Y4 - HIV

Question 1

How can you reduce the risk of a pregnant woman passing on the HIV virus to her baby?

Answer 1

ART (at least before 3rd trimester)
Aim for vaginal delivery
Do not breast feed

Question 2

What illness can present similarly to the HIV seroconversion illness?

Answer 2

Glandular fever (EBV infection)

Question 3

What are the symptoms of the seroconversion illness?

Answer 3

Fever, wt loss, malaise, headache, neuropathy, lymphadenopathy, rash, myalgia, mouth sores

Question 4

What conditions in young people should make you think of HIV?

Answer 4

Shingles (esp. if multi-dermatomal)
Oral hairy leukoplakia
Kaposi sarcoma

Question 5

What are the main opportunistic diseases associated with HIV?

Answer 5

Pneumocystitis jirovecii 
Candidiasis
Cryptococcus neoformans
Toxoplasma gondii
CMV
Cryptosporidium 
Kaposi's sarcoma
Lymphoma

Question 6

What is the presentation of PJP?

Answer 6

Progressive SoB on exertion, malaise, dry cough
Inc. RR
Often normal breath sounds

Question 7

What Ix should you do for PJP and what should you find?

Answer 7

SpO2
CXR: perihilar infiltrates
Induced sputum or BAL with staining of NAAT

Question 8

What is the Rx of PJP?

Answer 8

Co-trimoxazole

Can also be prevented by giving this if CD4 <200

Question 9

What type of candidiasis do HIV patients tend to get? How is it treated?

Answer 9

Oral/oesophageal

Rx: azole

Question 10

How can Cryptococcus neoformans present?

Answer 10

Meningitis (headache, fever, meningism), may have assoc. skin/lung disease

Question 11

What Ix should you do for cryptococcus neoformans?

Answer 11

LP
CSF staining
CSF/blood cryptococcal antigen

Question 12

How do you Rx cryptococcus neoformans infection?

Answer 12

Amphotericin B

Question 13

When are toxoplasma gondii lesions found and when do HIV patients tend to get them?

Answer 13

Commonest intracranial lesion when CD4 <200

Question 14

What is the presentation of toxoplasma gondii?

Answer 14

Focal neurological signs and seizures

May get headache and vomiting if raised ICP

Question 15

What Ix can you do for toxoplasma gondii?

Answer 15

MRI brain
LP and CSF PCR
Blood serology

Question 16

What is the presentation of CMV infection in HIV?

Answer 16

Retinitis (blurred vision), encephalitis, GI disease, bone marrow suppression, pneumonia

Question 17

What is the commonest cause of chronic diarrhoea in HIV pre-ART?

Answer 17

Cryptosporidium

Question 18

What is the most common tumour in AIDS/HIV?

Answer 18

Kaposi’s sarcoma

Question 19

What causes Kaposi’s sarcoma?

Answer 19

Human herpes virus 8

Question 20

What is the presentation of Kaposi’s sarcoma?

Answer 20

Cutaneous or mucosal lesions (patch, plaque or nodular

Question 21

What kind of lymphoma are HIV patients at increased risk of?

Answer 21

Non-Hodgkin’s lymphoma

Question 22

What are patients with a new diagnosis of HIV screened for?

Answer 22

Hep B, C, TB

Question 23

What are the baseline tests for a newly diagnosed HIV patient?

Answer 23

CD4, viral load, FBC, LFT, electrolytes, creatinine, pregnancy test, viral genotype for drug resistance

Question 24

What is involved in counselling a newly diagnosed HIV patient?

Answer 24

HIV transmission 
Sexual health 
Benefits of therapy 
Life long adherence
Resistance
Side effects
Monitoring
Disclosure to family/friends/partner
Partner testing