HIV

Question 1

What is primary HIV?

Answer 1

The period immediately after exposure to virus

Question 2

When does primary HIV occur?

Answer 2

Usually occurs within 3-12 weeks of exposure

Question 3

How does HIV progress to AIDs?

Answer 3

If it occurs longer than 2 weeks or involves the CNS

Question 4

How does HIV present?

Answer 4

• Fever
• Lymphadenopathy
• Maculopapular rash
• Mucosal ulcers.
• Sore throat

Question 5

Where would you get a maculopapular rash?

Answer 5

Upper chest

Question 6

How is HIV diagnosed?

Answer 6

Test for HIV antibody with Elisa

Confirm with western blot

Question 7

What would you use to confirm the diagnosis?

Answer 7

HIV PCR and P24 antigen

Question 8

What is a CD4 count used to diagnose?

Answer 8

AIDs

Question 9

When should you test asymptomatic patients?

Answer 9

4 weeks after exposure

Question 10

What is the management of HIV?

Answer 10

Anti-Retroviral therapy

Question 11

What does antiretroviral therapy involve?

Answer 11

• Two nucleoside reverse transcriptase inhibitors (NRTI)- Zidovudine, abacavir, tenofovir
• A protease inhibitor (PI) (-navir)
• or a non-nucleoside reverse transcriptase inhibitor (NNRTI)

Question 12

What are examples of 2 nucleoside reverse transcriptase inhibitors?

Answer 12

Zidovudine
Abacavir
Tenofovir

Question 13

What are examples of protease inhibitors?

Answer 13

Saquinavir

Indinavir,

Question 14

What is an example of a non-nucleoside reverse transcriptase inhibitor (NNRTI)?

Answer 14

Nevirapine

Question 15

When do you start treatment for HIV?

Answer 15

At the time of diagnosis- don’t wait for symptoms

Question 16

What is AID’s?

Answer 16

Advanced stage of HIV

Question 17

Why does AIDs develop?

Answer 17

cART has not stopped the spread of infection.

Question 18

How is AID’s defined?

Answer 18

Evidence of an AIDS defining illness

Alongside a CD4 count of less than 200. (Normal 500-1200 cells/mm3)

Question 19

What is the most common opportunistic infection?

Answer 19

Pneumocystis Jiroveci Pneumonia

Question 20

How does Pneumocystis Jiroveci Pneumonia present?

Answer 20

Dyspnoea
Cough
Fever
Chest signs

Question 21

What is a common complication of Pneumocystis Jiroveci Pneumonia?

Answer 21

Pneumothorax

Question 22

How does Pneumocystis Jiroveci Pneumonia stain?

Answer 22

With silver stain

Question 23

What is the main investigation for Pneumocystis Jiroveci Pneumonia?

Answer 23

Chest x-ray

Bilateral pulmonary interstitial filtrates

Question 24

What is the management for Pneumocystis Jiroveci Pneumonia

Answer 24

Co-trimoxazole

Question 25

Who is prophylaxis co-trimoxazole given to?

Answer 25

To patients with a CD4 under 200/mm3 to protect against pneumocystis jirovecii pneumonia (PCP).

Question 26

What is the cause of 50% of cerebral lesions in someone with HIV?

Answer 26

Toxoplasmosis

Question 27

How does toxoplasmosis present?

Answer 27

Constitutional symptoms Headache Confusion Drowsiness

Question 28

How is toxoplasmosis diagnosed?

Answer 28

CT scan

Question 29

What would you see on a CT scan on someone with toxoplasmosis?

Answer 29

Multiple ring or nodular enhancing lesions, mass effect may be seen

Question 30

Will a thallium SPECT be positive or negative in someone with toxoplasmosis?

Answer 30

Negative

Question 31

What is the management of toxoplasmosis?

Answer 31

Sulfadiazine | Pyrimethamine

Question 32

What is the cause of 30% of cerebral lesions in HIV?

Answer 32

Primary CNS lymphoma

Question 33

How does Primary CNS lymphoma present?

Answer 33

Poorly-defined symptoms of headache and drowsiness

Question 34

What is Primary CNS lymphoma associated with?

Answer 34

Epstein- Barr virus

Question 35

How is Primary CNS lymphoma diagnosed?

Answer 35

CT head

Question 36

What would you see on a CT scan of someone with Primary CNS lymphoma?

Answer 36

Single homogenous enhancing lesions

Question 37

Will a thallium SPECT be positive or negative with HIV?

Answer 37

Positive

Question 38

What is the management of Primary CNS lymphoma?

Answer 38

Steroids Chemotherapy (e.g. methotrexate) + possible brain irradiation Surgical may be considered for lower grade tumours Commence cART and whole brain irradiation

Question 39

What is the function of steroids in Primary CNA lymphoma?

Answer 39

Reduce tumour size

Question 40

What is Kaposi's sarcoma caused by?

Answer 40

HHV-8 (human herpes virus 8)

Question 41

How does Kaposi's sarcoma present?

Answer 41

Purple papules or plaques on the skin or mucosa

Question 42

Where in the body does Kaposi's sarcoma affect?

Answer 42

Gastrointestinal and respiratory tract

Question 43

What might happen to the skin lesions caused by Kaposi's sarcoma?

Answer 43

Ulcerate

Question 44

What might respiratory involvement in Kaposi's sarcoma cause?

Answer 44

May cause massive haemoptysis and pleural effusion

Question 45

What is the management of Kaposi's sarcoma?

Answer 45

Radiotherapy and resection

Question 46

What is less common than Primary CNS lymphoma or Toxoplasmosis?

Answer 46

Tuberculosis

Question 47

How is tuberculosis diagnosed?

Answer 47

CT scan

Question 48

What would you find on a CT scan of Tuberculosis?

Answer 48

Single enhancing lesion

Question 49

What is Progressive multifocal leukoencephalopathy (PML)?

Answer 49

Widespread demyelination

Question 50

What is Progressive multifocal leukoencephalopathy (PML) due to?

Answer 50

Due to infection of oligodendrocytes by JC virus (a polyoma DNA virus)

Question 51

How does Progressive multifocal leukoencephalopathy (PML) present?

Answer 51

Behavioural changes Speech Motor Visual impairment

Question 52

How is Progressive multifocal leukoencephalopathy (PML) diagnosed?

Answer 52

CT | MRI

Question 53

What is the best method of diagnosis for Progressive multifocal leukoencephalopathy (PML)?

Answer 53

MRI

Question 54

What would you find on a CT scan if someone has Progressive multifocal leukoencephalopathy (PML)?

Answer 54

Single or multiple lesions

Question 55

What would you find on an MRI if that person has Progressive multifocal leukoencephalopathy (PML)?

Answer 55

Demyelinating white matter lesions are seen

Question 56

What is the JC virus and what does it cause?

Answer 56

A polyoma DNA virus | Causes Progressive multifocal leukoencephalopathy (PML)

Question 57

When would a pregnant woman be offered a c-section with HIV?

Answer 57

If her viral load is above 50