Clinical Features of HIV

Question 1

What are the two markers used to monitor HIV infection

Answer 1

1. CD4 count

2. HIV viral load

Question 2

What is the following:

Normal throat
Mouth Ulcers
Mild Lymphadenopathy 
Diffuse Rash
Fever
Headache

Answer 2

Acute HIV syndrome

Question 3

What is distinguishable about the rash in HIV

Answer 3

The rash is symmetrical that involves the whole body

Question 4

What can the rash seen in acute HIV be mistaken for

Answer 4

Secondary Syphilis

Question 5

What is Maculopapular symptom

Answer 5

Raised red lumps

Question 6

When does Acute HIV syndrome occur

Answer 6

2-4 weeks after infection

HIV replicates rapidly causing CD4 count to rapidly increase and then rapidly drops during this time

Question 7

What can Acute HIV syndrome be mistaken for

Answer 7

Glandular fever

Flu

Question 8

What is the significance of the degree of severity of symptoms in Acute HIV syndrome

Answer 8

Progression is more rapid when severity is greater

Question 9

Why can some patients present with aseptic meningitis

Answer 9

Direct effect of HIV on CNS

Question 10

Recap: Symptoms of Acute HIV Syndrome

Answer 10

1. Fever
2. Sore throat
3. Myalgia
4. Rash
5. Headache
6. Weight loss
7. Lymphadenopathy
8. Vomiting

Question 11

What do you ask following a patient with fever, rash and non-specific symptoms

Answer 11

1. Ask about sexual history

2. Think of HIV conversion

Question 12

What is clinical latency

Answer 12

1. HIV viral load rapidly decreases due to activation of CD4
2. During clinical latency the CD4 population slowly declines causing a very slow increase in HIV viral load (become rapid after clinical latency period)

Question 13

What are the symptoms during clinical latency

Answer 13

1. NONE

2. May see enlarged lymph nodes

Question 14

What is Lymphadenopathy

Answer 14

Persistant generalised lymph node enlargement (2 areas of the body for atlas 3 months)

Question 15

How long can clinical latency last for

Answer 15

8 years

Question 16

How do we distinguish shingles from HIV

Answer 16

Shingles tends to appear in elderly NOT the young!

Question 17

What is shingles

Answer 17

Reactivation of chickenpox

Question 18

Shingles vs HIV

Answer 18

HIV affects many dermatological areas

Shingles effects one

Question 19

Later on in clinical latency once CD4 levels are extremely low, what indications are there for HIV

Answer 19

1. Minor infections become very common (thrush) or difficult to treat
2. . Thrush may appear in the mouth without another explanation

Question 20

Difference between Oral hairy leukoplakia vs thrush

Answer 20

Thrush can be scraped off but oral can’t

Question 21

What is Oral hair leukoplakia caused by

Answer 21

Glandular fever (EBV virus)

If you can scrape it, could be recurrent thrush associated with HIV

Question 22

What is Kerion

Answer 22

A scalp condition caused by ringworm (can become common in HIV)

Question 23

When do we diagnose AIDS

Answer 23

CD4 < 200 or AIDS defining illness symptoms present (PCP)

Question 24

If a patient presents with Thinness, oral thrush and SpO2 has dropped to 79% on walking, what do they have

Answer 24

Pneumocystis Pneumonia (associated with HIV patients)

Question 25

Difference between PCP and common pneumonia

Answer 25

Common pneumonia only effects one area of the lung whilst PCP affects every alveoli

Question 26

What is the PCP caused by

Answer 26

Fungal

Question 27

Signs of PCP

Answer 27

1. Fever 2. Dry cough 3. Drop in SpO2

Question 28

How dow e diagnose PCP

Answer 28

1. Chest x-ray 2. Arterial blood gas to assess for hypoxia 3. Induced septum for PCR

Question 29

What is Induced Septum

Answer 29

Squirt saline into the lung and extracted to acquire sputum

Question 30

What is PCP commonly treated with

Answer 30

Antibiotic: Cotrimoxazole with Prednisolone is hypoxic

Question 31

What drug is prednisolone

Answer 31

Steroid

Question 32

Three issues with late diagnoses

Answer 32

1. Increased transmission 2. Increased morbidity 3. Increased mortality

Question 33

How is HIV TB caused

Answer 33

Acid fast bacilli

Question 34

Symptoms of HIV TB

Answer 34

Night sweats Weight Loss Productive Cough

Question 35

When does HIV TB cause issues

Answer 35

At any CD4 count - this is AIDS defining

Question 36

What requirements do all patients with TB have

Answer 36

To do a HIV test

Question 37

How do we test for acid fast bacilli at a microscopic level

Answer 37

Diehl-Neilson staining

Question 38

How does HIV effect the CNS (AIDS defining symptoms involving mass lesions)

Answer 38

1. Mass lesions leads to primary CNS lymphoma 2. Single mass with surrounding oedema - lymphocytic CSF 3. Toxoplasmosis (lesions on MRI)

Question 39

If a patient has HIV and a headache, what do we do

Answer 39

Undergo a lumbar puncture (low threshold = HIV)

Question 40

How does HIV effect the risk of cancer

Answer 40

Any cancer associated with a virus can increase in risk

Question 41

What virus is caused by EBV

Answer 41

Lymphomas in HIV (common)

Question 42

What virus is caused by Human papillomavirus

Answer 42

Cervical, anal and penile carcinoma (HIV)

Question 43

What virus is caused in individuals with HIV by hepatitis BC

Answer 43

Hepatocellular carcinoma

Question 44

What cancer is most commonly seen in HV

Answer 44

Kaposi's sarcoma

Question 45

What is Kapok's sarcoma caused by

Answer 45

Human Herpesvirus 8

Question 46

Symptoms of Karposi's sarcoma

Answer 46

Single to multiple lesions on skin

Question 47

How is Kapok's sarcoma treated

Answer 47

with HAART and chemotherapy

Question 48

Is Kaposi's sarcoma genetic

Answer 48

No

Question 49

How can HIV be managed

Answer 49

HAART (highly active anti-retroviral therapy) 3 ART drugs

Question 50

What are the three ART drugs used in HAART

Answer 50

NRTI NRTI One other

Question 51

What does HAART do

Answer 51

Surpasses viruses to undetectable levels (CD4 count high)

Question 52

Pharmacology of ART

Answer 52

ART stops active CD4 cells with HIv making anymore viruses causing load to drop by 90% in first few days

Question 53

How long does it take for an individual with a viral count of 100,00 to fall to undetectable levels

Answer 53

three months

Question 54

How common is mutation in HIV

Answer 54

1 in every 2 produced

Question 55

How do we inhibit HIv from binding to CD4 receptor

Answer 55

1. ENF and MRC Fusion inhibitors

Question 56

What is the most common drug used to treat against HIV

Answer 56

Reverse Transcriptase Inhibitors (NRTIs)

Question 57

What are the two subcategories of NRTIs

Answer 57

Pyrimidine and Purine analogues

Question 58

What is an NRTI

Answer 58

Nucleotide reverse transcriptase inhibitors: Placing a dummy nucleotide in the genome so no more can be active

Question 59

What is an NNRTI

Answer 59

Occupy the active site of reverse transcriptase and stop it from working

Question 60

What are integrate inhibitors

Answer 60

They stop Viral DNA from integrating to genome

Question 61

What are protease inhibitors

Answer 61

Prevents budding and releasing of HIV

Question 62

What is the problem of protease inhibitors

Answer 62

Can effect host proteases too

Question 63

How do HIV develop drug resistance

Answer 63

Non-adherence - Missing one or two doses Drug-drug interactions

Question 64

What happens if I give lansoprazole to a patient on rilpvirine

Answer 64

Decreases rilpvirine conc. due to increased gastric acid pH levels

Question 65

What is lansoprazole used for

Answer 65

proton pump inhibitor

Question 66

Should we co-administer Nevirpine and Itraconazole

Answer 66

No

Question 67

Should we co-administer Darunavir/Ritonavir and Clindamycin

Answer 67

No

Question 68

Should we co-administer Abacavir and Amoxicillin

Answer 68

Yes