HIV Disease

Question 1

How is HIV transmitted?

Answer 1

Sexual transmission
Injection drug misuse
Blood products
Vertical transmission
Organ transplant

Question 2

What is the most common route of HIV transmission?

Answer 2

MSM

Question 3

What is the pathophysiology of HIV?

Answer 3

HIV attacks T-helper cells that are CD4+

Question 4

CD4 receptors are present where?

Answer 4

Macrophages
Monocytes
Cells in brain
Skin

Question 5

Worsening HIV is described as what?

Answer 5

↑viral load

↓CD4

Question 6

When does AIDS occur?

Answer 6

CD4 <200

Question 7

What is stage 1 HIV?

Answer 7

Asymptomatic

Persistent generalised lymphadenopathy

Question 8

What is stage 2 HIV?

Answer 8

Weight loss (<10%)
Minor mucocutaneous manifestations
Herpes zoster
Recurrent URTI

Question 9

What Minor mucocutaneous manifestations are associated with HIV?

Answer 9

Seborrheic dermatitis
Prurigo
Fungal nail infections
Recurrent oral ulcerations
Angular chelitis

Question 10

What is stage 3 HIV?

Answer 10

Weight loss >10%
Unexplained chronic diarrhoea
Prolonged fever
Tuberculosis
Oral candidiasis

Question 11

What are the earliest opportunistic infections associated with HIV?

Answer 11

Thrush
Skin changes
PJP

Question 12

What are the respiratory conditions suggestive of HIV?

Answer 12

TB
Pneumocystis
Bacterial pneumonia
Aspergillosis

Question 13

What are the neurological conditions suggestive of HIV?

Answer 13

Toxoplasmosis
Cryptococcal meningitis
PML 
Aseptic meningitis
Cerebral abscess

Question 14

What are the dermatological conditions suggestive of HIV?

Answer 14

Kaposi’s sarcoma
Severe dermatitis/psoriasis
Recurrent herpes zoster

Question 15

What are the GI conditions suggestive of HIV?

Answer 15

Persistent cryptosporidiosis

Oral candidiasis

Question 16

What are the oncological conditions suggestive of HIV?

Answer 16

Non-hodgkin’s lymphoma

lung, seminoma, anal, head and neck

Question 17

What are the cervical conditions suggestive of HIV?

Answer 17

Cervical cancer

Vaginal/cervical neoplasia

Question 18

What are the haematological conditions suggestive of HIV?

Answer 18

Unexplained:
Thrombocytopenia
Neutropenia
Lymphopenia

Question 19

What are the ophthalmological conditions suggestive of HIV?

Answer 19

Cytomegalovirus retinitis

Toxoplasma

Question 20

What is the natural history of HIV?

Answer 20

Acute infection - seroconversion
Asymptomatic
HIV related illness
AIDS defining illness
Death

Question 21

What proportion of HIV patients have seroconversion illness?

Answer 21

30-60%

Question 22

What are the symptoms of HIV seroconversion?

Answer 22

Non-specific:
Flu-like illness 
Fever
Malaise and lethargy 
Pharyngitis
Lymphadenopathy 
Toxic exanthema

Question 23

What is the most common AIDS infection?

Answer 23

Pneumocystis jiroveci pneumonia

Question 24

At what CD4 level does PJP commonly present?

Answer 24

<200

Question 25

How does PJP present?

Answer 25

Dry cough | Increasing breathlessness over weeks

Question 26

How should PJP be investigated?

Answer 26

CXR | Sputum broncoscopy - PCR

Question 27

How should PJP be treated?

Answer 27

Co-trimoxazole Pentamidine Prophylaxis until CD4>200

Question 28

What adherence is necessary for Combination antiretroviral therapy?

Answer 28

>90%

Question 29

What is Combination antiretroviral therapy?

Answer 29

At least 3 drugs from at least 2 different drugs

Question 30

Where do Combination antiretroviral therapy drugs act?

Answer 30

Reverse transcription inhibitors Integrase inhibitor Protease inhibitor

Question 31

What risk is associated with CD4<350?

Answer 31

Risk of symptoms without treatment

Question 32

When should pregnant women be started on Combination antiretroviral therapy?

Answer 32

Start before third trimester

Question 33

What is the life expectancy of HIV?

Answer 33

Depends on CD4 before starting therapy <100 - 52 100-200 - 62 >200 - 70+

Question 34

What are the typical causes of failed HIV treatment?

Answer 34

Inadequate potency Inadequate drug levels Inadequate adherence Pre-existing resistance

Question 35

What antiviral drugs are used in HIV?

Answer 35

Nucleoside reverse transcriptase inhibitors Non-nucleoside reverse transcriptase inhibitors Protease inhibitors Integrase inhibitors

Question 36

What side effects are associated with Nucleoside reverse transcriptase inhibitors?

Answer 36

LIPODYSTROPHY Marrow toxicity Neuropathy

Question 37

What side effects are associated with Non-nucleoside reverse transcriptase inhibitors

Answer 37

Skin rashes Hypersensitivity Drug interactions Neuropsychiatric effects

Question 38

What side effects are associated with Protease inhibitors?

Answer 38

LIPODYSTROPHY Drug interactions Diarrhoea Hyperlipidaemia

Question 39

What side effects are associated with Integrase inhibitors?

Answer 39

Rashes | Disturbed sleep

Question 40

How does Lipodystrophy present?

Answer 40

Additional visceral fat Sunken cheeks Less fat on limbs

Question 41

Lipodystophy is associated with what in HIV?

Answer 41

Older antivirals: Protease inhibitors Nucleoside RT inhibitors

Question 42

How is HIV prevented?

Answer 42

``` Behaviour/Condoms Circumcision Treatment as prevention Pre-exposure prophylaxis Post-exposure prophylaxis (for sex) ```