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HIV Flashcards

1
Q

what does HIV cause

A

Acquired Immunodeficiency Syndrome (AIDS)

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2
Q

how is AIDS preventable

A

early HIV diagnosis

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3
Q

what is HIV

A

retrovirus

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4
Q

what is the target site for HIV

A

CD4+ receptors

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5
Q

where are CD4+ receptors found

A

T helper lymphocytes (“CD4+ cells”)
Dentritic cells
Macrophages
Microglial cells

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6
Q

what is the function of CD4+ Th lymphocytes

A

Essential for induction of adaptive immune response

  • Recognition of MHC2 antigen-presenting cel
  • activate B cells
  • activate cytotoxic T-cells [CD8+]
  • cytokine release
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7
Q

what affects does HIV infection have on immune response [5 things]

A

Reduced circulating CD4+ cells

Reduced proliferation of CD4+ cells

Reduction CD8+ (cytotoxic) T cell activation

Reduction in antibody class switching = Reduced affinity of antibodies produced

Chronic Immune Activation

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8
Q

what does the affect on the immune response that HIV has make people susceptible to

A

viral infections
fungal infections
mycobacterial infections
infection-induced cancers

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9
Q

what is the normal CD4+ Th cell parameters

A

500-1600

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10
Q

when is there a risk of opportunistic infections

A

when CD4+ Th cell < 200

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11
Q

what are the key features of HIV viral replication

A

rapid replication in very early and very late infection

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12
Q

what cells does the HIV virus first infect

A

mucosal CD4 cells [Langerhans and Dendritic cells]

transported to regional lymph nodes

infection established within 3 days of entry

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13
Q

when can post-exposure prophylaxis be given and why

A

within 72 hours of exposure

as the infection needs 3 days to become established

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14
Q

when does the primary HIV infection symptoms occur

A

2-4 weeks after infection

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15
Q

what are the Sx seen in the primary HIV infection period

A 
fever
maculopapular rash
myalgia 
pharyngitis 
headache/aseptic meningitis
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16
Q

why are people in the primary HIV infection stage high risk

A

they have high viral load

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17
Q

what is happening during asymptomatic HIV infection

A

Ongoing viral replication
Ongoing CD4 count depletion
Ongoing immune activation

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18
Q

what is the definition of an opportunistic infection

A

infection caused by a pathogen that does not normally produce disease in a healthy individual

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19
Q

what type of pneumonia is seen in HIV

A

pneumocystis pneumonia

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20
Q

what organism causes pneumonia and what CD4 threshold is needed for it to cause Sx

A

Pneumocystis jiroveci

< 200

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21
Q

Sx of pneumocystis pneumonia

A

insidious onset
SOB
dry cough

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22
Q

Signs of pneumocystis pneumonia

A

exercise desaturation - when oxygen saturations drop after exercise

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23
Q

what Ix can be done of pneumocystis pneumonia

A

CXR = may be normal, interstitial infiltrates, reticulonodular marking

Diagnostic = Bronchoalveolar lavage and immunofluorescence +/- PCR

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24
Q

Tx of pneumocystis pneumonia

A

high dose co-trimoxazole +/- steroids

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25
what forms of TB are HIV +ve more prone to
``` Symptomatic primary infection Reactivation of latent TB Lymphadenopathies Miliary TB Extrapulmonary TB Multi-drug resistant TB ```
26
what organism causes Cerebral toxoplasmosis and what CD4 threshold is require for it to appear
Toxoplasma gondii = fungal infection < 150
27
what is seen on CT of Cerebral toxoplasmosis
multiple ring enhancing lesions
28
Sx of Cerebral toxoplasmosis
``` Headache Fever Focal neurology (weakness, sensory problem) Seizures Reduced consciousness Raised ICP ```
29
when does CMV cause Sx in HIV
when CD4 <50
30
what does CMV cause
retinitis colitis oesophagitis
31
how does CMV present
``` reduced visual acuity floaters abdo pain diarrhoea PR bleeding ```
32
what is offered to HIV patients to try prevent serious Sx of CMV
Ophthalmic screening for all individuals with CD4 <50
33
what skin infections are common in HIV
``` herpes zoster herpes simplex HPV Penicilliosis Histoplasmosis ```
34
what form of HIV is associated with "HIV-associated neurocognitive impairment"
HIV-1
35
what CD4 threshold in HIV-associated neurocognitive impairment seen
ANY increased incidence with increased immunosuppression
36
Sx of HIV-associated neurocognitive impairment
Reduced short term memory | +/- motor dysfunction
37
what organism causes Progressive multifocal leukoencephalopathy and what CD4 threshold is it seen
JC virus < 100
38
Sx of Progressive multifocal leukoencephalopathy
Rapidly progressing Focal neurology Confusion Personality change
39
what is "Slim's disease"
HIV-associated wasting/cachexia
40
what are the cancers related to AIDS
Karposi's sarcoma Non-Hodgkins lymphoma Cervical cancer
41
what organism is associated with Kaposi's sarcoma and at what CD4 threshold is it seen
Human herpes virus 8 (HHV8) Any however, increased incidence with increased immunosuppression
42
what is the pathology of a Kaposi's sarcoma
vascular tumour
43
where can kaposi's sarcoma occur
cutaneous mucosal visceral - pulmonary, GI
44
kaposi's sarcoma Tx
HAART Local therapies Systemic chemotherapy
45
excluding opportunistic HIV, what can be seen in symptomatic HIV
``` Mucosal candidiasis Seborrhoeic dermatitis Diarrhoea Fatigue Worsening psoriasis Lymphadenopathy Parotitis ```
46
what haematology manifestations are seen in HIV
anaemia | thrombocytopenia [commonly ITP]
47
through what ways is HIV transferred
sexual transmission parenteral transmission mother-to-child
48
how can HIV be transferred mother-to-child
In utero/trans-placental Delivery Breast-feeding
49
where is there opt-out HIV testing
``` Abortion services GUM clinics Drug dependency services Antenatal services Assisted conception services ```
50
what are the high risk groups that are screened for HIV
``` MSM Females of bisexual partners IVDU Partners of people with HIV Adults from endemic areas Children from endemic areas Sexual partners from endemic areas ```
51
what are the endemic areas of HIV
Sub-Saharan Africa Caribbean Thailand
52
what markers are used by the lab to detect HIV infection
RNA p24 antigen HIV-1 and HIV-2 [IgM and IgG] antibody (only positive after 3 months of being infected)
53
what is currently the best test to date for HIV
4th gen HIV test combined antibody and antigen (p24)
54
how can the 4th gen HIV test be interpreted
A negative 4th generation test performed at 4 weeks following an exposure is highly likely to exclude HIV infection
55
what is HAART
Highly active anti-retroviral therapy i.e. a combination of 3 drugs from at least 2 drug classes to which the virus is susceptible
56
what is the purpose of HAART therapy
Reduce viral load to undetectable Restore immunocompetence Reduce morbidity and mortality Minimise toxicity (maximise tolerability)
57
what are examples of single tablet formulations of HAART
Tenofovir Emtricitabine Efavirenz
58
what are examples of HAART side effects
``` GI = nausea, diarrhoea, abdominal pain, vomiting Skin = rash, hypersensitivity, Stevens-Johnsons syndrome CNS = mood changes, psychosis Renal = proximal renal tublopathies Bone = osteomalacia CVS = increased MI risk Haematology = anaemia ```
59
what are conception options for HIV couples where male is +ve, female is -ve
Timed unprotected sex with HAART | Treatment as Prevention
60
what are conception options for HIV couples where female is +ve, male is -ve
self-insemination timed unprotected sex with HAART Tx as prevention
61
what can be done to prevent transmission of HIV from mother to child
HAART during pregnancy Vaginal delivery if undetected viral load Caesarean section if detected viral load 4/52 Post-Exposure Prophylaxis for neonate Exclusive formula feeding

Reproduction SB (30 decks)

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