HIV

Question 1

Which cells express CD4? (4)

Answer 1

Th cells
Macrophages
Monocytes
Macroglia

Question 2

Normal range of CD4+ Th cells

Answer 2

500-1600 cells/mm3

Question 3

What range of CD4+ predisposes to opportunistic infections?

Question 4

When are HIV replication rates highest?

Answer 4

Very early and very late infection

Question 5

Outline how a person becomes infected with HIV (5)

Answer 5

Exposure to virus in mucosal surface
Mucosal CD4 cells become infected
Migrate to regional lymph nodes
Virus replicates
Infection is disseminated

Question 6

The four main stages of HIV infection

Answer 6

1. Seroconversion illness
2. Asymptomatic illness
3. Symptomatic infection
4. AIDS

Question 7

How long after infection does the initial seroconversion illness manifest?

Answer 7

About 2-4 weeks

Question 8

What are the symptoms of seroconversion?

Answer 8

glandular fever-like illness- rash, fever, myalgia, pharyngitis, headache

Question 9

What are the manifestations of symptomatic infection prior to AIDS? (2)

Answer 9

General systemic symptoms

Minor opportunistic infections

Question 10

What is the definition of an opportunistic infection?

Answer 10

Infection caused by a pathogen which does not normally cause disease in a healthy individual

Question 11

Hamatological manifestations of HIV/AIDS (2)

Answer 11

Anaemia

Thrombocytopenia

Question 12

Causative organism of pneomocystis pneumonia

Answer 12

Pneomocystic jiroveci

Question 13

Examples pulmonary OIs (4)

Answer 13

TB
Bacterial pneumonia
Pneumocystic pneumonia
Mycobacterium avium

Question 14

What is miliary TB?

Answer 14

Disseminated TB characterized by tiny lesions

Question 15

OI which causes multiple cerebral abscesses

Answer 15

Toxoplasmosis (toxoplasma gondii)

Question 16

OI which causes reduced visual acuity and floaters

Answer 16

CMV

Question 17

Types of meningitis seen in AIDS (3)

Answer 17

Viral
Aseptic
Cryptococcal

Question 18

Caused by the John Cunningham virus

Answer 18

Progressive multifocal leukoencephalopathy

Question 19

Symptoms of HIV-associated encephalopathy (2)

Answer 19

Reduced short term memory, motor problems

Question 20

Cancers associated with AIDS (3)

Answer 20

Kaposi sarcoma
Non-Hodgkins lymphoma
Cervical cancer

Question 21

What is Slim’s disease and what is thought to cause it?

Answer 21

HIV-associated wasting

Chronic immune activation; anorexia; malabsorption; hypogonadism

Question 22

What causes Kaposi sarcoma?

Answer 22

Human herpes virus 8

Question 23

Where are Kaposi sarcoma seen? (3)

Answer 23

Skin
Mucuous membranes e.g. mouth
Visceral e.g. lungs, gut

Question 24

Hamatological manifestations of HIV/AIDS (2)

Answer 24

Anaemia

Thrombocytopenia

Question 25

Commonest mode of transmission of HIV

Answer 25

Sexual transmission

Question 26

Factors which increase the risk of sexual transmission (4)

Answer 26

Anoreceptive sex Genital ulceration Trauma Concurrent STI

Question 27

Means of parenteral transmission (3)

Answer 27

"Works" sharing Infected blood products Iatrogenic

Question 28

What are the chances of at-risk children contracting HIV?

Answer 28

1/4

Question 29

How can HIV be transferred mother to child? (3)

Answer 29

Transplacenta Trauma during delivery Breastfeeding

Question 30

Why is the prevalence of HIV increasing while the incidence falls?

Answer 30

More people living with HIV- fewer people progressing early to AIDS/death

Question 31

In which groups is the prevalence of HIV highest?

Answer 31

Men who have sex with men (MSM) and Black African men and women

Question 32

Which group are most likely to be undiagnosed/present late?

Answer 32

Heterosexual men

Question 33

Four general scenarios where testing is recommended

Answer 33

In high prevalence areas (inc Tayside) In particular services (e.g. GUM, TOP, drug dependency clinics) High risk groups (MSM and their female partners, IVDU) Where HIV falls into the differential

Question 34

Prophylaxis of PCP

Answer 34

Co-trimoxazole 480mg daily

Question 35

What is highly active anti-retroviral therapy?

Answer 35

Combination of three drugs from at least two anti-viral classes

Question 36

In what two ways are the chances of preventing resistance enhancced?

Answer 36

Multi drug treatment | Ensuring adherence

Question 37

Three strategies for partner notification

Answer 37

Patient referral Provider referral Conditional referral

Question 38

Strategies to prevent onward transmission (5)

Answer 38

``` Condom use HAART to suppress viral load partner disclosure scale up testing programmes PEP/ PrEP ```

Question 39

Fertility options for serodiscordant couples (3)

Answer 39

Sperm washing with IUI/IVF Timed sex with HAART +/- PrEP Self-insemination

Question 40

How should the baby be delivered to prevent MTCT? (2)

Answer 40

Vaginal delivery if undetectable viral load | C-section if detectable

Question 41

Length of PEP for neonates?

Answer 41

4 weeks

Question 42

What did the HPTN-52 trial show?

Answer 42

Early HAART reduced sexual transmission in serodiscondart couples by 95% compared to untreated