Sexual Transmitted Disease: Epidemiology And Treatment Of HIV Flashcards

0
Q

AIDS

A

Opportunistic infections
Kaposi’s sarcoma
Some lymphomas
39.5 million people have AIDS

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1
Q

HIV

A
Virus isolated in AIDS 
9.6 kilo bases
Present in genitive secretions 
Variable transmission 
Needles
Vertical transmission-> breast feeding, pre and peri partial colescreon
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2
Q

Opportunistic infections and CD4

A

Remains stable in first viral peak but decreases with second
As the CD4 count decreases the more opportunistic pathogens infect the body
250-> progressive generalised lymphadenopathy
200-> skin infections, PCP, diarrhoea
150-> tumours
100-> mycobacterium avium complex, cryptococcal meningitis, toxoplasma encephalitis
50-> oesophageal candidia, HSV, HZV, molluscum, CMV

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3
Q

Clinical presentation of AIDS

A
Lymphadenopathy
Oral candida
Dysphagia
Weight loss
Dry skin
Shingles
Current HSV
Emergencies:
Respiratory 
CNS
Diarrhoea
PUO
Blurred vision
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4
Q

HIV and the lung

A
Infections 
-> fungi-> pneumocystis jivoveci, cryptococcus aspergillus
-> mycobacteria-> m. Tuberculosis 
-> bacteria-> strep pneumoniae 
Neoplasms
-> kaposi sarcoma
-> lymphoma
-> CA of lung
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5
Q

Pneumocystis jiroveci pneumonia

A
Repeated inhalation in from childhood
Replication increased in immunocomprimised
-> binds fibrocontectin-> injures type 1 alveolar cells-> increased permeability-> pneumontitis
Subacute onset
Systemically unwell
Dry cough and short of breath
Variable signs, O2 desaturation 
Bats wing interstitial CXR shadowing
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6
Q

treatment of PJP

A
Steroids for low O2 sats
14-21 days:
Co- trimoxazole IV or oral 
Trimethoprim
Pentamidine
Clindamyciatovaquone
Prophylaxis-> co-trimoxazole, dapsone
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7
Q

Investigations of PJP

A

Sputum-> microscopy/immunofluorescense, PCR, induced

Bronchoscopy-> BAL, biopsy

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8
Q

HIV and the CNS

A

Headache
-> with neck stiffness-> meningitis-> cryptococcus, TB, syphillis, aseptic toxoplasmosis, lymphoma, PML, abscesses,
-> with focal signs-> cryptococcoma
Focal signs no headache-> CVA
Change in conciousness-> CMV encephalitis, toxoplasmosis, lymphoma
Change in cognition-> AIDS dementia, depression, PML
Myelopathy-> vacuole myelopathy, CMV, VZV
Neuropathy-> HIV, VZV, CMV, drugs
Myopathy-> drugs

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9
Q

TB meningitis

A

Subacute onset
CSF-> increased lymphocytes and protein, decreased glucose
In the immunocomprimised may be associated with disseminated disease
-> Miliary-> many small lesions
-> multiple sites but not Miliary
Quadruple therapy-> Rifampicin, isoniazid, pyrazinamide, ethambutol

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10
Q

Cryptococcal meningitis

A

Cryptococcus neoformans-> inhaled environmental fungus
Pneumontitis filled by dissemination
Can seed to skin, prostate and CNS
May present like any other meningitis
If CD4 and inflammatory response is poor-> atypical
Amphaticin B for two weeks and fluconazole for life

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11
Q

Focal CNS lesions

A

Non infectious-> tumour, primary CNS lymphoma, infarct
Infectious-> bacterial brain abscess, tuberculous, toxoplasmosis
Immunocomprimised also-> nocardia, fungi (aspergillosis, cryptococcus, endemic mycoses), toxoplasmosis
Immunocompetent-> bacterial brain access
Immunocomprimised-> toxoplasmosis

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12
Q

Toxoplasma encephalitis

A

Toxoplasma Gondi acquired from cats or food
Cysts lie dormant and reactivate when immunocomprimised
Subacute onset
Clinical features due to a SOL or diffuse parenchymal disease plus fever
Serology and CT/MRI
SOL-> lymphoma, cryptococcoma, tuberculoma
Pyrimethamine and folinic acid, sulphadiaxine, continue as life long prophylaxis

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13
Q

Mycobacterium avium complex infection

A
Environmental, atypical mycobacteria present in soil and water
Inhaled or swallowed 
Hepatosplenomegaly 
Lymphadenopathy
Bone marrow involvement
Take blood culture and bone marrow
Clarithromycin and ethambutol
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14
Q

Cancers associated with HIV

A

Kaposi sarcoma
Non Hodgkins and Hodgkin’s lymphoma
Antogenital neoplasia
Co incidence with lung

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15
Q

Types of anti retroviral drugs

A

Nucleoside analogues-> NRTI’s eg zidovudine
Non nucleoside analogues-> nevirapine, efavirenz
Protease inhibitors-> PI’s eg saquinavir
Fusion inhibitor-> enfuvirtide

16
Q

Principles of anti viral therapy

A

AZT monotherapy-> reduces HIV viral load-> resistance develops
AZT+3TC (two NRTI’s)-> reduces vial load more-> resistance develops-> increase lire expectancy by 6 months
PI or NNRTI-> reduce vial load by the same as two NRTIs
Minimum of 3 drugs are required for prolonged benefit and resistance mat not develop for 2-5 years
Sequential combinations prolongs life expectancy by > 10 years

17
Q

Issues with anti retro virals

A

Toxic items
Drug interactions
Eligibility issues
>£6000 per year however cheaper than hospital care for infections

18
Q

Anti retroviral regimes

A

1) 2NRTI+1NNRTI

2) obtain genotype resistance testing, ritonavir boosted PI+2NRTI

19
Q

Side effects of anti retrovirals

A

Gastrointestinal upset
Rash
Disturbance of LFTs
Mitochondrial toxicity
NRTI-> anaemia, myopathy, peripheral neuropathy, hypersensitivity
NNRTI-> psychological disturbance, nervirapinhepatotoxicity
PI-> dyslipidaemia, lipodystrophy