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HIV Flashcards

1
Q

which HIV group is more virulent

A

HIV-1

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2
Q

what is the target site for HIV

A

CD4+ receptors

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3
Q

what is CD4

A 
glycoprotein found on the surface of a range of cells including 
T helper lymphocytes 
dendritic cells 
macrophages 
microglial cells
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4
Q

what do CD4+ Th lymphocytes do

A

essential of induction of adaptive immune response

  • recognition of MHC2 antigen-presenting cell
  • activation of B cells
  • activation of cytotoxic T cells
  • cytokine release
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5
Q

how does HIV effect the immune response

A
  • sequestration of cells in lymphoid tissue (reduced circulating CD4+ cells)
  • reduced proliferation of CD4+ cells
  • reduction of CD8+ T cell activation (dysregulated expression of cytokines and increasing susceptibility to viral infections)
  • reduction in antibody class switching (reduced affinity of antibodies produced)
    chronic immune activation
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6
Q

normal CD4+ Th cell levels

A

500-1600 cells/mm^3

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7
Q

level of CD4+ cells with risk of opportunistic infections

A

<200 cells/mm^3

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8
Q

when is HIV replication fastest

A

very early and very late infection

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9
Q

how often is a new generation of HIV produced

A

every 6-12 hours

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10
Q

what is the average time to death without treatment

A

9-11 years

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11
Q

pathogenesis of HIV infection

A

infection of mucosal CD4 cell (langerhans and dendritic cells)
transport to regional lymph nodes
infection established within 3 days of entry
dissemination of virus

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12
Q

average onset of HIV symptoms

A

2-4 weeks post infection

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13
Q

primary HIV infection presentation

A 
fever
maculopapular rash
myalgia 
pharyngitis 
headache 
aseptic meningitis
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14
Q

what occurs during asymptomatic HIV infection (after initial presentation)

A

ongoing viral replication
ongoing CD4 count depletion
ongoing immune activation
risk of onward transmission if remains undiagnosed

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15
Q

what is an opportunistic infection

A

an infection caused by a pathogen the does not normally produce disease in a health individual

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16
Q

opportunistic pneumonia

A

pneumocystis jiroveci

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17
Q

signs/symptoms of pneumocystis pneumonia

A

insidious one
SOB dry cough
exercise desaturation

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18
Q

treatment of pneumocystis pneumonia

A

high dose cotrimoxazole (+/- steroid)

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19
Q

types of TB more common in HIV+ individuals

A 
symptomatic primary infection 
reactivation of latent TB
lymphadenopathies 
miliary TB
extrapulmonary TB
multi-drug resistant TB
immune reconstitution syndrome
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20
Q

presentation of cerebral toxoplasmosis

A 
headache 
fever 
focal neurology 
seizures 
reduced consciousness
raised ICP
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21
Q

presentation of CMV

A

reduced VA
floaters
abdo pain/diarrhoea/PR bleeding

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22
Q

skin infections associated with HIV

A 
HZV
HSV
HPV
penicilliosis 
histoplasmosis
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23
Q

presentation of HIV-associated neurocognitive impairment

A

reduced short-term memory

+/- motor dysfunction

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24
Q

presentation of progressive multifocal leukoencephalopathy

A

rapidly progressing
focal neurology
confusion
personality change

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25
what is 'slim's disease'
HIV-associated wasting
26
AIDS related cancers
kaposi's sarcoma (vascular tumour) non-hodgkins lymphoma cervical cancer
27
factors increasing sexual transmission risk
unreceptive sex trauma genital ulceration concurrent STI
28
forms of parenteral transmission
infection drug use (sharing needles etc) infected blood products iatrogenic
29
how can HIV be transmitted from mother to child
in utero/trans-placental delivery breast-feeding
30
likelihood of an at-risk baby becoming infected
1/4
31
group most at risk of HIV (UK)
MSM
32
what percentage of people with HIV are undiagnosed
17%
33
which group is most likely to be undiagnosed
heterosexual men
34
who should be tested for HIV
universal testing in high prevalence areas opt-out in certain clinical settings screening of high risk groups testing in the presence of 'clinical indicators'
35
high risk groups that should be screened regularly
MSM females with bisexual male partners PWIDs partners of people with HIV
36
endemic areas
sub-saharan africa caribbean thailand
37
what is needed for a HIV test
venous blood sample for serology
38
which markers are highest in the first 3 months of infection
viral load | p24 (antigen)
39
which markers are highest in chronic infection
antibody
40
which markers are highest in late disease
antibody and viral load
41
what do HIV antibody tests detect
HIV-1 and HIV-2 antibody | IgM and IgG
42
which test has a shorter window period
4th generation HIV test
43
what is the difference between 3rd and 4th generation HIV test
``` 3rd generation - antibody only - window period 20-25 days 4th generation - antibody and antigen - shorter window period (14-28 days) ```
44
a negative 4th generation test performed at ___ weeks after exposure is highly likely to exclude HIV infection
4 weeks
45
what is a rapid HIV test
fingerprick specimen or saliva results within 20-30 minutes 3rd/4th generation wide variation in performance
46
advantages of rapid HIV test
``` simple to use no lab required no venipuncture required no anxious wait reduce follow up good sensitivity ```
47
disadvantages of rapid HIV test
``` expensive quality control poor positive predictive value in low prevalence settings not suitable for high volume can't be relied on in early infection ```
48
which enzyme is used in HIV viral RNA replication
reverse transcriptase
49
what is the function of integrase
integrates the new viral double stranded DNA into the host DNA
50
what is the function of protease
cleaves the viral proteins into smaller proteins to form mature HIV particles
51
what are targets for anti-retroviral drugs
``` reverse transcriptase integrase protease entry (fusion or CCR5 receptor) maturation ```
52
when are protease inhibitors used in HIV treatment
for non-responsive HIV
53
how do CCR5 receptors work
block the correceptor to prevent virus entering the cell
54
what is highly active anti-retroviral therapy
a combination of 3 drugs from at least 2 drug classes to which the virus is susceptible
55
what is the purpose of HAART
reduce viral load to undetectable restore immunocompetence reduce morbidity and mortality minimise toxicity
56
why is there a higher rte of 'mistakes' during viral replication than human DNA replication
reverse transcriptase doesn't have a 'proof-reading' ability so can't tell if it has made a mistake transcriptase does have this function so can detect mutations
57
how to prevent drug resistance
adherence/compliance - lifestyle - tolerability - pharmacokinetics - drug-drug interactions - treatment interruptions
58
what is functional mono therapy
if taking combination therapy that is suddenly stopped, the drug with the longest half-life will continue to be present in the blood which therefore puts it at risk of becoming resistant
59
skin side effects of HAART
rash | hypersensitivity
60
CNS side effects of HAART
mood | psychosis
61
renal side effects of HAART
proximal renal tubulopathies
62
bone side effects of HAART
osteomalacia
63
CVS side effects of HAART
increased MI risk
64
haematological side effects of HAART
anaemia
65
GI side effects of HAART
transaminitis | fulminant hepatitis
66
how to prevent transmission of HIV from mother to child
``` HAART during pregnancy vaginal delivery if undetected viral load (at 36 weeks) c-section if detected viral load 4/52 PEP for neonate exclusive formula feeding ```
67
eligibility criteria for prep
high risk for HIV (HIV+ partner with detectable viral load or MSM or transwoman) age >16 HIV negative willing to stop if criteria no longer apply resident in scotland

3 REPRO (40 decks)

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