Secondary immune deficiencies HIV 1 infection 150921

Question 1

What are common causes of secondary immune deficiencies

Answer 1

Malnutrition(commonest cause), measles (lasts months to years), mycobacterium tuberculosis, hIV, sars cov2, drugs

Question 2

What kind of drugs cause immune deficiency

Answer 2

Small molecules (steroids, cytotoxic agents, calcineurin inhibitors, anti epileptic drugs, DMARDs;

Jak inhibitors (tofactinib, upsadacitinib, ruxolitinib)

Biological e.g. anti-CD20
Cellular therapies

Question 3

Evaluation of secondary immune deficiency

Answer 3

Clinical history of infection, loss of schooling, reaction to vaccines, history of other illnesses e.g. anger, hepatitis, family history, childhood vaccines

Question 4

FISH for immune deficiency

What does FISH stand for

Answer 4

Full blood count, immunoglobulins, serum complement, HIV

Question 5

Serum immunoglobulins profile

Answer 5

Isolated reduction in IgG protein loosing enteropathy
Reduction in IgG and IgM monitor for B cell neoplasm, history of exposure to rituximab
Reduction in IgG and IgA. Primary antibody deficiency?

Question 6

Second line tests to investigate immune deficiency pies

Answer 6

Vaccine antibodies e.g. tetanus and pneumovax, failure to respond to vaccines is part of diagnostic criteria for a number of primary antibody deficiency syndromes and needs IgG replacement therapy

Question 7

Management of secondary immune deficiencies

Answer 7

Treat underlying cause

Advise on measures to reduce exposure to in

Question 8

HIV -1

Answer 8

Lentivirus, double strand RNA virus,
Retrovirus, binds to cd4 then to co receptors ccr5 or cxcr4, replications, via dna intermediate, integrates into host genom, HIV dna transcribed to viral mRNA etc.

Question 9

What happens to Cd4 in HIV

Answer 9

Depleted