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MRCP: Infectious Diseases > HIV > Flashcards

HIV Flashcards

1
Q

What are neurological complications of HIV?

A

Toxoplasmosis
Primary CNS lymphoma
Tuberculosis
Encephalitis
Cryptococcus
PML
AIDs dementia complex

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2
Q

What is the most common neurological complication of HIV?

A

Toxoplasmosis

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3
Q

What are scan appearances of toxoplasmosis?

A

CT: usually single or multiple ring enhancing lesions, mass effect may be seen

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4
Q

How is cerebral toxoplasmosis treated?

A

sulfadiazine and pyrimethamine

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5
Q

What is the second most common neurological complication of HIV?

A

Primary CNS lymphoma

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6
Q

What is associated with CNS lymphonma?

A

Ebstein Barr virus

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7
Q

What is the CT appearance of CNS lymphoma?

A

Homogenous enhancing lesions

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8
Q

More likely to be toxoplasmosis or lymphoma?:
1, Multiple lesions
2. Ring or nodular enhacement
3. Thallium spect negative

A

Toxoplasmosis

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9
Q

More likely to be toxoplasmosis or lymphoma?:
1. Single lesion
2. Homogenous enhancement
3. Thallium spect positive

A

Lymphoma

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10
Q

Causes of encephalitis in HIV?

A

CMV
HIV
HSV

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11
Q

What is the most common neurological fungal infection in HIV?

A

Cryptococcus

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12
Q

Features of CNS cryptococcal infection in HIV?

A

CSF: high opening pressure, India ink test positive
CT: meningeal enhancement, cerebral oedema
meningitis is typical presentation but may occasionally cause a space occupying lesion

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13
Q

What infective agent undepins PML in HIV neurological infections?

A

JC virus

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14
Q

Features of PML on CT scan?

A

Widespread demyelination

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15
Q

Features of AID dementia complex?

A

caused by HIV virus itself
symptoms: behavioural changes, motor impairment
CT: cortical and subcortical atrophy

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16
Q

What severe respiratory complication can occur if CD4 < 200

A

PCP - although the organism is Pneumocystis jiroveci

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17
Q

What type of organism is PCP?

A

Fungal

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18
Q

What are the features if PCP?

A

Dyspnoea
Cough
Fever
Very few chest signs
Exercise induced dyspnoea

Extrapulmonary symptoms: 1-2%
- hepatosplenomegaly
- lymphadenopathy
- choroid lesions

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19
Q

What are the features of PCP on CXR?

A

Bilateral interstitial pulmonary infiltrates - although may also me normal

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20
Q

How best to investigate and diagnose PCP?

A

Sputum often fails to show PCP

Bronchoalveolar lavage (BAL) often needed to demonstrate PCP (silver stain shows characteristic cysts)

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21
Q

How to treat PCP?

A

Co-trimoxazole

Steroids if hypoxic (if pO2 < 9.3kPa then steroids reduce risk of respiratory failure by 50% and death by a third)

IV Pentamidine in severe cases

Aerosolized pentamidine is an alternative treatment for Pneumocystis jiroveci pneumonia but is less effective with a risk of pneumothorax

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22
Q

When is the best time to start treatment for HIV?

A

Time of diagnosis

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23
Q

What is the CD4 count cut off for classified as AIDS?

A

<200

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24
Q

What are the three types of antiretroviral therapy (ART)?

A

Combination of three:
- Nucleoside reverse transcriptase inhibitors (NRTI)
- Protease inhibitor (PI)
- Non-nucleoside reverse transcriptase inhibitor (NNRTI)

There are also:
- Entry inhibitors
- Integrase inhibitors

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25
Q

How do entry inhibitors work in HIV? Name two?

A

Maravoc - binds to CCR5, preventing an interaction with gp41
Enfuvirtide (binds to gp41, also known as a ‘fusion inhibitor’)

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26
Q

What is the general side effect of NRTI?

A

Peripheral neuropathy

27
Q

List some NRTI’s?

A

Zidovudine (AZT), Emtricitabine, Didanosine, Lamivudine, Stavudine, Zalcitabine,

Tenofovir, Abacavir,

28
Q

What is Zidovudine, and what are the side effects?

A

NRTI

Anaemia
Myopathy
Black nails

29
Q

What is Tenofovir and its side effects?

A

NRTI

Renal impairment
Ostesoporosis

30
Q

What is Didanosine and its side effects?

A

NRTI

Pancreatitis

31
Q

Give examples of non-nucleoside transcriptase inhibitors?

A

Nevirapine, Efavirenz

32
Q

What are side effects of non-nucleoside transcriptase inhibitors?

A

P450 interactions
Rashes

33
Q

Give examples of protease inhibitors in HIV?

A

Examples: indinavir, nelfinavir, ritonavir, saquinavir

34
Q

Side effects of protease inhibitors?

A

Diabetes, hyperlipidaemia, buffalo hump, central obesity, P450 enzyme inhibition

35
Q

What is Indinavir and its side effects?

A

Protease inhibitor

Renal stones
Asymptomatic bilirubinaemia

36
Q

How do integrate inhibitors work ?
Examples?

A

block the action of integrase, a viral enzyme that inserts the viral genome into the DNA of the host cell

examples: raltegravir, elvitegravir, dolutegravir

37
Q

A pregnant woman with HIV. What is the preferred method of delivery?

A

Vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended

38
Q

How should a neonate of a mother with HIV be managed?

A

Zidovudine if copies < 50

ART should be used. Therapy should be continued for 4-6 weeks.

39
Q

What viruses causes kaposi sarcoma?

A

HHV-8 virus

40
Q

What opportunistic infections are likely is CD4 count 200-500?

A

Oral thrush - Candida
Shingles - Herpes zoster reactivate
Hairy leukoplakia - EBV
Kaposi sarcoma - EBV

41
Q

What opportunistic infections are likely is CD4 count 100-200?

A

Cryptosporidosis
Cerebral toxoplasmosis
PML - JC virus
PCP

42
Q

What opportunistic infections are likely is CD4 count 50-100?

A

Aspergillosis
Oesophageal candidiasis
Cryptococcal
Primary CNS lymphoma

43
Q

What opportunistic infections are likely is CD4 count <50?

A

CMV retinitis
Mycobacterium avium-intracellulare infection

44
Q

What are the most common crytococcus species?

A

Cryptosporidium hominis
Cryptosporidium parvum

45
Q

What are the features of cryptococcus?

A

watery diarrhoea
abdominal cramps
fever
in immunocompromised patients, the entire gastrointestinal tract may be affected resulting in complications such as sclerosing cholangitis and pancreatitis

46
Q

How is cryptococcus diagnosed?

A

modified Ziehl-Neelsen stain (acid-fast stain) of the stool may reveal the characteristic red cysts of Cryptosporidium

47
Q

What is the management of cryptococcus?

A

Largely supportive for immunocompetent patients

nitazoxanide may be used for immunocompromised patients

48
Q

What is more pathogenic: HIV1 or HIV 2?

A

HIV1

49
Q

What factors increase the risk of transmitting HIV?

A

Mucosal ulceration
High viral load
Circumcision is protective

50
Q

What makes the tuberculin skin test unreliable?

A

HIV - or immunosuppression

51
Q

What is a common complication of PCP?

A

Pneumothorax

52
Q

What is HIV seroconversion?

A

seroconversion is symptomatic in 60-80%
glandular fever type illness
3-12 weeks after infection

53
Q

What tests should be used to diagnosis HIV?

A

HIV PCR
P24 antigen

54
Q

What is the P24 antigen?

A

Component of HIV viral coat

55
Q

What prophylaxis should CD4 < 200 be put on ? And why?

A

Co-Trimoxazole

Prevention of PCP

56
Q

What vaccinations cannot be used if HIV is <200 CD4?

A

Measles, Mumps, Rubella (MMR)
Varicella
Yellow Fever

57
Q

What vaccinations are always contraindicated in HIV?

A

Cholera CVD103-HgR
Influenza-intranasal
Poliomyelitis-oral (OPV)
Tuberculosis (BCG)

58
Q

What is Monod’s sign?

A

Monod’s sign is similar to the air-crescent sign, which is a classic radiographic feature of air around a ball of fungus (in this case, an aspergilloma).

59
Q

What stain is needed for PCP?

A

Silver stain

60
Q

How do you treated cryptosporidosis?

A

Supportive in immunocompetent
Nitazoxanide may be used for immunocompromised patients
Rifaximin is also sometimes used for immunocompromised patients/patients with severe disease

61
Q

What causes mycobacterium avian complex?

A

Mycobacterium avium
Mycobacterium intracellulare

62
Q

What is the treatment of mycobacterium avian complex?

A

Fever, sweats
Abdominal: pain, diarrhoea
Lung: dyspnoea, cough
Anaemia
Lymphadenopathy
Hepatomegaly/deranged LFTs

63
Q

What prophylaxis should HIV patients be on less at CD 100 for MAC?

A

Clarithromycin or azathioprine

64
Q

What is the treatment of MAC active infection?

A

rifampicin + ethambutol + clarithromycin

MRCP: Infectious Diseases (15 decks)

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