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BDS4 Oral Medicine > STD 3 > Flashcards

STD 3 Flashcards

1
Q

What are retroviridae?

A

Family of enveloped viruses with single stranded positive sense RNA
-> replicate in host cell through reverse transcription

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2
Q

Why is HIV called a lentivirus?

A

Long interval between initial infection and symptoms onset

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3
Q

What are the component of HIV virus?

A
  • Viral RNA
  • Lipid bilayer
  • Nucleocapsid- P7
  • Matrix- p17
  • Caspid- p24
  • Protease- p15
  • Reverse transcriptase- p66
  • Integrase- p31
  • Envelope- Su gp12, TM gp41
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4
Q

What is the prevalence of HIV?

A

4.6%
-> 38 million people living with HIV (2019)
-> 6000 in scotland

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5
Q

What are the stages in HIV life cycle?

A
  1. Attachment
  2. Fusion- uncoating
  3. Reverse transcription- nuclear import
  4. Integration
  5. Transcription - nuclear export
  6. Translation- assembly of proteins
  7. Budding and maturation
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6
Q

What are the modes of transmission for HIV?

A

Paternal exposure (can be vertical at time of birth)
Blood transfusion
Sharing needles
Needle stick injury
Sexual exposure without condom use (oral, anal, vaginal)

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7
Q

What risk factors make HIV infection more likely?

A

Higher viral levels in plasma/ genital infections

Other STIs

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8
Q

What are the phases of HIV infection?

A

Primary infection- acute HIV syndrome, wide dissemination, seeding of lymphoid organs

Clinical latency

Constitutional symptoms

Opportunistic disease

Death

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9
Q

What are the features of HIV stage 1 (acute infection)?

A

Patient may be asymptomatic

Pt has persistent generalised lymphadenopathy in at least 2 sites (for longer than 6 months)

CD4+- at least 500 cells/ul

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10
Q

What are the features of HIV stage 2 (early or mildly symptomatic)?

A

Unexplained weight loss (<10% of total body weight)

Recurrent respiratory infections- sinusitis, bronchitis, otitis media, pharyngitis

Dermatological conditions
-> VZV flares
-> Angular cheilitis
-> Recurrent oral ulceration
-> papilar pruritic eruption

CD4+- 350-499/ul

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11
Q

What are the features of Stage 3 HIV (late or moderately symptomatic stage)?

A

Weight loss (>10%)

Unexplained diarrhoea

Pulmonary TB

Severe bacterial infections
-> Pneumonia
-> pyelonephritis
-> meningitis
-> bone and joint infections
-> bacteraemia

Candiasis

Hairy Leukoplakia

ANUG

CD4+- 200 to 349

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12
Q

What is considered AIDS (stage 4)?

A

<200 CD4+ cells/ul

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13
Q

What does AIDS stand for?

A

Acquired immunodeficiency syndrome

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14
Q

What conditions are considered AIDS-defining

A
  • HIV wasting syndrome
  • Pneumocystis pneumonia
  • Recurrent severe or radiological bacterial pneumonia
  • Extrapulmonary tuberculosis
  • HIV encephalopathy
  • CNS toxoplasmosis
  • Chronic orolabial herpes simplex infection
  • Oesophageal candidiasis
  • Kaposi’s sarcoma
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15
Q

What conditions may arouse suspicion that patient has AIDS?

A
  • CMV infections- retinitis, liver, spleen, LNs
  • Extrapulmonary crytococcosis
  • Disseminated endemic mycoses
  • Disseminated non TB mycobacteria infection
  • Tracheal, bronchial, pulmnory candiasis
  • Visceral HSV
  • Cerebral b-cell NHL
  • HIV cardiomyopathy/nephropathy
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16
Q

What is the most prevalent opportunistic disease among people with HIV?

A

TB

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17
Q

What neoplastic conditions are caused by HIV?

A

NH/H lymphoma

Lip/oral cancer

Kaposi’s Sarcoma

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18
Q

Which type of fungal pathogens cause superficial fungal infection in HIV?

A

Candida

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19
Q

Which type of fungal pathogens cause invasive/deep oral pharyngeal fungal infections?

A

Histoplasma genus

Blastomyces genus

Aspergillus genus

Rhizopus, Rhizomucor, Mucor, Absidia, Cokeromyces, Apophysomyces Cunninghamella,
Saksenaea genus

Cryptococcus genus

20
Q

Which viral infections are commonly superimposed on HIV infections?

A

Herpes Simplex Virus (HSV)
Varicella Zoster Virus (VZV)
Cytomegalovirus (CMV)
Epstein-Barr Virus (EBV)
Human Papilloma Virus (HPV)
Human Herpes Virus – 8

21
Q

Which oral bacterial infections are common in HIV patients?

A

TB

Syphillis

22
Q

How do TB oral lesions seen in HIV present?

A

Painful superficial lingual ulcer
-> circumscribed
-> crateriform aspect
-> Elevated
-> Indurated

23
Q

How do secondary syphillis oral lesions seen in HIV present?

A

Mucous patched
-> raised plaques
-> erythematous base
-> serpentine white/redish outline

24
Q

What conditions affecting the periodontium is HIV associated with?

A

Linear gingival erythema- distinct band around margin (does not respond to perio tx)

Necrotising gingivitis, periodontitis, stomatitis

25
Q

How do mouth ulcers in HIV present?

A

Start off aphthous like- can be come necrotising stomatitis

Range in size

Persistent

Painful

Frequency increases with HIV progression

26
Q

What issues can HIV cause in salivary glands?

A

Bilateral parotid enlargement
-> increased on HAART

Xerostomia- HIV related medication
-> caries
-> oral fungal infections

27
Q

How does Kaposi’s Sarcoma present? (associated with HHV-8)

A

Red/blue/purple macular and nodular lesions

28
Q

How is Kaposi sarcoma diagnosed?

A

Biopsy and pathology assessment

29
Q

How does NHL appear clinically?

A
  • Rapidly enlarging necrotic masses
  • Ulcerated or nonulcerated masses
  • Palate and gingivae most common sites

-> Prognosis is very poor

30
Q

How is NHL diagnosed?

A

Biopsy and histological evaluation

31
Q

How is NHL treated?

A

Aggressive oncology therapy

32
Q

What antigens are used in HIV diagnostic testing in sandwich ELISA?

A

Recombinant and synthetic peptides
-> 99.5% specificity, 100% sensitivity

33
Q

What antibodies does sandwich ELISA for HIV detect?

A

IgG and IgM for anti HIV1/2/group )

HIV1 p24 Ag

34
Q

What are some examples of rapid tests for HIV?

A

Chembio HIV/HCV/syphilis- HIV Ab

Biolytical HIV1

35
Q

What is used to manage HIV?

A

HAART- Highly active anti-retroviral therapy
-> reduces levels of viraemia
-> not always fully effective
-> long and short-term toxicity issues

36
Q

What combination of drugs is used in HAART?

A

2 nucleoside reverse transcriptase inhibitors

1 of :
Integrase stand transfer inhibitor
Non-nucleoside reverse transcriptase inhibitor
Protease inhibitor

Plus pharmacokinetic enhancer- booster
-> Cobicistat
-> Ritonavir

37
Q

What are some examples of NRTIs?

A

Tenofivir

Lamivudine and Emtricitabine

Abacavir

38
Q

What are some examples of INSTI?

A

Dolutegravir

Raltegravir

Elvitegravir

39
Q

What are some examples of NNRTI?

A

Efavirenz

Nevirapine

Rilpivirine

40
Q

What are some examples of Protease inhibitors?

A

Darunavir

Atazanivir

41
Q

What are some of the adverse orofacial side effects of HAART?

A

Erythema Multiforme

Xerostomia

Ulcers

Altered tast

Peri-oral paraethesia

Facial lipodystrophy

42
Q

How are STIs prevented?

A

Abstinence

Condoms

Vaccination- Hep B, HPV

Reduce number of partners

Mutual monogamy

43
Q

How is mother-child transmission of HIV prevented?

A

All HIV positive woman who are pregnant or breastfeeding should maintain viral suppression therapy

44
Q

How quickly should PEP be taken?

A

ASAP after the exposure
-> no longer than 72 hours after
-> continue for 4 weeks to maximise chance of prevention

45
Q

What is PrEP?

A

Pre-exposure prophylaxis- daily tenofovir/emtricitabine
-> given to high risk individuals

BDS4 Oral Medicine (28 decks)

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