HIV lesions Flashcards
where is the main reservoir of HIV?
East and Southern Africa
how many genes does HIV contain and name a few
- 9
- 3 structural - gag, pol, rev
- 6 non-structural/regulatory
what enzymes does HIV contain? (4)
- reverse transcriptase
- integrase
- protease
- ligase
describe briefly the replication cycle of HIV
1 binding by gp120 and gp41 to CD4 and co receptro (CCR5 or CXCR4)
2 fusion and entry by endocytosis
3 reverse transcription of viral RNA = SS DNA –> DS DNA
4 integration of DS viral DNA into host DNA
5 transcription, translation by host
6 assembly of virus
7 budding
what types of cells does HIV affect? (3)
- CD4+ Th cells
- macrophages
- dendritic cells
how is HIV transmitted?
body fluids only
describe the natural history of infection and give the relative CD4 counts and viral loads
5 continuous stages:
1 primary HIV infection = rapid CD4 decrease and high VL
2 early stage = CD4 >500, low VL
3 middle stage = lower CD4
4 advanced stage = lower CD4, high VL
5 late stage = CD4 <50, very high VL
what is acute seroconversion syndrome? (what, time, s/s)
- primary HIV infection, days-weeks post-exposure
- most develop influenza-like illness (non-specific symptoms)
– fever, malaise, lymphadenopathy, myalgia, pharyngitis, rash, oral ULCERS
what are the different groups of HIV oral manifestations? (3)
- group 1 = strongly associated with HIV
- group 2 = less commonly associated
- group 3 = lesions seen in HIV inection, rare
what is seen in group 1 HIV oral manifestations? (4)
(strongly associated with HIV)
- oral hairy leukoplakia
- rapidly progression periodontal disease
- Kaposi’s sarcoma
- non-Hodgkin’s lymphoma
what is seen in group 2 HIV oral manifestations? (4)
(less commonly associated with HIV)
- ulceration
- salivary gland disease
- thrombocytopaenic purpura
- viral infections (HSV, HPV, VZV, CMV)
what is seen in group 3 HIV oral manifestations? (3)
(rare, seen in HIV infection)
- drug reactions
- fungal, viral infections
- neurological disturbances
what is one of the most frequent oral manifestations of untreated HIV?
oral hairy leukoplakia with oral candidiasis
how may periodontal disease present in HIV-infected pts? (4)
- painful
- disproportionate to OH/plaque levels
- localised
- rapid alveolar bone loss
(linear gingival erythema, NPDs)
management of rapidly progressing periodontal disease in HIV-infected pts (4)
- manage HIV infection (antiviral therapy)
- OHI, debridement
- CHX 0.2% mouthwash
- metronidazole
treatment of Kaposi’s sarcoma in HIV-infected pts
- ART (prevention and treatment_
- +/- chemotherapy
describe non-Hodgkin’s lymphoma in HIV-infected pts (presentation, Ix)
- rapidly enlarging masses with bone destruction
- esp gingivae, fauces
- with systemic symptoms = fever, night sweats, lymphadenopathy, weight loss, fatigue
- biopsy/histological diagnosis
list the different drug classes used to treat HIV (5)
- entry inhibitors
- nucleoside reverse transcriptase inhibitors
- non-nucleoside reverse transcriptase inhibitors
- integrase inhibitors
- protease inhibitors
what are the BHIVA guidelines regarding HIV treatment? (2)
- treatment-naïve = start ART containing at least 2 nucleoside reverse transcriptase inhibitors AND one other drug type
- all HIV pts should consider starting ART regardless of CD4 count or VL
how does ART affect the orofacial region? (6)
- decreased prevalence in most HIV-associated oral lesions (reported exceptions with papilloma and HIV-related salivary gland disease)
- adverse effects:
– lipodystrophy
– hyperpigmentation
– oral ulceration
– xerostomia
– hypersensitivity reactions (SJS, TEN)
what to do if you get a sharps injury? (2)
- refer to occupational health for risk assessment
- early prophylaxis (PEP) if high risk (type of injury, type of fluid, source pt)
what is PrEP?
- pre-exposure prophylaxis
- consistent use can decrease transmission through sex by 90%
