HIV Flashcards by Zoe Doak

Factors which reduce vertical HIV transmission in pregnancy

maternal antiretroviral therapy (zidovudine)
caesarean section
neonatal antiretroviral therapy (zidovudine)
bottle feeding

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CMV retinitis affects HIV patients with a CD4 count below what level?

< 50

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Clinical features of CMV retinitis

‘blurred vision’
retinal haemorrhages/ necrosis on fundoscopy

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Management of CMV retinitis in HIV

IV ganciclovir

alternative: IV foscarnet or cidofovir

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Causes of diarrhoea in HIV

HIV enteritis

Opportunistic infections:
- Cryptosporidium + other protozoa
- CMV
- Mycobacterium avium intracellulare
- Giardia

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Below what CD4 count in HIV does Mycobacterium avium intracellulare cause infection?

< 50.

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Clinical features of Mycobacterium avium intracellulare in HIV

fever
sweats
abdominal pain
diarrhoea

may be hepatomegaly and deranged LFTs

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Diagnostic investigations for mycobacterium avium intracellulare

blood cultures
bone marrow examination

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Management of mycobacterium avium intracellulare

Rifabutin
ethambutol
clarithromycin

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Vaccines given to ALL HIV infected adults

Hepatitis A
Hepatitis B
Haemophilus influenzae B (Hib)
Influenza-parenteral
Japanese encephalitis
Meningococcus-MenC
Meningococcus-ACWY I
Pneumococcus-PPV23
Poliomyelitis-parenteral (IPV)
Rabies
Tetanus-Diphtheria (Td)

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Vaccines given to HIV patients with CD4 counts <200

Measles, Mumps, Rubella (MMR)
Varicella
Yellow Fever

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Vaccines which are contraindicated in HIV

Cholera CVD103-HgR
Influenza-intranasal
Poliomyelitis-oral (OPV)
Tuberculosis (BCG)

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What viral infection causes Kaposi’s sarcoma in HIV patients?

HHV-8 (human herpes virus 8)

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purple papules or plaques on the skin or mucosa (e.g. GI and respiratory tract)

Respiratory involvement may cause massive haemoptysis and pleural effusion

Kaposi’s sarcoma

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Management of Kaposi’s sarcoma

radiotherapy + resection

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Typical combination of drugs used in anti-retroviral therapy

3 drug combo

2 nucleoside reverse transcriptase inhibitors (NRTI)

+ protease inhibitor (PI)
OR
+ non-nucleoside reverse transcriptase inhibitor (NNRTI)

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These agents prevent HIV-1 from entering and infecting immune cells

Entry inhibitors

maraviroc
enfuvirtide

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Examples include:
- zidovudine
- zalcitabine
- tenofovir

Nucleoside analogue reverse transcriptase inhibitors (NRTI)

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nevirapine, efavirenz

Non-nucleoside reverse transcriptase inhibitors (NNRTI)

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Examples include:
- indinavir
- nelfinavir
- ritonavir

Protease inhibitors (PI)

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These antivirals blocks the insertion of the viral genome into the DNA of the host cell

Integrase inhibitors

e.g. raltegravir, elvitegravir, dolutegravir

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NRTI side effects

Peripheral neuropathy

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NNRTI side effects

P450 enzyme interaction
Rash

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Protease inhibitor side effects

Study These Flashcards

diabetes
hyperlipidaemia
buffalo hump
central obesity
P450 enzyme inhibition

Common cause for cerebral lesions in HIV

Toxoplasmosis

Presentation of toxoplasmosis in HIV

Constitutional symptoms - headache - confusion - drowsiness

Appearance of Toxoplasmosis on CT

single or multiple ring enhancing lesions +/- mass effect

Management of Toxoplasmosis in HIV

sulfadiazine and pyrimethamine

Causes of viral encephalitis in HIV?

CMV HIV itself HSV (rare)

Viral encephalitis appearance on CT?

oedematous brain

Most common fungal infection of CNS in HIV

Cryptococcus CSF high opening pressure elevated protein reduced glucose normally a lymphocyte predominance but in HIV white cell count many be normal India ink test positive CT: meningeal enhancement, cerebral oedema meningitis is typical presentation but may occasionally cause a space-occupying lesion

Clinical features of cryptococcus infection

headache fever malaise nausea/vomiting seizures focal neurological deficit

CSF findings in cryptococcus infection in HIV

high opening pressure high protein low glucose lymphocyte predominance India ink test positive

CT findings in cryptococcus infection

meningeal enhancement cerebral oedema

Viral cause of Progressive multifocal leukoencephalopathy (PML)

JC virus (a polyoma DNA virus)

Pathopysiology of Progressive multifocal leukoencephalopathy

infection of oligodendrocytes => widespread demyelination

Symptoms of Progressive multifocal leukoencephalopathy

behavioural changes speech/motor/visual impairment

CT / MRI findings in Progressive multifocal leukoencephalopathy

CT: - single or multiple lesions - no mass effect - lesions don't enhance. MRI - high-signal where demyelinating white matter lesions are seen

CT appearances in AIDS dementia complex

cortical and subcortical atrophy

Common infections in HIV if CD4 count 200-500 cells

Thrush (Candida) Shingles (herpes zoster) Hairy leukoplakia (EBV) Kaposi sarcoma (HHV-8)

Common infections in HIV if CD4 count 100-200 cells

Cryptosporidiosis Toxoplasmosis Progressive multifocal leukoencephalopathy (JC virus) Pneumocystis jirovecii pneumonia (PJP)

Common infections in HIV if CD4 count 50-100 cells

Aspergillosis Oesophageal candidiasis Cryptococcal meningitis Primary CNS lymphoma (EBV)

Common infections in HIV if CD4 count <50

CMV retinitis Mycobacterium avium-intracellulare

What type of organism is PJP?

unicellular eukaryote - classified as a fungus but some consider it a protozoa

Features of PJP infection

dyspnoea dry cough fever very few chest signs

Common complication of PJP which causes dyspnoea and acute chest pain

Pneumothorax

Extrapulmonary manifestations of PJP

hepatosplenomegaly lymphadenopathy choroid lesions

CXR findings in PJP

- bilateral interstitial pulmonary infiltrates - lobar consolidation - May be normal

Diagnostic investigation for PJP

- bronchoalveolar lavage (silver stain shows characteristic cysts)

Management of PJP

co-trimoxazole IV pentamidine in severe cases steroids if hypoxic (reduce risk of respiratory failure)

How does HIV seroconversion typically present?

glandular fever-type illness - sore throat - lymphadenopathy - malaise, myalgia, arthralgia - maculopapular rash - mouth ulcers

When does HIV seroconversion usually occur?

3-12 weeks after infection

Tests used to diagnose HIV

HIV antibody and HIV antigen - most develop antibodies at 4-6 weeks but 99% do by 3 months HIV RNA (qualitative or quantitative) - useful for diagnosis of neonatal HIV infection and screening blood donors

What type of virus is HIV?

RNA retrovirus of the lentivirus genus (long incubation period)

Which subtype of HIV has a lower transmission rate anf slower progression to AIDS?

HIV-2 (more common in west Africa)

What types of white cells can HIV infect?

CD4 T cells macrophages dendritic cells

How does HIV replicate in the host?

reverse transcriptase creates dsDNA from the RNA for integration into the host cell's genome

HIV Flashcards

(58 cards)