Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SEXUAL HEALTH AND HIV > CLINICAL STAGING AND NATURAL HISTORY OF UNTREATED HIV > Flashcards

CLINICAL STAGING AND NATURAL HISTORY OF UNTREATED HIV Flashcards

1
Q

What is the first stage of HIV infection called?

A

Primary HIV infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the rate of CD4 loss per year in untreated HIV?

A

Between 50 and 100 cells/microlitre per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the definition of AIDS in terms of CD4 count?

A

Less than 200 or a CD4 lymphocytes percentage of total lymphocytes of less than 14%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the median time from infection to developing AIDS in untreated people? What is the range?

A

10 years (range: 18 months to 25 years)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What percentage of patients will be able to control HIV viraemia without combination antiretrovirals?

A

Less than 1% - the elite controllers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What group are more likely to elite controllers?

A

Children with vertically transmitted disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Prior to the introduction of antiretrovirals, what was the mean survival time after a diagnosis of AIDS?

A

Less than 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the life expectancy of someone who is HIV positive who is being treated with antiretrovirals?

A

Almost normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the three categories of HIV infection?

A

Category A

Category B

Category C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the conditions of category A in the classification of HIV infection?

A

Asymptomatic

Persistent generalised lymphadenopathy

Acute (primary) HIV infection with accompanying illness or history of acute HIV infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the conditions of category B in the classification of HIV infection?

A

Bacillary angiomatosis

Oropharyngeal candidiasis

Vulvovaginal candidiasis that is persistent, frequent or poorly responsive to therapy

Cervical dysplasia (moderate to severe) or cervical carcinoma in situ

Constitutional symptoms - Fever (38˚) or diarrhoea lasting more than a month*

Hairy leucoplakia - oral

Herpes zoster - shingles, involving at least two distinct episodes or more than one dermatome.

Idiopathic thromobocytopenic purpura.

Listeriosis

PID - particularly if complicated by tuco-ovarian abscess

Peripheral neuropathy

*NB if associated with 10% weight loss then it becomes HIV wasting syndrome and therefore AIDS defining and category C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the conditions of category C in the classification of HIV infection?

A

All AIDS defining conditions (see HIV testing cards)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is other name for the primary or acute HIV infection?

A

HIV seroconversion illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the clinical features of HIV seroconversion illness?

A

Fever (96%)

Lymphadenopathy (74%)

Pharyngitis (70%)

Rash (70%)

Myalgia (54%)

Diarrhoea
Headache
Nausea and vomiting
Hepatosplenomegaly
Weight loss
Oral candida
Neurological symptoms - encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How long after exposure do symptoms of HIV seroconversion occur?

A

1 to 3 weeks

(Not sure about these figures as textbook says that early onset of symptoms in primary HIV infection includes anything less than 3 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is occurring during the primary HIV infection?

A

Time between initial infection to the development of antibodies against HIV.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the rash associated with primary HIV infection?

A

Erythematous, maculopapular rash mainly on face and trunk with or without mucocutaneous ulcers of the mouth, oesophagus or genitals.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What happens to CD4 levels during the primary HIV infection?

A

They will fall and can fall quite dramatically. This can result in manifestations more often seen later in disease such as oral candida. This can lead to occasional diagnostic confusion as to the stage of HIV infection.

19
Q

When would cART (combined anti-retroviral treatment) be considered in primary HIV infection?

A

Only with very severe symptoms - especially encephalopathy, an AIDS defining illness or CD4 count of less than 350 cells/microlitre)

20
Q

What are the theoretical advantages of starting cART (combined anti-retroviral treatment) early in primary HIV infection?

A

HIV may be more susceptible due to:

Relatively low diversity of replicating virus

Reduced ability of predominantly non-syncytium-inducing (NSI) strains of virus to infect a wide variety of cell types

Enhanced immune response at this stage

21
Q

Are people with primary HIV infection, more or less infectious than an untreated asymptomatic individual later on in disease?

A

More due to high viral load

22
Q

What are the typical levels of CD4 during the asymptomatic second stage of HIV infection?

A

Normally above 350 cell/microlitre

23
Q

Is transmission possible during the asymptomatic second stage of HIV infection?

A

Yes

24
Q

What is persistent generalised lymphadenopathy?

A

Lymphadenopathy that persistes for at least 3 months in at least two-extra inguinal sites and is not due to any other cause.

25
Q

What are the important differentials to rule out before diagnosing persistent generalised lymphadenopathy in someone who is HIV postitive?

A

TB

Lymphoma

26
Q

What lymphatic sites are not part of the definition of persistent generalised lymphadenopathy and should therefore prompt further investigation to exclude infection and neoplasia?

A

Mediastinal lymphadenopathy

Intra-abdominal lymphadenopathy

27
Q

How does persistent generalised lymphadenopathy reflect disease progression?

A

It doesn’t and it is therefore not an indication to start HIV treatment

28
Q

Is someone considered to have AIDS once symptoms start to develop after the asymptomatic stage?

A

No. Patients may develop symptoms and conditions that are not AIDS defining and before their CD4 count drops below 200 cells/microlitre.

29
Q

What are the sites commonly affected first when HIV reaches the symptomatic phase after the latent asymptomatic period?

A

Category B conditions:

Constitutional symptoms

Skin and mouth

Some haematological disorders

30
Q

What are the non-AIDS defining constitutional symptoms associated with reactivation of HIV after the asymptomatic latent stage?

A

Malaise

Fever

Night sweats

Weight loss (that does not meet HIV wasting criteria)

Diarrhoea

31
Q

What are the exact criteria for diagnosing the AIDS defining HIV wasting syndrome?

A

10% weight loss from baseline

AND one of:

Fever
Diarrhoea lasting at least 1 month

32
Q

What are the skin and mouth conditions often seen first upon reactivation of HIV after the asymptomatic latent stage?

A

Candida

Shingles

Herpes

Oral hairy leucoplakia

33
Q

What are the haematological problems often seen first upon reactivation of HIV after the asymptomatic latent stage?

A

Lymphopenia

Moderate neutropenia

Normochromic, normocytic anaemia

Thrombocytopenia

Idiopathic thrombocytopenia purpura (ITP)

34
Q

Other than CD4 T cells, what cells are affected by HIV?

A

Immune dysregulation of:

Natural killer cells

Plasmacytoid dendritic cells

CD8 T-cells

35
Q

What are the diseases that still occur at higher levels of CD4 due to the effect that HIV has on other parts of the immune system? How should these patients be treated?

A

Idiopathic thrombocytopenic purpura (ITP)

Thrombotic thrombocytopenic purpura (TTP)

HIV-associated nephropathy (HIV AN)

Severe refractory psoriasis

Pulmonary arterial hypertension

HIV vasculitis

These patients should start cART

36
Q

What are the factors that speed up the progression to AIDS in untreated individuals?

A

Older age

Higher plasma HIV viral load

Early onset (less than 3 weeks) of primary infection symptoms

Prolonged (more than 2 weeks) or severe symptoms in primary HIV infection

Baseline albumin of less than 35 mg/ml

CXCR4 (syncitium inducing) strain of HIV

Rapid rate of fall of absolute CD4 cell count

Route of infection - blood transfusion

37
Q

What are the two most widely used markers of disease progression?

A

CD4 counts

Viral load

38
Q

If a patient is found to have a low CD4 count on a blood test, what should happen before therapy is initiated?

A

Blood test should be repeated as CD4 count is subject to diurnal and seasonal variation and reduced by intercurrent infection.

39
Q

At what CD4 count might you expect a patient to develop pneumocystis pneumonia (PCP)?

A

Less than 200 cells/microlitre

40
Q

At what CD4 count might you expect a patient to develop toxoplasmosis?

A

Less than 100 cells/microlitre

41
Q

At what CD4 count might you expect a patient to develop cryptococcosis?

A

Less than 100 cells/microlitre

42
Q

At what CD4 count might you expect a patient to develop oesophageal candidiasis?

A

Less than 100 cells/microlitre

43
Q

At what CD4 count might you expect a patient to develop disseminated cytomegalovirus?

A

Less than 50 cells/microlitre

44
Q

At what CD4 count might you expect a patient to develop disseminated Mycobacterium avium complex?

A

Less than 50 cells/microlitre

SEXUAL HEALTH AND HIV (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions