W6L6 HIV Flashcards
What are the 2 key organisms to swab for in the setting of anogenital pain?
Herpes, gonorrhoea, chlamydia, mycoplasma genitalium.
How long after exposure should an HIV test be performed?
6 weeks (although usually one is done right away and then another in 6 weeks)
What are 7 typical infections that people with HIV get?
Atypical mycobacteria infection (eg lymphadenitis, pneumonia, bone marrow infection)
TB
Toxoplasma (eg cerebral toxoplasmosis)
cryptococcal meningitis
Pneumocystis jirovecii pneumonia
CMV retinitis
Skin/ oral infections:
– Shingles in a young person
– Intra-oral warts, widespread facial warts, severe anogenital warts
– severe or widespread herpes simplex,
– facial molluscum contagiosum,
– Oral candidiasis, oral hairy leukoplakia, necrotising gingivitis
What kind of T cell count do you have to have to be at risk of TB?
Not that low (can be only mildly depressed and still be at risk)
What is the CD4 T cell number you should stay above so you are not at risk of opportunistic infection?
> 200 T cells/ml
What is the normal range of CD4 T cells in healthy adults?
500-1200 T cells/ul
What is the significance of a rising viral load in a patient with HIV?
HIV strain is resistant to current medication and/ or the patient is non-compliant with meds
What are the symptoms of HIV seroconversion, and when does this occur?
fever, rash, sweats, sore throat–> ‘influenza like’, may also have rash, diarrhoea, weight loss
Occurs 3 weeks post infection
Which infection is particularly synergistic with HIV?
HPV
When is the best time to start treatment in an HIV positive person?
ASAP
What does Pneumocystis pneumonia look like on X-ray
‘ground glass’ opacities
What is immune reconstitution inflammatory syndrome?
When cell-mediated immunity improves, some weeks after starting antiretroviral therapy (ART), asymptomatic infections may suddenly present with inflammation
- symptoms occurring some weeks after starting ART, in a person with initially low CD4 (usually <100/μl) consider the possibility of a T-cell mediated immune flare in an existing infection (which may not yet be diagnosed).
- This has most commonly been reported in mycobacterial infections (TB, MAC) (EG NECK LUMPS from MAC lymphadenitis) but cases have been reported in a wide range of infections including viral –eg Hepatitis B, CMV.
- SO not all symptoms after starting ART are side-effects. Some need careful investigation.
What are 4 ddx for anal pain?
Anal fissure, thrombosed pile, IBS confined to the rectum, herpes simplex.
Which STIs do you test for with serology?
syphilis, HIV and hepatitis C&B
Which STIs do you test for with swabs and PCR?
Herpes, Gonorrhoea, Chlamydia
