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HIV Flashcards

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1
Q

What type of virus is HIV

A

Lentivirus- part of retrovirus family
Single stranded RNA
2 copies in nuclear capsid of p24 protein

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2
Q

What is classicla of retroviruses

A

Long incubation and latency

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3
Q

Targets of virus for serologic testing

A

p24 viral protein nucelar capsid
Lipid membrane evelope proteins

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4
Q

What are the only external genes on HIV

A

GP 120
3 x GP41 attachoing to lipid coat
Uses to attach to target cells

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5
Q

Major cellular targets of HIV

A

CD4 binds GP120
CD4 positive T lymphocytes, macrophages, glial cells

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6
Q

Why is reverse transcriptatse being unstable an adaptation of HIV

A

V quickly becomes drug resistant

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7
Q

3 enzymes of HIV

A

Reverse transcriptase
Integrase
Protease

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8
Q

When do antibodies to HIV become detectable in blood

A

> 2 weeks

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9
Q

ACute infection of HIV

A

Ranges in severity
Myalgia, sweats, fever
Lymphadenopathy generalised, may persist, widespread macular rash, pharyngitis
CNS - bells palsy, seizures
Diarrhoea
Mouth ulcers
After rapid reproduction in body - high levels of viraemia

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10
Q

What is seroconversion

A

Initial infection w HIV - serum becomes antibody positive
Viral load is depressed

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11
Q

Whats the median clinical latency of HIV

A

5 years

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12
Q

What does CD4 count <500 cause

A

Bacterial pneumonias egTB
Oral pharyngeal candidiaseis, OHL
Herpes zoster/shingles - recurrent, multidermatomal
Psoriasis
Diarrhoeal illness - parasitic infections eg kryptosporiasis

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13
Q

CD4 count <200 presentation

A

PMultifocal encephalopathy - JC virus
Karposis sarcoma
Pneumocystis pneumonia

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14
Q

CD4 <100 presentation

A

Cerbral toxoplasmosis
Retinitis or colitis - reactivated CMV
non TB - Mycobacterium complex eg MACC
Lyphoid malignancies eg primary CNS lymphomas

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15
Q

How predict developent of AIDS

A

CD4 count and viraemia level combined

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16
Q

What is PGL

A

Persistent generalised lympahdenopathy

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17
Q

What lesions see in karposis sarcoma

A

Highly vascular red lesions on skin and mucosal, rubbery appearnace

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18
Q

Karposis sarcoma treat

A

Retreats with antriretrovirals
If inviscera need chemo

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19
Q

What causes hairy leukoplakia

A

EBV
Immunocomp in general not just HIV
Regresses once immune system reovers

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20
Q

Staging of HIV

A

I - asymptomatic
II - minor symptoms
III - moderate dymptoms
IV - AIDS defining illness

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21
Q

Typical diseases of Stage I HIV

A

Mo symptoms
PGL

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22
Q

Typical diseases Stage II hIV

A

Cutaneous manifestation folliculitis, dermatomal herpes varicella zoster

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23
Q

Typical diseases Stage III HIV

A

Oral candidiasis, oral hairy leukopenia, pulmonary TB

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24
Q

Typical diseases Stage IV HIV

A

Karposis sarcoman, oral KS MAC, severe chronic herpes ulcers, tozoplasmosis, cryptococcus

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25
CD4 counts in each stage of HIV
1 >500 2 - 500-350 3 - 350 TO 250 4 - <200
26
Vrial load and stage of HIV
I - 10^3 - 0.000000010 II - 10^3 to 10^4 III - 10^4 to 10^5 IV - 10^5 -10^6
27
Life cycle of HIV
Fusion w CD4 positive T cell Reverse transcription HIV RNA -> proviral DNA Integration Maturation and polyprotein cleavage Co-receptor binding
28
What drugs target reverse transcription of HIV
Nucleoside reverse transcriptase inhibitors
29
START study
Immediate treatment reduces death and serious complications by half Prev onl treat if CD4<350
30
Combination therapy for HIV what is used
Two different NRTIs and a third agent from another class
31
Preferred tratment HIV
Tedofovir + FTC ATV/r, DRV/r - protease inhibiors EVG/COBI, RAL - integrase inhibitors
32
Why need multi therapy treatments for HIV
Mutations accumulate within person themselves from reverse transcriptase Multiple strains of HIV circulating
33
Speed of HIV mutation is dependent on...
The viral load 300,000 one mitation in hours 30 - 2.5 years before mutation
34
What is blurring on optic disc known as
Papilloedema - can be due to raised ICP
35
Differentials for raised ICP
Space occupying lesion CNS inflammation eg meningitis
36
HIV positive further test
CD4 count to quantify
37
What are raised lymphocytes on CSF a signal of
Viral, fungal, treponemal + mycpbacterial, AI conditions, paraneoplastic
38
What do to investigate atypical infections of CSF
ZN (Tb) India ink - cryptococcus PCR culture
39
What stain use for cryptococcus
India ink Encapsulated yeast
40
Treatment for crytpococaal meningiits
Lisposomal amphotericinB and flucytosine then oral fluconazole Co-trimaxaxole prophylaxis for PCP
41
What give prophylactivally when CD4 count under 200 resp
Co-trimaxaxole prophylaxis for PCP
42
When should you start ART opportunistic infections
within 2 weeks
43
Why sometimes delay ART therapy w opportunistic infection HIV
delay 5 weeks w eg cryptococcal meninigitis risk of IRIS
44
What is IRIS
Immune reconstitution infllammatory syndrome Failing immune system recovers -> exaggerated inflammatory responses
45
Types of IRIS
Paradoxical and unmasking Paradoxical - Inflam response to known opportunistic infection becomes more pronounced Unmasked - no evidenev of opportunistic infection until immune system improves -> signs and symptoms emerge
46
Treatment IRIS
NSAIDs or steroids Can be dangerous
47
tYPES OF CRYPTOCOCCUS
C.neoformans var neoformas/gattii/grubii C gattii: infection rare in ummunocompetent hosts var neoformans is found worldwide (pigeon droppings) var gattii: Tropical and sub-tropical (eucalyptus trees)
48
Risk factors for cryptococcal infection
T cell depletion eg HIV, haemotological disorders, iatrogenic immunosupression, steroids, Hodgkins lymphoma
48
Route of cryptococcal infection
Inhalation
49
Features of OHL vs oral candidiasis
OHL-> White linear/shaggy or hairy appearance Non tender Can’t be scrapped off Usually on sides of the tongue
50
What causes oral hairy leukopenia
EBV Indicates immunosupression
51
How confirm PCP diagnosis
Deep sputum sample - induced sputum or Bronchoscopic alveolar lavage - BAL Staining and sluroscopuc examination for cysts
52
Treatment PCP
High dose Co-trimoxazole and steroids
53
Clinical features of PCP
Dry cough Fevers Malaise Weight loss Exertional dyspnoea/de-saturation Hypoxia
54
Investiagtion results in PCP - ABG, CXR, BAL
Hypoxia/T1 resp failure CXR - diffuse intersitial infiltrates with bat wing distribution, 1/4 normal if early BAL - PJP oocysts
55
What is ring enhancing lesion on CT head
Oedema around lesion - suggests reactive inflammation Metabolically active lesions eg abscesses, tumours, parasites
56
Common causes of neurological deficits in advanced HIV
Cerebral toxoplasmosis CNS lymphoma Tuberculoma Primary brain tumour, cerebral metastases PML, cryptococcus and syphilis can rarely cause SOLs
57
What is IGRA
Interferon gamma release assay
58
What does IGRA measure
Blood test measures production of IG by T cells - increases if T cells exposed to TB antgens, therefore diagnoses latent TB or TB expisyre
59
What test tests for TB latent or exposure
IGRA
60
How get definitive diagnosis of toxoplasmosis
Brain biopsu - high risk
61
Treatment for toxoplasmosis
2 weeks sulphadiazone and pyrimthamine Trial and repeat imaging in 2 weeks If no improvement - brain biops for lymphoma
62
What causes toxoplasmosis
Toxoplasma gondii Protazoan parasite
63
Route of transmission of toxoplasmosis
Eating undercooked meat of animals with tissue cysts Food or water w cat faeces or contaminated encironemntal samples eg soil, litter box Blood transfusion or organ transplantiton Transplacentally
64
How can toxoplasmosis present in immmunocompromised patients
Glandular fever like Myalgai, lymphadenopathy May go unnoticed, lie dormant and reactivate Causes CNS comps space occpying lesinos/chorioretinitis
65
Toxoplasmosis pregnancy
COngenital infection - miscarriage, stillbirth, severe disability
66
What does toxoplasma cause in CNS immunocomp patients
Reactivation - space occupying lesions Multiple and concentrated round basal ganglia Rim enhances w IV contrast
67
When can or0-pharyngeal candidiasis occur
Recent anibitocis or incorrect steroid inhaler use HIV immunocompromise
68
Cause of kaposis sarcoma
HHV 8 - human herpes virus 8
69
What is kaposis sarcoma
Skin cancer ass w AIDs causing purple brown raised lesions on lower limbs or head an neck but can be anywhere If visceral - bronchial walls, haemoptysis/dyspnoea GI tract - haematemesis, dysphagia, bowel obstruction, melaena
70
Treatment kaposis sarcoma
If only skin may regress w antiretrovirals If visceral or extenisve - chemotherapy
71
What weight loss is definitive for AIDs
>10% BW loss
72
What parasite GI tract is AIDs efining
Cryptosporidiosis (self limiting if immunocompetent) If persistent = AIDs defining
73
Causes of diarrhoea in HIV bacteria
Campylobacter C difficile E coli Salmonella Sjigella Myconbacterium TB Mycobacteruum avium intracellulareae
74
Parastitic causes of iarrhoea HIV
Cryptosporidium Cyclospora Cayetaness Giardia amlia Entamoeba histolytica Isospora belli Microsporidia Strongyloides stercoralis
75
Virus and other causes of diarrhoea HIV
CMV HSV Rotavirus Norovirus ART Kaposis sarcoma Non hodgkin and hodgkin lymphoma
76
How cryptosporidium contracted
Protozoan parasite - drinking water contaminated with oocysts Not killed chlorine If immunocompetent normally clear without treatment Treat w ART
77
When test for HIV in patients
TOP/GUM/ante-natal/drug dependency/TB.hepatitis/lymphoma services All medical admissions >2/1000 prevalence of HIV All adults register w GP Indicator diseases/AIDs defining condition
78
AIDs defining conditions
TB, PCP Cerebral Toxoplasmosis, Cryptococcal meningits, PML Karposi Sarcoma Persistent cryptosporidiosis NHL Cervical cancer CMV retinitis
79
Examples of entry inhibitors
Maraviroc -CCR5 Enfuviritide - gp41 Prevent HIV entry into cells therefore infection
80
Examples of integrase inhibitors
Raltegravir, elvitegravir, dolutegravir
81
NRTI examples
zidovudine (AZT), abacavir, emtricitabine, didanosine, lamivudine, stavudine, zalcitabine, tenofovir
82
Tenofovir side effects
Renal impairment Osteoporosis
83
General NRTI side effect
Peripheral neuropathu
84
NNRTI examples and side effects
Nevirapine - CYP450 inducer Efavirenz Rashes
85
Protease inhibitors examples
Indinavir, nefanivir, retionavir, saquinavir
86
Side effects of protease inhibtiors
DM, hyperlipidaemia, buffalo hump, central obestiy, P45- inhibitors Indaniviri - renal stones, increased bilirubin Retinovir is esp potent P450 inhibitor

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