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Yr 3 Infection > HIV and AIDS > Flashcards

HIV and AIDS Flashcards

1
Q

How is HIV spread?

A
  • Sexual transmission
  • Injection drug misuse
  • Blood products
  • Vertical transmission
  • organ transplant
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2
Q

Can you test an unconscious patient for HIV?

A

Yes - if you think its in their best interest. Negative result doesn’t affect insurance premium

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3
Q

Discuss the immunology behind HIV infection?

A

HIV infects and destroys immune system cells, esp CD4+ T Helper cells

CD4 receptors also present on macrophages and monocytes, brain cells, skin, and more

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4
Q

What is the natural history of HIV as it progresses?

A

> CD4 count declines and HIV viral load inc.
Inc risk of infections and tumours
severity of illnesses is greater the lower the CD4 count (normal >500)
most AIDS diagnoses (severe infections) at CD4 count <200

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5
Q

How many clinical stages of HIV is there?

A

4

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6
Q

Discuss clinical stage I of HIV?

A

-Asymptomatic, persistent generalised lymphadenopathy (PGL)

|&raquo_space;Performance scale 1: Asymptomatic, normal activity

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7
Q

Discuss clinical stage II symptoms of HIV?

A

-weight loss (<10%)
-Minor mucocutaneous manifestations (seborrhoeic dermatitis, prurigo, fungal nail infections, recurrent oral ulcerations, angular cheritis)
-Herpes Zoster (in last 5y)
-Recurrent URTI
»and/or performance scale 2: symptomatic, normal activity

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8
Q

Discuss clinical stage III symptoms of HIV?

A

-Weight loss (>10%)
-Unexplained chronic diarrhoea (>1m)
-unexplained prolonged fever (intermittent or prolonged) >1m
-oral candidiasis
-oral hairy leukoplakia
-Pulmonary TB in last yr
-severe bacterial infections
»and/or performance scale 3: bedridden <50% of day in last month

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9
Q

Discuss clinical stage IV symptoms of HIV?

A
  • HIV toxoplasmosis
  • CMV disease of organ other than liver/spleen/LN
  • HSV infection
  • PML
  • Candidiasis incl. oesophague/trachea/bronchii/lungs
  • HIV encephalopathy
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10
Q

HIV and AIDS are directly linked in infection. When someone gets a certain infection or tumour is it classified as AIDS illness or HIV illness?

A

AIDS illness. If no symptoms you have HIV infection only

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11
Q

Name some AIDS-defining conditions

A
  • TB
  • Cerebral toxoplasmosis
  • PML
  • Cryptococcal meningitis
  • Kaposi’s sarcoma
  • Non-Hodgkins lymphoma
  • Cervical cancer
  • CMV retinitis
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12
Q

Name conditions when HIV testing should be offered?

A
  • aseptic meningitis/encephalitis
  • GBS
  • transverse myelitis
  • dementia
  • leucoencephalopathy
  • oral candidiasis
  • unknown weight loss
  • hep b/c infection
  • lung cancer
  • seminoma
  • hodgkins lymphoma
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13
Q

What is the progression of HIV from initial infection?

A 
>acute infection (seroconversion)
>Asymptomatic
>HIV related illnesses
>AIDS defining illness
>death
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14
Q

What are the symptoms of seroconversion (when HIV antibodies first develop)?

A
  • flu-like illness
  • fever
  • malaise and lethargy
  • pharyngitis
  • lymphadenopathy
  • toxic exanthema

may look like glandular fever but EBV serology negative

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15
Q

How soon does seroconversion present?

A

2-4 weeks post exposure. 1-2 weeks is self limiting

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16
Q

What is the treatment for HIV?

A

Combination antiretroviral therapy - cART (at least 3 drugs from at least 2 groups)

17
Q

Side effects of cART?

A
  • metabolic problems

- lipodystrophy

18
Q

What are the 3 drugs combined in HIV therapy? What other drug is also available?

A
  • Reverse transcriptase inhibitors
  • Integrase inhibitors
  • Protease inhibitors

-Entry inhibitors

19
Q

When should you consider commencing treatment for HIV?

A

> consider all patients at diagnosis regardless of CD4 count
if CD4<350 cells/mm3 encourage treatment
if CD4 <200cells/mm3 start asap
any pregnant woman - start before 3rd trimester

20
Q

Is HIV treatment lifelong?

A

yes

21
Q

What does life expectancy depend on in HIV sufferers?

A

how early treatment is started from point patient is infected

22
Q

Why do treatments fail?

A
  • inadequate potency
  • inadequate drug levels
  • inadequate adherence (leads to viral mutation and resistance)
  • pre-existing resistance
23
Q

List the 4 antiviral drugs and one side effect of each:

  • Nucleoside reverse transcriptase inhibitors
  • non-nucleoside reverse transcriptase inhibitors
  • protease inhibitors
  • integrase inhibitors
A

> NRT inhibitors: lipodystrophy
NNRT inhibitors: skin rashes
Protease inhibitors: lipodystrophy
Integrase inhibitors: rashes

24
Q

Cosmetic procedures to treat lipodystrophy?

A
  • facelift
  • liposuction
  • fillers
25
Q

How can HIV be prevented?

A
  • behaviour change and condoms
  • circumcision
  • treatment as prevention
  • Pre-exposure prophylaxis
  • Post exposure prophylaxis for sexual exposure

Yr 3 Infection (12 decks)

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