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Immunology > HIV Infection and Secondary Causes of Immunodeficiency > Flashcards

HIV Infection and Secondary Causes of Immunodeficiency Flashcards

1
Q

How are immune deficiencies classified?

A
  • Primary and Secondary
  • Secondary - much more common than primary
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2
Q

What are the clinical features of immune deficiencies?

A
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3
Q

What are the common causes of secondaey immune deficiencies?

A
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4
Q

What drugs cause immune deficiency?

A

DMARD = Disease modified altering rhuematoid drugs

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5
Q

What biologic and cellular therapies cause immune deficiency?

A
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6
Q

How do haematological cancers cause immune deficiency? What types in particular?

A
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7
Q

How can we evaluate secondary immune deficiencies?

A
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8
Q

Describe the FISH method.

A

lymphocyte < 8 –> worrying

Serum complement - good for lupus

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9
Q

What are other front line investigations for immune deficiency?

A
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10
Q
A
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11
Q

What serum immunoglobulins would you check? What should you keep in mind?

A

Rituximab - first IgM and then IgG

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12
Q

How does serum protein electrophoresis work?

A
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13
Q

What are the second line tests to investigate immune deficiencies?

A

These are dynamic tests.

Flow cytometry too.

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14
Q

What are the third line investigations for immune deficiencies?

A
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15
Q

What is the management of secondary immune deficiencies?

A
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16
Q

When would igG replacement therapy be given?

A
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17
Q

Describe the epidemiology of HIV-1

A
18
Q

How is HIV-1 care in the UK?

A

90% HIV is treated

75% successful anti-retroviral treatment

19
Q

What type of virus is HIV-1? How does it infect?

A
20
Q

What are the stages of HIV infection?

A
  • Virus incoroporates in the first 72 hours
  • 3-6 months later comes to a setpoint
  • The more virus in blood - the higher risk of transmission
  • Virus mutates and you have several strains
21
Q

What are the key concepts of HIV-1 replication cycle?

A
22
Q

What is the natural progression of T cells immunolofy in HIV infection

A
  • CD4 T cells level drops initially
  • Then rises again
  • Then drops
23
Q

Describe the humoral immunology of HIV infection

A
  • Initial immune response against GP120
  • By the time immune response optimal, lots of mutations
24
Q

Describe the 5 characteristic features of immunology of HIV infection

A
25
Q

What happens during acute HIV infection?

A
26
Q

How would you diagnose HIV.1?

A
27
Q

How would you manage HIV-1?

A
28
Q

What are the baseline investigations in clinic for HIV

A
29
Q

What are the HIV specific tests

A
30
Q

Why do we look at viral load?

A
31
Q

How does CD4 T cell count and risk of infection correlate in HIV infection?

A
32
Q

How do clinicians use CD4 T cell counts in HIV?

A
33
Q

What anti-retroviral therapy is available in the UK?

A

Protease and integrase inhibitors are most common.

34
Q

What are the uses of anti-retroviral therapy?

A
35
Q

How does ART work?

A

Does not get rid of virus - stops replication

36
Q

How do we monitor individuals on ART?

A
37
Q

What are the challenges for preventing HIV-1 infection

A
38
Q

What are the strategies for curing HIV-1?

A
39
Q

Question 2. A 57-year-old male is referred to the Chest clinic with recurrent chest infections, requiring antibiotic therapy. Past medical history reveal lichen planus and a history of surgery for an anterior mediastinal mass 4 year previously. Physical examination show nail candidiasis, sternotomy scar and bi-basal crepitations. A HRCT chest scan shows extensive bronchiectasis.
Immune investigation are as follows
IgG – 3.1g/L (ref interval 6.4-16.0g/L)
IgA – 0.4g/L (ref interval 0.8-3.4g/L)
IgM – 0.2g/L (ref interval 0.5-2.0g/L)
IgE 500IU/ml (reference interval 3-120IU/ml)
B cell count 10cell/ul ( ref interval 100-500)

What is the most likely diagnosis?

A) Partial antibody deficiency syndrome
B) Common variable immune deficiency
C) High grade B cell Mediastinal Lymphoma
D) Thymoma with antibody deficiency/Good’s syndrome
E) Hyper IgE syndrome

A

Thymoma with antibody deficiency

40
Q

A 65 year-old male with a history of steroid dependent asthma, hypertension, Type 2 Diabetes Mellitus and osteoporosis presents with recurrent chest, sinus, and skin infections. Past medical history of chemotherapy for follicular lymphoma and he has recently completed a 2 year maintenance therapy of 3 monthly rituximab. Current oral medication includes Prednisolone 5mg OD, Losartan 50mg OD, metformin500mg BD, alendronic acid 70mg weekly.

Serum immunoglobulins are as follows
IgG – 3.9g/L (ref interval 6.4-16.0g/L)
IgA – 0.9g/L (ref interval 0.8-3.4g/L)
IgM – 0.1g/L (ref interval 0.5-2.0g/L)
IgE 200IU/ml (reference interval 3-120IU/ml)

Which of the following medication are most likely to have cause antibody deficiency
A) Metformin
B) Losartan
C) Prednisolone
D) Alendronic Acid
E) Rituximab

A

Rituximab

41
Q

Which of the following condition are more likely to present in patients with a CD4 T cell counts of more than 350cells/ul

A) CMV retinitis, Toxoplasma encephalitis, visceral Kaposi sarcoma

B) Herpes zoster, Pulmonary Tuberculosis, Pneumococcal pneumonia

C) Pneumocystis jirovecci pneumonia, disseminated MAC, ITP

D) EBV CNS lymphoma, oral candida, cryptococcal meningitis

E) Cutaneous Kaposi sarcoma, disseminated MAC, HSV infection

A

B

42
Q

Which of the following statements are true about HIV-1 infection

A) Reverse transcription is associated with few errors in copying HIV-1 RNA template

B) Preferred option to commence ART in the UK is dual combination therapy containing an integrase inhibitor and NRTI

C) HLA-B*5701 blood test is used to prevent hypersensitivity reaction with protease inhibitors

D) Residual immune activation is commonly seen in patients on suppressive ART regimens

E) HIV-1 serology point care tests have similar diagnostic performance to 4th generation combined p24antigen/antibody tests

A

Residual immune activation is commonly seen in patients on suppressive ART regimens

Immunology (10 decks)

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