Infectious Diseases: HIV

Question 1

How should HIV be investigated?

Answer 1

• Confirmatory HIV test
• CD4 count
• HIV viral load
• HIV resistance profile
• HLA B*5701 status
• Serology for syphilis, hep B (sAg, cAb, sAb), hep C, hep A
• Toxoplasma IgG, measles IgG, varicella IgG, rubella IgG
• FBC, U+Es, LFTs, bone profile, lipid profile
• Schistosoma serology (if has spent >1 month in sub-Saharan Africa)
• Women should have annual cervical cytology

Question 2

Outline the management of HIV

Answer 2

HIV nurse - advice, education, and medical and social support

Clinical psychology referral

ARVs =
Nucleoside reverse transcriptase inhib (NRTI) X2
+ non-NRTI OR protease inhib OR integrase inhib

Low CD4

• <200 Co-trimoxazole 480mg PO OD as primary prophylaxis against PCP
• <50 Azithromycin 1250mg PO once weekly to protect against MAI

Vaccines

• Hep B
• Pneumococcal
• Influenza

Question 3

What 3 key enzymes are involved in HIV replication within a host cell?

Answer 3

Reverse transcriptase, integrase, protease

Question 4

How is HIV transmitted?

Answer 4

Contact with large quantities of body fluids = sexual, transfusion, needles, medical procedures, perinatal transmission

Question 5

Outline the stages of the HIV viral load

Answer 5

Primary infection: very high viral load, Ab response, can present like glandular fever.

Latent: (months-years) low viral load (lower = healthier the pt) CD4 count drops with the rise in viral load.

Symptomatic infect: CD4 count <350, infections present.

Severe/AIDS: <200

Question 6

What are the main symptoms of acute HIV?

Answer 6

Fever, weight loss, pharyngitis, myalgia, hepatosplenomegaly, nausea, vomiting, rash, lymphadenopathy

Question 7

What are the peripheral signs of HIV/immunocompromised?

Answer 7

Oral candidiasis, kaposi’s sarcoma, PCP: Pneumocystis carinii pneumonia