I.D Flashcards
A person with <200 CD4 count should be offered what prophylaxis
Co-trimoxazole against PCP
can sometimes use acyclovir against HSV
When to treat in HIV
When +ve diagnosis!
HIV pathophysiology
binds to CD4 receptors on Macrophages Monocytes T helper cells Neural cells
Binds to CD4 receptors using GP120 an envelope protein
Then copies the DNA using reverse transcriptase
Then integrates the copies with integrate
Then builds back up with protease
HIV investigations
Test at 4 weeks and 12 weeks (after suspected exposure)
HIV ab - done with ELISA testing and confirmed with western blot
HIV PCR and test for p24
When to test for HIV
4 weeks and 12 weeks (or if symptoms)
HIV big overview of symptoms
2-6 weeks - seroconversion
1) Fever
2) Lymphadenopathy
3) Rash (maculopapular)
Asymptomatic phase Persistent generalised lymphadenopathy >2 extra-inguinal sites >3 months >1 cm size
AIDS
- Opportunistic infections
- Chronic diarrhoea
- Fever/ NS/ weight loss
Main cause of diarrhoea in HIV
Cryptospoiridosis
HIV CD4 count and infections
200-500 Shingles Hairy leukoplakia Oral candidiasis Kaposi's sarcoma
100-200 Cryptosporidosis Cerebral toxoplasmosis PCP PML
50-100 Aspergilloma Oesophageal candida Cryotococcal meningitis Primary CNS lymphoma
<50
MAI
CMV retinitis
HIV transmission
Vertical
- Breast milk
- In utero
Sexual
Blood
Needles
HIV lung conditions (just the list)
PCP
TB
MAI
Other causes of pneumonia
Hib
Pseudomonas
Legionella
PCP
Presentation
Investigations
Rx
Prophylaxis
Presentation Dry cough Dyspnoea, fever, SOB Desaturation on exercise No chest signs
Investigations
May need to do BAL
CXR often clear
Rx
Co-trimoxazole
Prophylaxis
Co-trimox if CD <200
Desaturations on exercise in HIV +ve person
PCP
Toxoplasmosis
ring enhancement
Multiple lesions
Rx - sulfadiazine
Cryptococcal meningitis
High opening presusure
Indian ink stain
Primary CNS lymphoma
Solid enhancement
Single lesion
SPECT +ve
Rx steroids
EBV
PML cause (in HIV)
JC virus
Neuro HIV list
Toxoplasmosis Cryptococcal meningitis PML Primary CNS lymphoma TB HIV dementia
Cause of Primary CNS lymphoma in HIV
EBV
HIV and pregnancy measures
Delivery vaginally unless viral load <50
Do NOT breast feed
Give mother HAART when pregnant regardless
Give child triple ART (or oral zidovudine if <50 maternal copies
Typical HIV regime
HAART - commence as soon as status +ve
2 NRTI (nucleoside reverse transcriptase inhibitor)
1 of
protease inhibitor or NNRTI
Hepatitis antibody antigen overview
AntiGENS
Surface antigen – current infection
Envelope antigen – assess phase of infection
Core antigen
AntiBODIES
Surface antibody – they have immunity
Envelope antibody – appears later in the disease
Core antibody – shows they have immunity from the previous exposure (not vaccination)
Do they have a surface antigen Yes They are currently infected No Not currently infected – so next Q are they immune? Hep B surface antibody \+ve immune – how so? Core antibody \+ve – previous exposure - ve previous vaccination - - not immune
Hepatitis symptoms
Jaundice Hepatosplenomegaly Pale stools, Dark urine B symptoms Abdo pain - RUQ pain Joint pain
Hepatitis investigations
Antigen/antibody LFTs – specifically AST/ALT Disease severity is measured by: Prothrombin time Serum bilirubin
Types of malaria
P. Falciparum – varies
Most dangerous
Sub-saharan Africa
SEA
P. Vivax – Duffy antigen
Asia, north America, north africa
P. Ovale – 48hr cycle
Western and central Africa
P. Malariae - 72
P. Knowlesi
