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Reproduction > Week 2- HIV > Flashcards

Week 2- HIV Flashcards

1
Q

What does HIV target?

A

The CD4 receptors on cells.

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2
Q

Where can you find CD4 receptors?

A 
Mostly- on CD4 T cells
but also on:
-dendritic cells
-microglial cells (so it affects the CNS)
-macrophages
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3
Q

What does HIV do once it comes into contact with CD4 cells?

A

It binds to the host cell via these CD4 receptors.

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4
Q

What do CD4 T helper lymphocytes actually do?

A

They are messengers really- they activate CD8 T cells, recognise MHC class II antigen presenting cells, activate B cells and release cytokines (chemical signals).

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5
Q

What effect does HIV have on the immune system?

A

The CD4 cells stay in the lymphoid tissues.
This causes the CD8 cells to proliferate.
The antibodies produced are reduced in quality (due to reduction in antibody class switching)
Chronic immune activation

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6
Q

What is the normal level of CD4?

A

500-1600 cells

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7
Q

At what level of CD4 are you at risk of opportunistic infection?

A

<200 cells

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8
Q

Describe the characteristics of the HIV virus?

A

Replicates really quickly at the start of infection and late in infection.

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9
Q

Describe the amount of virus in the system and the levels of CD4 as time goes on?

A

Initially- the amount of virus is increasing so the level of CD4 drastically decreases.
They then start to recover a bit. And then slowly decline again.

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10
Q

How is the infection of HIV transmitted from mucosal tissues to lymphoid tissues?

A

Infection of mucosal CD4 cells (langerhan and dendritic cells)
Transported to regional lymph nodes
Virus is disseminated to the rest of the body.

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11
Q

Which mucosal tissues are commonly the sites of transmission of HIV?

A

Rectum (only 1 cell thick so easy) and vagina.

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12
Q

Does everyone with primary HIV present with symptoms?

A

80% do.

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13
Q

When would symptoms of primary HIV present after infection?

A

2-4 weeks after infection.

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14
Q

What symptoms does primary HIV present with?

A

A combination of

  • fever
  • myalgia
  • rash (maculopapular)
  • pharyngitis
  • headache
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15
Q

Is there a latent period in HIV?

A

No its not latent- the CD4 cell count still decreases, however its asymptomatic after the initial primary infection. There is still ongoing immune activation and risk of onward transmission.

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16
Q

What is the definition of an opportunistic infection?

A

An infection caused by a pathogen that does not normally cause disease in a healthy individual. It uses the ‘opportunity’ offered by a weakened immune system.

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17
Q

What organism causes pneumocystis pneumonia?

A

Pneumocystis jiroveci

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18
Q

What CD4 count will allow you to be affected by pneumocystis pneumonia?

A

Less than 200.

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19
Q

What are the symptoms of pneumocystis pneumonia?

A

Insidious onset of shortness of breath and dry cough.
They might also have oxygen desaturation when they exercise.
They wouldn’t have any spit or pleuritic chest pain.

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20
Q

What will a CXR of pneumocystis pneumonia show?

A

May be normal
Or could show interstitial infiltrates, reticulonodular markings. Looks kind of like cardiac failure with the bat wings but without cardiomegaly.

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21
Q

How would you diagnose pneumocystis pneumonia?

A

Bronchoalveolar lavage and immunofluorescence +/- PCR.

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22
Q

How would you treat pneumocystis pneumonia?

A

High dose co-trimoxazole +/- steroid.

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23
Q

When would you give prophylaxis for pneumocystis pneumonia and what is the prophylaxis treatment?

A

Anyone with a CD4 count of less than 200

Low dose co-trimoxazole

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24
Q

In relation to tuberculosis, what is more common in HIV positive individuals?

A 
Symptomatic primary infection
Reactivation of latent TB
Lymphadenopathies 
Miliary TB
Extrapulmonary TB
Multi-drug resistant TB
Immune reconstituant syndrome
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25
Q

What organism causes cerebral toxoplasmosis?

A

Toxoplasma gondii.

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26
Q

At what CD4 count are you susceptible to cerebral toxoplasmosis?

A

Less than 150.

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27
Q

What occurs in cerebral toxoplasmosis (pathophysiology esc)?

A

Multiple cerebral abscesses (chorioretinitis) from reactivation of latent infection.

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28
Q

What symptoms will you have with cerebral toxoplasmosis?

A 
Headache
Fever
Focal neurology 
Seizures
Reduced consciousness
Raised ICP
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29
Q

What organism causes cytomegalovirus?

A

CMV

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30
Q

What does cytomegalovirus cause?

A

Retinitis
Colitis
Oesophagitis

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31
Q

How does cytomegalovirus present?

A 
Reduced visual acuity
Floaters
Abdominal pain 
Diarrhoea
PR bleeding
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32
Q

When would you screen for cytomegalovirus and how would you do this?

A

Screen at a CD4 count of less than 50.

Ophthalmic screening is done.

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33
Q

What skin infections can be opportunistic infections in HIV?

A

Herpes zoster- however often multidermatomal and recurrent
Herpes simplex- hypertrophic (looks kind of warty)
HPV- generally extensive.

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34
Q

What organism causes HIV associated neurocognitive impairment?

A

HIV-1

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35
Q

How does HIV associated neurocognitive impairment present?

A

Reduced short term memory

+/- motor dysfunction

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36
Q

What CD4 count can HIV associated neurocognitive impairment present at?

A

Any CD4 count however incidence increases the lower it is.

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37
Q

What virus causes progressive multifocal lymphadenopathy?

A

JC virus (reactivation of latent infection)

NOTE- you get white matter changes so it can look like multiple sclerosis.

38
Q

What CD4 count can progressive multifocal lymphadenopathy present at?

A

<100

39
Q

How does progressive multifocal lymphadenopathy present?

A

Rapidly progressing
Focal neurology
Confusion
Personality change

40
Q

NOTE

A 
You can get HIV associated wasting- so cachexia is enough reason to do a HIV test. 
Can be due to
- metabolic
-anorexia
-Malabsorption/diarrhoea 
-Hypogonadism
41
Q

Name some AIDS related cancers?

A

Koposi’s sarcoma
Non-hodgekin lymphoma
Cervical cancer

42
Q

What virus causes Koposi’s sarcoma?

What is it?

A

Human herpes virus 8

A vascular tumour

43
Q

How does Koposi’s sarcoma present?

A

Usually presents on the skin as spongy raised nodules/papules.
Can occur on mucosal surfaces and viscera of organs too.

44
Q

How do you treat Koposi’s sarcoma?

A

Treat the HIV.
Apply local therapies if its uncomfortable.
If systemic disease then systemic chemotherapy.

45
Q

What organism causes Non-Hodgekin lymphoma?

A

EBV

46
Q

What symptoms does Non-Hodgekin lymphoma present with?

A

Painless swelling of lymph nodes
B symptoms- these are fever, weight loss and night sweats
Extranodal disease- extends outwit the lymph nodes
Increased CNS involvement.
Bone marrow involvement

47
Q

How do you treat non-Hodgkin lymphoma?

A

Same as HIV just add an antiviral.

48
Q

What virus causes cervical cancer?

A

HPV

49
Q

When should HIV testing be offered for cervical cancer?

A

For all complicated HPV disease.

50
Q

What haematological manifestations of HIV can you get?

A

Anaemia (affects up to 90%)

Thrombocytopenia

51
Q

What factors increase transmission of HIV?

A

Anoreceptive sex
Trauma
Genital ulceration
Concurrent STI

52
Q

How is HIV transmitted?

A

Sexually
Infected blood products
injected drug use.
Mother to child

53
Q

When can HIV be transmitted from mother to child?

A

Could be in utero
Could be at delivery
Could be during breast feeding.

54
Q

Which population group is most likely to get HIV?

A

men who have sex with men.

55
Q

Which population group is most likely to present late or remain undiagnosed with HIV?

A

Heterosexual men.

56
Q

Which clinics routinely check for HIV?

A 
Termination of pregnancy services
Drug dependency units
Antenatal services
Sexual health clinics
GUM clinic (genitouterine medicine)
57
Q

Which high risk groups are screened?

A

Men who have sex with men
Female partners of bisexual men
PWID
Partners of people with HIV

58
Q

Generally, whats the rule for performing an HIV test in a clinical setting?

A

If its on the list of differentials (regardless of risk factors being present/absent) you should perform an HIV test.

59
Q

How would you obtain consent for a HIV test?

A

Explain why you are performing the test
What the benefits of the test are
How and when they can expect to receive results
Reassure about confidentiality

60
Q

When would you perform an HIV test on an incapacitated patient?

A

Only test if its in the patients best interest
Consent from relative is not required
If its safe, wait until patient has capacity before
Obtain support from HIV team if required

61
Q

What do you test for to diagnose HIV?

A 
You can either test for the 
-viral load
-antibody
-antigen 
They usually test for combined antibody/antigen.
62
Q

Which marker allows you to test for HIV the quickest?

A

The viral load
Then the p24 antigen
Then the antibody

63
Q

What do 3rd generation HIV antibody tests look for?

A

HIV-1 and HIV2 antibody
They detect IgG and IgM.
They are very sensitive and specific in established infection.

64
Q

What is the window period for 3rd generation HIV tests?

A

20-25 days ish.

This means they won’t test positive in this period.

65
Q

What do the 4th generation HIV antibody tests look for?

A

They look for the combined antibody/antigen (p24)

It shortens the window period by about 5 days (now 20ish).

66
Q

True or false.

A negative 4th generation HIV test 4 weeks after exposure is likely to rule out HIV?

A

True.

67
Q

How do rapid acting HIV tests work?

A

Use a finger prick for blood
Can be third generation- and just look at antibody
Or fourth generation- look at antibody/antigen complex (p24)

68
Q

What are the advantages of using rapid acting HIV tests?

A 
Simple to use
No lab required
No venipuncture required 
No anxious wait
Reduced follow up
Good sensitivity
69
Q

What are the disadvantages of using rapid acting HIV tests?

A 
Expensive (each test is £10)
Quality control
Poor positive predictive value in low prevalence settings
Not suitable for high volume
Not good in early infection
70
Q

What is the purpose of a RITA test and what does RITA stand for?

A

Recent infection testing algorithm
Allows you to see if an infection occurred within the previous 4-6 months.
However large margin of error.

71
Q

Advantages of RITA?

A 
Surveillance 
Local epidemiology
Assess HIV testing programmes 
Safer sex advice
Interpretation of CD4.
72
Q

Disadvantages of RITA?

A

Accuracy
Patient distress
Criminalisation

73
Q

What is highly active anti-retroviral treatment (HAART)?

A

A combination of three drugs from at least 2 different drug classes to which the virus is susceptible.

74
Q

What is the purpose of HAART?

A

Reduce the viral load to undetectable
Restore immunocompetence
Reduce morbidity and mortality
Minimise toxicity

75
Q

What would you like HAART therapy to be ideally?

A 
Low toxicity
Low pill burden
Low dosing frequency
Minimal drug interactions
High barrier to resistance
76
Q

What GI signs indicate HAART therapy toxicity?

A

Side effects of protease inhibitors- nausea, diarrhoea, rash, stomach pain, vomiting, headache, fever etc.

77
Q

What skin signs indicate HAART therapy toxicity?

A

Rash
Hypersensitivity
Steven-Johnsons (abacavir, nevirapine)

78
Q

What CNS side effects can HAART toxicity cause?

Which specific drug causes psychosis?

A

Mood

Psychosis (efavirenz)

79
Q

Which drugs can cause renal pathologies in HAART toxicity, and what exactly is the pathology?

A

Tenofovir and Atazanavir

Causes renal proximal tubulopathies

80
Q

Which HAART drug causes osteomalacia?

A

Tenofovir

81
Q

Which HAART drugs increase cardiovascular risk?

A

Abacavir
Lopinavir
Maraviroc

82
Q

Which HAART drug causes anaemia?

A

zidovudine

83
Q

Which HAART drug causes transaminitis and/or fulminant hepatitis?

A

Nevirapine

84
Q

Which drugs in the treatment of HIV need pharmacological boosting?

A

Potent liver enzyme inhibitors e.g. NNRTI’s.

85
Q

Should you as a doctor notify the partner of someone who is HIV positive?

A

No- your duty is to your patient (the HIV+ patient), therefore you should discuss with them how/why they should tell their partner.

86
Q

How can you prevent onward HIV transmission?

A 
Condom use
HIV treatment
STI screening
Disclosure
Pre-exposure prophalyxis
Post-exposure prophylaxis.
87
Q

If a female HIV positive patient wants to have a child with an HIV- male, what precautions should be taken?

A

Pre-exposure prophalyxis (PreP)
Self-insemination?- possible option.
Treatment as prevention

88
Q

If a female HIV negative female wants to have a child with an HIV+ male, what precautions should be taken?

A

PreP

Treatment as prevention.

89
Q

How would you prevent mother to child transmission of HIV?

A

HAART (highly active anti-retroviral therapy) during pregnancy
Vaginal delivery if undetectable viral load
C section if detected viral load
4 week PeP for neonate
Exclusive formula feeding

90
Q

What are the 4 criteria for it being illegal to have HIV and sex with someone?

A
  • know you have HIV at the time of sex
  • Have unprotected sex with someone who is HIV negative who then becomes HIV positive
  • You do not disclose your status prior to sex
  • You have to be proven to be the only other potential source of that persons infection.
91
Q

If you have a viral load of 0 and have unprotected sex without disclosing your status, are you breaking the law?

A

No because it is proven at a viral load of 0 you cannot transmit the disease.

Reproduction (34 decks)

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