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Infection > HIV lecture > Flashcards

HIV lecture Flashcards

1
Q

How is HIV spread?

A

Sexual transmission

Injection drug misuse

Blood products

Vertical transmission

Organ transplant

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2
Q

Can you test an unconscious patient for HIV?

A

Unconscious patients can be tested if you think it is in the patient’s interest to have the test

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3
Q

How does HIV affect the immune system?

A

HIV infects and destroys cells of the immune system especially the T-Helper cells that are CD4+ (have a CD4 receptor on their surface)

CD4 receptors are not exclusive to lymphocytes – they are also present on the surface of macrophages and monocytes, cells in the brain, skin, and probably many other sites

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4
Q

How does CD4 count change over the course of the disease?

A

Increasing risk of developing infections and tumours

The severity of these illnesses is greater the lower the CD4 count (normal CD4 > 500)

Most AIDS diagnoses (severe infections) occur at CD4 count <200

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5
Q

Give features of clinical stage 1 HIV infection

A

Asymptomatic

Persistent generalised lympahdenopathy

Performance scale 1

Asymptomatic, normal activity

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6
Q

Give features of clinical stage 2 HIV

A

Weight loss (less than 10% body weight)

Herpes zoster within the last 5 years

Recurrent upper respiratory tract infections

Minor mucocutaneous manifestations (seborrheic dermatitis, fungal nail infections, recurrent oral ulcerations)

Performance scale 2:

Symptomatic normal activity

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7
Q

Give features of stage 3 HIV

A

Weight loss greater than 10%

Unexplained chronic diarrhoea for over 1 month

Prolonged fever over 1 month

Oral candidiasis

Severe bacterial infections

Performance scale 3: Bedridden for less than 50% of the day

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8
Q

Give features of stage 4 HIV

A

HIV wasting syndrome

Toxoplasmosis of the brain

Progressive multifocal leukoencephalopathy

Candidiasis of the oesophagus, trachea bronchi or lungs

Extrapulmonary TB

Performance scale 4 - bedridden for over 50% of the day during the last month

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9
Q

What is an AIDS illness?

A

Certain infections and tumours that develop due to a weakness in the immune system are classified as AIDS illnesses. If you have no symptoms then you have HIV infection only.

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10
Q

What are the AIDS defining conditions of the lungs?

A

Tuberculosis

Pneumocystis

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11
Q

What are the aids defining conditions of the brain?

A

Cerebral toxoplasmosis (parasitic infeciton of the brain)

Primary cerebral lymphoma

Cryptococcal meningitis

Progressive multifocal leucoencephalopathy (white matter diseases)

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12
Q

What are the aids defining conditions of the skin?

A

Kaposi’s sarcoma

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13
Q

What are the aids defining conditions of the stomach and intestines?

A

Persistent cryptosporidiosis

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14
Q

What are the aids defining cacners?

A

Non-hodgkins lymphoma

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15
Q

What is the aids defining condition of the female reproductive system?

A

Cervical cancer

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16
Q

What is the aids defining condition of the eyes?

A

Cytomegalovirus retinitis

17
Q

For reference

A
18
Q

For reference

A
19
Q

What is the natural history of HIV/AIDS

A

Acute infection - seroconversion

Asymptomatic

HIV related illness

AIDS defining illness

Death

20
Q

What percentage of patients experience seroconversion illness?

A

30-60%

Abrupt onset 2-4 weeks post exposure

Self-limiting 1-2 weeks

Symptoms are non-specific

21
Q

What are the symptoms of seroconversion illness?

A

Flu-like illness

Fever

Malaise and lethargy

Pharyngitis

Lymphadenopathy

Toxic exanthema

“looks like glandular fever but EBV serology not in keeping”

22
Q

What are the classes of antiretroviral drugs?

A

Nucleoside reverse transcriptase inhibitors (NRTIs) - abacavir, zidovudine

Non-nucleoside reverse transcripatse inhibitors (NNRTIs) - efavirenz

Protease inhibitors (PIs) - atazanavir

Integrase Inhibitors - Raltegravir

Entry inhibitors (including fusion inhibitors)

23
Q

What are the standard combination antiretroviral regimens?

A

Two NRTI’s together with an NNRTI

or

Protease inhibitor

or

Integrase inhibitor

(Lecture says - Combination antiretroviral therapy (cART) means at least 3 drugs from at least 2 groups

Adherence needs to be over 90% - support patient

cART can lead to a normal life but side effects can be significant eg metabolic, lipodystrophy)

24
Q

Why is ritonavir given with protease inhibitors?

A

Massivley increases the concentrations and elimination half-lives of other PIs by inhibiting their metabolism by cytochrome P450 - Prolongs the PI’s half-life, allowing reduction in pill burden and dosing frquency - optimising adherence

25
Q

When should ART commence?

A

Consider starting all patients at diagnosis regardless of CD4

If CD4 < 350 cells/mm3 encourage patients to start treatment (or clinical stage 3-4)

If CD4 < 200 need to start as soon as possible

Any pregnant woman – start before third trimester

Three drug combination with treatment adjustment if viral load not adequately suppressed after 4-6 weeks of therapy

HIV infected partners in serodiscordant couples should commence ART irrespective of their CD4 count or clinical stage - reduces risk of transmission to unaffected partner

Other patients who should start ART earlier include those with chronic liver disease from viral hepatitis, non-AIDS malignancies, and conditions requiring long-term immunosuppression therapy

26
Q
A
27
Q

How long is the treatment for HIV?

A

Once you start treatment you need to continue it for the rest of your life. The treatment may need to be changed from time to time but you will always need to be taking some form of antiviral medication.

In many ways, the treatment of HIV is similar to that of a chronic condition (like hypertension) rather than to the treatment of an infection.

28
Q

What is the result of poor adherence?

A

Viral mutation and resistance

29
Q

What are the side effects of nucleoside reverse transcriptase inhibitors?

A

–marrow toxicity, neuropathy, lipodystrophy

30
Q

What are the side effects of non-nucleoside reverse transcriptase inhibitors?

A

–skin rashes, hypersensitivity, drug interactions

31
Q

What are the side effects of protease inhibitors?

A

–drug interactions, diarrhoea, lipodystrophy and hyperlipidaemia.

Hyperlipidaemia comes with an increased risk of MI

32
Q

What are the side effects of integrase inhibitors?

A

Rashes

33
Q

What are the challenges of HIV care in 2018?

A

Osteoporosis

Cognitive impairment

Malignancy

Cerebrovascular disease

Renal disease

Ischaemic heart disease

Diabetes mellitus

34
Q

What are HIV prevention methods?

A

Behaviour change and condoms

Circumcision (reduces risk of transmission from women to men)

Treatment as prevention

–VL undetectable = untransmissable (pregnancy)

Pre-exposure prophylaxis (PrEP)

Post-exposure prophylaxis for sexual exposure (PEPSE)

35
Q
A

Infection (17 decks)

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