneous manifestations are associated with HIV?
Seborrheic dermatitis Prurigo Fungal nail infections Recurrent oral ulcerations Angular chelitis
What is stage 3 HIV?
Weight loss >10% Unexplained chronic diarrhoea Prolonged fever Tuberculosis Oral candidiasis
What are the earliest opportunistic infections associated with HIV?
Thrush
Skin changes
PJP
What are the respiratory conditions suggestive of HIV?
TB
Pneumocystis
Bacterial pneumonia
Aspergillosis
What are the neurological conditions suggestive of HIV?
Toxoplasmosis Cryptococcal meningitis PML Aseptic meningitis Cerebral abscess
What are the dermatological conditions suggestive of HIV?
Kaposi’s sarcoma
Severe dermatitis/psoriasis
Recurrent herpes zoster
What are the GI conditions suggestive of HIV?
Persistent cryptosporidiosis
Oral candidiasis
What are the oncological conditions suggestive of HIV?
Non-hodgkin’s lymphoma
lung, seminoma, anal, head and neck
What are the cervical conditions suggestive of HIV?
Cervical cancer
Vaginal/cervical neoplasia
What are the haematological conditions suggestive of HIV?
Unexplained:
Thrombocytopenia
Neutropenia
Lymphopenia
What are the ophthalmological conditions suggestive of HIV?
Cytomegalovirus retinitis
Toxoplasma
What is the natural history of HIV?
Acute infection - seroconversion Asymptomatic HIV related illness AIDS defining illness Death
What proportion of HIV patients have seroconversion illness?
30-60%
What are the symptoms of HIV seroconversion?
Non-specific: Flu-like illness Fever Malaise and lethargy Pharyngitis Lymphadenopathy Toxic exanthema
What is the most common AIDS infection?
Pneumocystis jiroveci pneumonia
At what CD4 level does PJP commonly present?
<200
How does PJP present?
Dry cough
Increasing breathlessness over weeks
How should PJP be investigated?
CXR
Sputum broncoscopy - PCR
How should PJP be treated?
Co-trimoxazole
Pentamidine
Prophylaxis until CD4>200
What adherence is necessary for Combination antiretroviral therapy?
> 90%
What is Combination antiretroviral therapy?
At least 3 drugs from at least 2 different drugs
Where do Combination antiretroviral therapy drugs act?
Reverse transcription inhibitors
Integrase inhibitor
Protease inhibitor
What risk is associated with CD4<350?
Risk of symptoms without treatment
When should pregnant women be started on Combination antiretroviral therapy?
Start before third trimester
What is the life expectancy of HIV?
Depends on CD4 before starting therapy
<100 - 52
100-200 - 62
>200 - 70+
What are the typical causes of failed HIV treatment?
Inadequate potency
Inadequate drug levels
Inadequate adherence
Pre-existing resistance
What antiviral drugs are used in HIV?
Nucleoside reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Protease inhibitors
Integrase inhibitors
What side effects are associated with Nucleoside reverse transcriptase inhibitors?
LIPODYSTROPHY
Marrow toxicity
Neuropathy
What side effects are associated with Non-nucleoside reverse transcriptase inhibitors
Skin rashes
Hypersensitivity
Drug interactions
Neuropsychiatric effects
What side effects are associated with Protease inhibitors?
LIPODYSTROPHY
Drug interactions
Diarrhoea
Hyperlipidaemia
What side effects are associated with Integrase inhibitors?
Rashes
Disturbed sleep
How does Lipodystrophy present?
Additional visceral fat
Sunken cheeks
Less fat on limbs
Lipodystophy is associated with what in HIV?
Older antivirals:
Protease inhibitors
Nucleoside RT inhibitors
How is HIV prevented?
Behaviour/Condoms Circumcision Treatment as prevention Pre-exposure prophylaxis Post-exposure prophylaxis (for sex)
