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Infectious Disease > 1: HIV > Flashcards

1: HIV Flashcards

(101 cards)

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1
Q

What is HIV

A

Retrovirus that replicates in CD4 cells and macrophages causing progressive immune dysfunction

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2
Q

Define AIDS

A

CD4 count less than 200 or presence of AIDS defining illness

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3
Q

How is HIV transmitted

A
  • Sexual (80%)
  • Parental
  • Vertical (Childbirth, Breastfeeding)
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4
Q

At what viral load should a C-section be performed to deliver baby to HIV mother

A

Viral load is greater-than 50 a women should have a c-section

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5
Q

Can HIV mothers breastfeed

A

NO

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6
Q

What are 5 RF for HIV

A

MSM
Multiple Sexual partners
Unprotected Sex

Needle-sharing
Unsterilised procedures
IVDU

Viral load: undetectable means untransmissable

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7
Q

What is the risk of obtaining HIV through needle-stick injury

A

less than 1 in 300

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8
Q

What is the risk of transmitting Hep C via needlestick

A

2 in 100

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9
Q

In what % of individuals is seroconversion (primary HIV) symptomatic

A

80

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10
Q

when does primary conversion present

A

2-4W following infection

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11
Q

what are symptoms of primary HIV infection

A
  • Flu-like illness
  • Malaise
  • Sore-throat
  • Mucosal ulceration
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12
Q

What is a feature of chronic HIV

A

Persistent generalised lymphadenopathy

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13
Q

what is persistent generalised lymphadenopathy

A

Enlargement lymph nodes >1cm, in two or more contagious sites persisting beyond 3-months

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14
Q

what causes persistent generalised lymphadenopathy

A

follicular hyperplasia secondary to HIV

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15
Q

how does chronic HIV present

A

Asymptomatic - aside from opportunistic infections

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16
Q

What is a mnemonic to remember opportunistic infections that occur CD4 200-500

A

SHOK

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17
Q

What infections occur in HIV at CD4 200-500

A

Shingles

Hairy leukoplakia

Oral candidiasis

Kaposi’s sarcoma

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18
Q

What causes shingles

A

VZV

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19
Q

How does shingles present

A

Rash in dermatomal position

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20
Q

What causes hairy leukoplakia

A

EBV

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21
Q

What causes oral thrush

A

Candida albicans

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22
Q

What causes kaposi’s sarcoma

A

HHV8

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23
Q

How does Kaposi’s sarcoma present clinically

A

Purple macules-papules over trunk that can ulcerate

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24
Q

Aside from skin lesions, what can happen in Kaposi’s sarcoma

A

Involvement of respiratory tract can cause pleural effusion and haemoptysis

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25
How is Kaposi's sarcoma managed
Radiotherapy and resection of lesions
26
What is a mnemonic to remember infections that occur at CD4 count 100-200
CCPPH
27
What infections may occur at CD4 100-200
``` Cerebral toxoplasmosis Cryptosporidium Progressive multifocal leucoencephalopathy PCP HIV dementia ```
28
What does cryptosporidium cause
Diarrhoea
29
What causes cerebral toxoplasmosis
Toxoplasmosis Gondii
30
Where is toxoplasmosis gondii acquired from
Cat faeces
31
How does toxoplasmosis gondii present
- Asymptomatic | - Can present with malaise and headache
32
What investigation is ordered in cerebral toxoplasmosis
CT | Sabin-Feldman Dye Test
33
What will be seen on CT scan
Multiple ring-enhancing lesions
34
How can ring-enhancing lesions in cerebral toxplasmosis be differentiated from those of cerebral abscess
Toxoplasmosis = adjacent to basal ganglia | Cerebral abscess = periphery
35
How is cerebral toxoplasmosis managed
6W of pyrimethamine and sulphadiazine
36
What causes PML
JC virus
37
What does PML cause
Multi-focal demyelination
38
How is PML investigated
CT - single or multiple enhancing lesions | MRI - demyelinating white matter lesions
39
What causes PCP
Pneumocystitis Jirovecci
40
What is the most common HIV opportunistic infection
PCP
41
How does PCP present clinically
- Dyspneoa - Dry cough - Exercise induced desaturations - Fever - Few chest signs
42
What is a common complication of PCP
Pneumothorax
43
How does a CXR of PCP present
Bilateral interstitial pulmonary infiltrates
44
What investigation is required in PCP and why
Bronchoalveolar lavage - as CXR usually negative
45
Explain prophylaxis for PCP
All individuals with CD4 under 200 are given prophylaxis with co-trimoxazole
46
How are severe cases of PCP managed
Pentamidine
47
If a patient with PCP has hypoxia, how are they managed
Steroids
48
What will be seen on CT in HIV dementia
Cortical or subcortical atrophy
49
How can cryptosporidium diarrhoea be detected
Red cysts on Ziehl-Neelsen stain
50
What is a mnemonic to remember opportunistic infections CD4 count 50-100
COPA
51
what are opportunistic infections 50-100
Cryptococcus meningitis Oesophageal candiasis Primary CNS lymphoma Asperigillosis
52
what is the most common CNS fungal infection
cryptococcus
53
how does cryptococcus present
Headache Fever N+V Focal Neurological Deficit
54
what test is used to detect cryptococcus
LP = high opening pressure | India ink stain
55
what causes oesophageal candiasis
Candida albicans
56
how does oesophageal candiasis present
dysphagia | odynophagia
57
how is oesophageal candiasis managed
fluconazole or itraconazole
58
what causes primary CNS lymphoma
EBV
59
how does primary CNS lymphoma present on CT
single homogenous enhancing lesion
60
what is positive in CNS lymphoma
Thallium SPECT positive
61
how is primary CNS lymphoma managed
steroids radiation chemotherapy
62
what two infections can occur at a CD4 of less than 50
CMV encephalitis | Mycobacterium avium intracellulare
63
how does mycobacterium avium intracellulare present
Diarrhoea Abdominal pain Deranged LFTs Hepatomegaly
64
what molecule does HIV bind to on CD4 cells
gp120
65
what does HIV use gp120 to do
uses gp120 to bind to co-receptors CXCR4 and CCR5
66
what does HIV require to enter cells
gp120, CCR5 and CXCR4
67
what type of virus is HIV
viral RNA
68
what does HIV require to replicate
reverse transcriptase to convert to DNA virus
69
explain CD4-HIV ratio
HIV initially replicates, there is a decrease in CD4 cells. These cells then launch a counter-attack and HIV decreases. Reaches steady state where HIV gradually increases
70
what is the first-line test for HIV
rapid point of care testing
71
what is rapid point of care testing
immunoassay kit that gives rapid result from finger prick or swab
72
what is the gold-standard test for HIV
4th generation testing
73
what does the 4th-generation HIV test detect
HIV antibodies and p24 antigen
74
what is the window period of fourth-generation HIV test
10-days
75
what is the window period
false negative - time between infection and positive antibody/antigen test
76
what is viral load
qualification of HIV RNA
77
what is viral load used for
measure response to anti-retroviral antibodies
78
why is HIV RNA not diagnostic
high false negative rate
79
what is nucleic acid testing
viral PCR
80
what test is used to detect vertical transfer of HIV
nucleic acid testing
81
why can the 4th generation testing not be used in cases of suspected vertical transfer
maternal autoantibodies can alter ELISA results up to 18-months of age
82
explain role of CD4 count
not used to diagnose HIV - but used to define AIDS and monitor disease progression
83
what is current HIV anti-retroviral therapy
individual requires two NRTIs and one of: - NNRTI - Protease Inhibitor - Integrase Inhibitors
84
what are nucleoside reverse transcriptase inhibitors (NRTIs)
inhibit reverse transcriptase convening HIV RNA to DNA
85
what NRTI is given in the UK
Truvada: tenofovir and emtricitabine
86
what is an integrase inhibitor
inhibits HIV DNA entering nucleus of CD4 cells
87
what is the suffix of integrase inhibitors
'gravir'
88
what is the MOA of protease inhibitors
Inhibit protease - required for maturation of particles
89
what is the role of NNRTIs
Inhibit reverse transcriptase
90
what is maraviroc
binds CCR5 preventing interaction with gp41
91
what is enfuvirtide
inhibits gp41
92
what is PREP
given to individuals who do not have HIV, but are at a high-risk of HIV
93
what is licensed for PREP
Truvada
94
what is Truvada
tenofovir and ematricibine
95
what is PEP
post-exposure prophylaxis
96
when must PEP be started by
Within 72h of exposure
97
how long is PEP taken
28-days
98
what is given as PEP in the UK
Truvada and raltegravir
99
when should all pregnant women with HIV have commenced ART by
24W
100
what viral load does a women need a C-section
>50 copies
101
explain neonatal PEP
given from birth until 4W - if born to HIV mum

Infectious Disease (8 decks)

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