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Flashcards in FN: HIV Deck (20):
1

Immunology

1. HIV binds via gp 120 to CD4 - Th cells, monocytes, macrophages, neural cells

2. CD4+ cells migrate to lymphoid tissue where virus replicates --> infectino of new CD4+ cells
3. Depletion and impaired function of CD4+ cells - immune dysfunction

2

Virology

1. RNA retrovirus
2. After entry, viral reverse transcriptase makes DNA copy of viral RNA genome
3. Viral integrase enzyme integrates this with host DNA
4. Core viral proteins synthesised by host and then cleaved by viral protease into mature subunits
5. Completeed virions released by budding

3

Natural Hx

1. Acute infection: usually asympto
2. Seroconversion
3. Asymptomatic infection

4

Seroconversion

1. Transient illness 2-6 wks after exposure
2. Fever, malaise, myalgia, pharyngitis, macpap rash
3. Rarely meningoencephalitis

5

Asymptomatic infections

But 30% will have PGL
-Notes >1 cm in diameter
- >2 extra-inguinal sites
- >3mo

6

AIDS related Complex

1. AIDS prodrome
2. Constitutional symptoms: fever, night sweats, wt. loss
3. Minor opportunistic infections
-Oral candida
2. Oral hairy leukoplakia (EBV)
3. Recurrent HSV
4. Seborrhoeic dermatitis

7

AIDS

Defining illness
CD4 usually

8

OTher effects of HIV

1. OSteoporosis
2. Dementia
3. Neuropathy
4. Nephropathy

9

Diagnosis

1. ELISA: detect serum (or salivary) anti-HIV abs
2. Western Blot: for confirmation
3. PCR: can detect HIV virions in the windown period
4. Rapid antibody tests: false positives are a problem and results should be confirmed by western blot

10

Recent exposure window for diagnosis

Usually 1-3 wks
Can be 3-6 months

11

Investigations

1. HIV diagnostic tests
2. Drug resistance studies e.g. genotyping for reverse transcriptase or protease mutations
3. Mantoux test
4. Serology: toxo, CMV, HBV, HCV, syphilis

12

Monitoring

CD4 count
Viral load (HIV RNA)
FBC, U+E, LFTs, lipids, glucose

13

HAART indications

CD4

14

REgimens

1 NNRTI + 2 NRTIs
PI+ 2 NRTIs

15

1 NNRTI + 2 NRTIs

NNRTI - efavirenz
NRTI - emtricitabine + tenofovir (Truvada)
Atripla - efavirenz + emtricitabine + tenofovir

16

PI + 2 NRTIs

PI = lopinavir (+ low dose ritonavir = kaletra)

17

Aim of Regimens

1. Undetectable VL after 4mo
2. If VL remains high despite good compliance
- Change to a new drug combination
- Request resistance studies

18

Prophylaxis

CD4

19

HIV exposure

1. Seroconversion post-needle-stick = 0.3% (1/300)
2. Report to occupational health
3. Immunise agaisnt hep B (active + passive)
4. TEst blood form both parties: HIV, HBC, HCV
5. Repeat recipient testing @ 3 and 6mo

20

Pep start and used for

Start PEP in high-risk exposure form HIV+ or unknown source

Start ASAP as possible
Continue for at least 28d
E.g. Truvade + Kaletra

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