REPRO 8 Flashcards
what does HIV cause
acquired immunodeficiency syndrome (AIDS)
what kind of virus is HIV and how does it transcribe itsself
RNA
reverse replication
HIV 2 is what
less virulent and less likely to cause AIDS
what does HIV do to the CD4 count leading to what
decreases it
increased susceptibility to viral, fungal, bacterial infections and infection induced cancers
normal CD4 count
when can you get oppertubnisitc infection
500-1600
<200 high risk
but 200-500 can still get
how foeti doe HIV replicate
every 6-12 weeks new gen
how does the infection establish itself
infection of mucosal CD4 langerhan cells and dendritic cells -> regional LNs inflectional established within 3 days. replication and dissemination
who is at higher risk of HIV
MSM
low seocioeconomis status
how many people present with symptoms after primary infection
how long after and what are the symptoms
80% 2-4 w after infection
fever, maculopapular rash, myalgia, pharyngitis, headache, aseptic meningits
v high risk of what in primary HIV infection
transmission
asymp HIV infection what is happening
what is there still a risk of
ongoing viral replication and CD 4 count depletion
ongoing transmission if remains undiagnosed
pneumocystis pneumonia caused by what
CD4 count what
symp
pneumocystis jiroveci
<200
dry cough, insidious onset, exercise desaturated
CXR of pneumocystis pneumonia
dx
intestinal infiltrates, retinodular marking, can be normal
BAL and immunofluorescence +/- PCR
treatment of pneumocystis pneumonia
proph
high dose co -trimox +/- steroid
low dose co trim
TB is what in HIV px
types
what is IRS
more common
symptomatic primary, reactivation, military, extra pulmonary, multi drug resistant
immune reconstruction syndrome - immune system is reactivated but is much more aggressive
cerebral toxoplasmosis CD4
ae
what can HIV cause
<150
toxoplasmosis gondii
cause reactivation of latent infection
symptoms of cerebral toxoplasmosis
multiple cerebral abscesses, chorioretinitis, headache, fever, focal neuro, seizures, reduced consciousness, increased ICP
MRI of cerebral toxoplasmosis
MRI ring enhancing lesions
cytomegalovirus caused by what
CD4
what can HIV cause
CMV
<50
reactivation of latent virus - retinitis, oesophagi’s, colitis
symptoms of cytomegalovirus
decreased visual acuity, floaters, abdominal pain, diarrhoea, PR bleeding
screening for cytomegalovirus
ophthalmic screening for all patients with cd4<50
skin infections include what
recurrent herpes zoster herpes simplex HPV pencillosis histoplasmosis
HIV associated neurocognitive symptoms CD4 count
cause
symp
any CD4 count - associated with increased immunosuppression
HIV1
reduced short term memory +/- motor dysfunction
progressive multifocal leucoencephalopathy caused by what CD4
symptoms
JC virus - reactivation of latent virus
<100
rapid progression, personality change, focal neuro, seizures
neuropresentations of HIV related to what
related to viral replication
distal sensory polyneuropathy, mononeuritis multiplex, vascular myelopathy, aseptic meningitis, GBS, viral meningitis - CMV, HSV, cryptococcal menignitis
haematological occur when
what
increased incidence with increased immunosuppression
malignancies, anaemia, thrombocytopenia
HIV associated wasting - slims disease cause
metabolic
anorexia
malabsorption/diarrhoea
hypergonadism
Non OI symptoms of HIV
mucosal candidsis, sebbhoreic derm, diarrhoea, fatigue, worsening psoriasis, LD, STIs, hep B/C
karposki’s sarcoma caused by what
CD4
HHV 8
risk increased with increased immunodeficiency
karposkis symptoms
more common in who
rx
vascular tumour. cutaneous. mucosal. visceral - pulmonary, GI
MSM
HAART. local like systemic chemo for visceral
NHL caused by what
CD4 what
EBV
increased risk with increased immunodefic
NHL symp
rx
bone marrow involvement. extranodal disease. increased CNS involvement
HAART
cervical cancer caused by what
what is done in HIV px
HPV
screening every year rather than every 3 years
sexual transmission of HIV in MSM
MSW
what increases the risk
51%
45%
concurrent STIs, unreceptive sex, trauma, genital ulceration
parental transmission of HIV
IVDU, infected blood products, iatrogenic
maternal transmission of HIV - how 3
whats the risk and whats the risk when the viral load is undetectable at delivery
inutero/transplacental. delivery. breast feeding
1-2%. <0.1%
three main groups that are tested
high prevelance areas
opt out
high risk
who are the opt outs
GUM, TOP, drug dependancy, antenatal, conception screening
who are the high risk groups
MSM, female partner of bisexual man, drug infections, partners of HIV px, people from endemic areas
what is the antigen tested for in HIV
p24
rapid hiv testing - what is used
when do results come
whats the neg
fingerprick. saliva.
within 20-30 mins
expensive
treatment is what
HAART
two NRTI and either a protease inhibitor or a NNRTI
how to prevent drug resistance
compliant
prevention of HIV 4
treatment. condoms. STI screening and prophylaxis. post/pre exposure proph
wanna be pregnancy and HIV positive female
negative male
insemination and HAART
wanna be pregnant and HIV positive male and negative female
UPSI and HAART
prevention of maternal transmission
when can woman delivery vaginally
can she breastfeed
what should be given to the neonate
HAART during pregnancy
if viral load undetectable
no
4 weeks of PEP
