HIV

Question 1

What type of virus is HIV?

Answer 1

HIV is an RNA retrovirus

Question 2

What is the most common type of HIV?

Answer 2

HIV-1

Question 3

What type of HIV is mainly found in Western Africa?

Answer 3

HIV-2

Question 4

What is the pathophysiology of HIV?

Answer 4

The virus enters and destroys the CD4 T helper cells of the immune system

Question 5

How can HIV be transmitted?

Answer 5

Unprotected anal, vaginal or oral sex
Vertical transmission
Exposure to infected bodily fluids

Question 6

How does HIV replicate inside the body?

Answer 6

Once in the T helper cells, it uses the enzyme reverse transcriptase to convert viral RNA into a DNA copy

Question 7

What is HIV seroconversion?

Answer 7

When the body starts to produce antibodies to HIV
- After seroconversion, HIV can be tested for

Question 8

What are the symptoms of HIV seroconversion?

Answer 8

Flu-like illness symptoms
- Sore throat
- Lymphadenopathy
- Diarrhoea
- Malaise, myalgia
- Maculopapular rash
- Mouth ulcers

Question 9

How long after infection does seroconversion occur?

Answer 9

3-12 weeks

Question 10

What are the risk factors for HIV infection?

Answer 10

IV drug use
Homo and heterosexual unprotected intercourse
Percutaneous needlestick injury
Having another STI
Blood transfusion

Question 11

What methods are used to diagnose HIV?

Answer 11

HIV antibodies
p24 antigen

Question 12

How are HIV antibodies used to diagnose HIV?

Answer 12

ELISA test and a confirmatory Western Blot assay are used to detect antibodies to HIV

Question 13

After how long can HIV antibodies be detected in the blood?

Answer 13

Most people have antibodies by 4-6 weeks, but 99% of people have antibodies by 3 months

Question 14

How are p24 antigens used to diagnose HIV?

Answer 14

A viral core protein can be detected as RNA viral levels increase in the blood

Question 15

When can p24 antigens be detected in the blood?

Answer 15

Between 1 weeks and 3-4 weeks after infection

Question 16

How are most people diagnosed with HIV?

Answer 16

A test combining p24 antigen testing and HIV antibodies

Question 17

When should an asymptomatic patient be offered testing after a possible exposure?

Answer 17

4 weeks after the exposure
- Repeated at 12 weeks if first test is negative

Question 18

What are the differentials of HIV infection?

Answer 18

Infectious mononucleosis
CMV
Influenza
Viral hepatitis
Secondary syphilis

Question 19

What is the normal CD4 count range?

Answer 19

500-1200 cells/mm3

Question 20

Under what CD4 count puts a patient at risk of opportunistic infections?

Answer 20

200

Question 21

What is the main treatment of HIV?

Answer 21

Anti-retroviral treatment

Question 22

Who is antiretroviral treatment offered to?

Answer 22

All patients regardless of CD4 count - ART should be started as soon as a HIV diagnosis is made

Question 23

What are the classes of ART?

Answer 23

Protease inhibitors
Integrase inhibitors
Nucleoside reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Entry inhibitors

Question 24

What is the usual starting regime for HIV treatment?

Answer 24

Two NRTIs plus an additional drug (preferred combination is tenofovir/emtricitabine with a third agent)

Question 25

What additional management is required in HIV?

Answer 25

Prophylactic co-trimoxazole for patients with CD4 count under 200 Yearly cervical smears Up to date vaccinations

Question 26

When can a woman with HIV have a normal vaginal birth?

Answer 26

If viral load is under 50

Question 27

What drug can be given to a woman in labour to prevent vertical transmission?

Answer 27

IV zidovudine

Question 28

What prophylaxis may be given to a baby with a HIV positive mother?

Answer 28

Zidovudine, lamivudine and nevirapine for 4 weeks

Question 29

What is the safest advice to breastfeeding mothers that are HIV positive?

Answer 29

To avoid breastfeeding - HIV can be transmitted through breast milk

Question 30

What is PEP?

Answer 30

Post exposure prophylaxis - Given within 72 hours to patients who have been exposed to HIV

Question 31

What is the current combination of drugs used in PEP?

Answer 31

emtricitabine/tenofovir (Truvada) and raltegravir for 28 days

Question 32

What is PrEP?

Answer 32

Pre-exposure prophylaxis for HIV

Question 33

What is the current combination of drugs used in PrEP?

Answer 33

emtricitabine/tenofovir (Truvada)

Question 34

What are the most common AIDS defining illnesses?

Answer 34

Kaposi's sarcoma Pneumocystis jirovecii pneumonia Cytomegalovirus infection Candidiasis Lymphomas TB

Question 35

When should children be tested for HIV?

Answer 35

Babies to HIV positive parents When immunodeficiency is suspected Young people who are sexually active and there are concerns Needle stick injuries Sexual abuse IV drug use

Question 36

What eye conditions may be seen in someone with HIV?

Answer 36

CMV retinitis Kaposi's sarcoma HSV infection VSV infection Tuberculosis

Question 37

What is the presentation of CMV retinitis?

Answer 37

Reduced visual acuity Pizza pie appearance on fundoscopy - areas of thick white infiltrate accompanied by retinal haemorrhages

Question 38

What is the treatment of CMV retinitis?

Answer 38

Intra-ocular ganciclovir Oral valganciclovir

Question 39

What is Kaposi's sarcoma?

Answer 39

A cancer caused by HSV-8 commonly seen in patients with HIV

Question 40

Where does Kaposi's sarcoma develop from?

Answer 40

Endothelial cells - It is seen in the skin

Question 41

What is the appearance of Kaposi's sarcoma?

Answer 41

Purple papules or plaques on the skin

Question 42

What is the treatment of Kaposi's sarcoma?

Answer 42

Radiotherapy Resection

Question 43

What types of cancers is HIV associated with?

Answer 43

Anal Liver Lung Hodgkin's lymphoma Burkitt's lymphoma Kaposi's sarcoma

Question 44

What is the treatment of pneumocystis jiroveci pneumonia?

Answer 44

Co-trimoxazole

Question 45

What are the features of pneumocystis jiroveci pneumonia?

Answer 45

Bilateral bihilar interstitial infiltrates Desaturating on exertion Non-productive cough Poorly controlled HIV

Question 46

How should anti-retrovirals be taken?

Answer 46

They should be taken at the same time every day

Question 47

What opportunistic infections occur in HIV but are not AIDS defining?

Answer 47

Oral candidiasis Hairy leukoplakia Shingles Aspergillosis