HIV, opportunisitic infections and STIs Flashcards
what cells does HIV target?
CD4
how can HIV transmission be prevented?
Post-exposure prophylaxis
- tenofivir + raltegravir for 28 days
Pre exo[posure prophylaxis
ART in pregnant women to prevent vertical transmission
what are the symptoms of primary HIV infection and when do they occur?
2-4 weeks post infection
- fever
- rash
- myalgia
- pharyngitis
- mucosal ulceration
- lymphadenopathy
- headache
Diagnosing primary HIV is a unique opportunity to prevent transmission. what test should be done and why?
HIV RNA levels as antibody testing will be negative
what are the late features of HIV?
fever and night sweats weight loss maculopapular rash AIDS defining illness Oral ulcers, angular chelitis or thrush Lymphadenopathy
how can HIV be diagnosed?
ELISA for HIV antibody and antigen
Western blot
Rapid point of care testing
Viral load testing (HIV RNA)
Nucleic acid testing
what test is used to measure response to ART?
CD4 count
what are some aids defining illnesses?
pneumocystis jirovecii candidiasis cryptococcus neoformans toxoplasmosis cytomegalovirus cryptosporidium Kaposi sarcoma lymphoma HSV TB
how does pneumocystis jirovecii present? How is it diagnosed?
SOB on exertion
Malaise
Dry cough
occasionally haemoptysis and pleuritic pain
Sp02 low on exertion compared to rest
CXR shows perihilar infiltrates
Sputum staining or NAAT
how is pneumocystis jirovecii treated?
IV Co-trimoxazole
Steroids if severe
how does candidiasis present? What is the treatment?
oral or oesophageal white fur appearance
pain
dysphagia
fluconazole
how does crytpococcus neoformans present, how is it diagnosed and treated?
meningitis
headache
molluscum like papules
fever
LP with manometry (increased opening pressure)
CSF stain and antigen testing
Amphotericin B and fluconazole
what is toxoplasmosis?
caused by toxoplasma gondii
commonest cause of intracranial mass lesions with low CD4 count
Ring enhancing lesion on MRI with CSF PCR positive for T. Gondii
how does CMV present?
retinitis encephalitis oesophagitis/colitis hepatitis pneumonia
how does cryptospordium present and how is it investigated?
chronic diarrhoea in pre ART HIV
- watery diarrhoea
- cholangitis and pancreatitis may also occur
Stool microscopy
PCR
Enzyme immunoassay
what drugs are used in anti retroviral treatment?
Nucleoside reverse transcriptase inhibitors
- tenofivir and emtricitabine
Non - Nucleoside reverse transcriptase inhibitors
- rilpivirine and efavirenz
Protease inhibitors
- atazanavir and darunavir
integrase inhibitors
- dolutegravir and elvitegravir
what virus causes infectious mononucleosis?
Epstein Barr virus
how does IM present?
fever pharyngitis (exudative or non-exudative) Cervical lymphadenopathy petechiae on soft palate malaise hepatosplenomegaly
what InV are done in IM?
FBC
- lymphocytosis
LFTs
- transaminitis
Heterophile antibodies
PCR for EBV
Abdo US - hepatosplenomegaly
what are the treatment options for IM?
hydration, ibruprofen, paracetamol
Prednisolone if upper airway obstruction or haemolytic anaemia
IVIG if immune thrombocytopenia develops
how does chlamydia trachomatis present, diagnosed and treated?
dysuria, discharge, post coital bleeding, dyspareunia
NAAT of first pass urine or oral/anal/vag swab
Azithromycin 1g PO or 100mg doxycyline for 7 days
how does neisseria gonorrhoeae present, diagnosed and treated?
dicharge, dysuria, pharyngeal or rectal infection
NAAT
Ceftriaxone 500mg IM and Azithromycin 1g PO
how does trichomatis vaginalis present, diagnosed and treated?
vaginal discharge and itch
NAAT, culture microscopy
metronidazole
how does bacterial vaginosis present, diagnosed and treated?
thin white fishy smelling vaginal discharge. No itch or soreness
Gram stain to examine vaginal flora, vaginal pH >4.5
Metronidazole
what bacteria causes syphilis?
treponema pallidum
what are the S&S of syphilis?
anogenital ulcer lymphadenopathy diffuse maculopapular rash constitutional symptoms patchy alopecia ataxia hepatosplenomegaly
how is syphilis investigated?
dark field microscopy of lesion swab
serum treponema enzyme assay
rapid plasma antigen test
CSF analysis
how is syphilis treated?
Benzylpenicillin
