Summary Book Infectious Disease

Question 1

HIV Target

Answer 1

Less than 20 copies per ml and high T cell (CD4) count. Transmission is minimised if less than 200 copies.

Question 2

Starting and maintaining ART

Answer 2

Start immediately after diagnosis. Is lifelong. Need to ensure compliance to prevent resistance.

Question 3

What opportunistic infections and their management should be considered at CD4 <200 and <75?

Answer 3

If less than 200 than PJP (manage with Bactrim) and Toxoplasmosis. If less than 75 then MAC and give Azithromycin.

Question 4

When can you consider stopping prophylaxis for opportunistic infections?

Answer 4

If viral load less than 50 and CD4 counts less than 200 for 3 months.

Question 5

What secondary prophylaxis should be considered in HIV patients?

Answer 5

Fluconazole for candida

Question 6

Risk factors for HIV

Answer 6

MSM, Africa, chronic blood transfusions, IVDU

Question 7

Symptoms of seroconversion

Answer 7

Weight loss, fever, lymphadenopathy, myalgia/arthralgia

Question 8

Investigations to diagnose HIV

Answer 8

Most have ELISA (1month post contact, very sensitive) then confirm with Western Blot (very specific). HIV DNA is most conclusive.

Question 9

Initial management of HIV

Answer 9

Initial therapy includes intergase inhibitor and two NRTI (abacavir, tenofavir). Intergase inhibitor = raltegravir, dolutegravir, bictegravir, these carry risk of weight gain. NRTI combinations = TAF/FTC (descovy) and TDF/FTC (truvada).

Question 10

2nd line management of HIV

Answer 10

NNRTI (ripeverine) and 2 NRTI

Question 11

Monitoring for HIV post initial management and expectations

Answer 11

Monthly, then 3 monthly for 2 years, then 6 months till suppressed. Expect viral load to be less than 50 by 3 months and 200 by 12 months.

Question 12

Reasons to switch management of HIV

Answer 12

Side effects, new comorbidities, new infections, cost, pill burden.

Question 13

Risks of having HIV

Answer 13

CVD ( cardiac death most common), metabolic, NAFLD, renal disease, OP, cancer, frailty, TB, thrombo or pancytopenia. Also infections HHV8 - kaposi sarcoma.

Question 14

Preventative vaccination in HIV patients

Answer 14

Hep A/B, pneumococcal, flu

Question 15

TDF side effects

Answer 15

OP, lipodystrophy, renal impairment, hepatitis, peripheral neuropathy, diabetes, diarrhoea.

Question 16

Risk factors for fever of unknown origin

Answer 16

Travel, sick contacts, animal contact, history of connective tissue disease or vasculitis, immunodeficiency/chemotherapy, presence of prosthesis

Question 17

Investigations for fever of unknown origin

Answer 17

Cultures, serological testing for atypical organisms (q fever, legionella), autoimmune (ANA, ESR, CRP, ENA, RF, antiCCP), imaging, biopsy