Teaching Clinic: HIV Flashcards
What is HIV?
* Retrovirus (RNA virus), genus Lentivirus, family Retroviridae
* failing immune system - life-threatening opportunisEc infecEon
* leads to AIDS CD4 <200
* Bodily fluid: blood, semen, vaginal fluid or breast milk
* Free virus particles or virus in infected immune cells
What cells does HIV primarily infect?
Primarily infects: T helper cells, macrophages and dendritic cells (CD4 receptor; CCR5 receptor)
Where is HIV subtype B and subtype C most commonly found?
- Subtype C common in Asians
- Subtype B common in US
HIV-1 is more virulent compared to HIV-2: cause of global pandemic
What are the routes of transmission of HIV?
Risk factors of HIV transmission
Clinical course of infection
Some patients may die during initial HIV infection due to dramatically lowered CD4+ T lymphocyte
Presentations of acute HIV infection
AIDS definining conditions
HIV antibodies testing
Window period for HIV
Treatment of HIV
What are the major classes of HIV medications?
- Reverse transciptase inhibitors
◦ NRTI
◦ NNRTI drugs - Integrase
- PI more side effect compared to other
* 23M, Vietnamese prisoner
* IVDA
* Admitted 21/8/2006
* Fever, 3 weeks
* Syphillis
* Cutaneous lesions: arms 2 weeks, face 3 days
* 4 kg weight loss
* Poor appetite
* Denied chill, myalgia, cough or diarrhea
* Unwell and faEgue * T 38.2, pulse 84/min * Bilateral cervical LN * Numerous skin-colour cutaneous papules, with umbilicaEon * Face and both arms * Lesions on the buccal mucosa and sod and hard palates * Normal lungs and heart * Enlarged liver 2 cm below R costal margin
* WCC 2.2 (N 2.0, L 0.2) * Plt 185 * ALP 85, ALT 50, Bil 23 * 1. Abnormality? * 2. Differen/al diagnosis?
* Abnormality: severe lymphopenia
* Differentials:
– Penicillium marneffei infection
– Cryptococcus neoformans infection
– Molluscum contagiosum
– Bacillary angiomatosis
How to treat penicillium marneffei?
Case 2 * Man in his twenEes with HIV * Cough, fever and SOB * Unwell for 2 months * Cough with white sputum, poor appeEte and wt loss * Clinic visit 3 weeks ago: CXR normal, sputum culture -ve * Short course of anEbioEcs: no improvement * No pleuriEc chest pain, haemoptysis or leg swelling Past Medical Hx * HIV +ve; unknown CD4 count * No history of asthma * Smoked 10 cigareles per day Physical Examina/on * CachecEc * Mild respiratory distress * Body temp: 37.5C * Pulse: 126 beats/ min * Oral thrush with no LNs * Trachea deviated to R * Clear chest and absent breath sounds and hyperresonance to percussion L side * WC 6.4 L 0.2 CD4 78 * ABG: pH 7.47 pCO2 4kPa pO2 18kPa (2LO2)
Abnormalities? Differentials?
L-sided tension pneumothorax
* PneumocysEs jiroveci pneumonia * Pulmonary tuberculosis * Pulmonary cryptococcosis * Pulmonary Kaposi’s sarcoma * Chronic obstrucEve pulmonary disease
Start on HRMZ, chest drain clamped and removed 1 week
HAART started
What is DDx?
Case 7
* HIV & AIDS
* Profuse watery diarrhea
* CD4 40
* Foul smelling diarrhea
* No blood
What are the DDx?
Case 8
- PR bleed
- Patient has family Hx of Crohn’s
- Went to Bangkok multiple months ago
Case 8
* Anti-HIV 1 +ve (EIA/ Western blot) * Doxycycline 100mg bid 3 weeks
* Anal swab culture: Chlamydia
* Ceftriaxone 250mg IMI x 1
* Anal & urethral swab NAT:
* Benzathine penicillin IMI
Chlamydia trachomatis DNA +ve
weekly x 3
* Anal swab culture: Neisseria
gonorrhoede
* VDRL 1:16
* Histology: granulation tissue, lymphocytic infiltration, no crypt abscess, proctitis
* Referred ITC
* CD4 362
* HIV 320,000 copies/mL
* Plan to commence Truvada and
Dolutegravir
* Repeat colonoscopy in 1 month, proctitis settled
LGV rare in developed world
* LGV: Chlamydia trachomatis
(except endemic in Africa, India,
serotypes L1, L2 (most
SEA and the Caribbean)
common), L3
* 2003, cluster of LGV reported in * Diagnosis: culture/ NAT MSM in the Netherlands
* Screen for HIV, syphilis,
* MSM, Caucasian, presented
gonorrhoea and HSV
with proctocolitis, very high HIV co-intection rate
* Complications of LGV
proctocolitis: rectal stricture
* Multiple sexual contacts
* Causal sex gatherings
* 71% met partners at sex-on-premises venues or sex parties
* 23% met partners via internet
