HIV

Question 1

What is the target site for HIV?

Answer 1

CD4+ receptors

Question 2

What is the function of CD4+ T cells?

Answer 2

Recognise the antigen-presenting cell and activate the adaptive immune response

Question 3

Give some effects of HIV infection on immune response

Answer 3

Reduced circulating CD4+ cells
Dysregulated CD8+ cell activation
Reduced antibody class switching

Question 4

CD4+ T cells should always be above what value?

Answer 4

500 cells/mm

Question 5

At what level of CD4+ T cells is there risk of opportunistic infections?

Answer 5

<200 cells/mm

Question 6

What occurs in the primary infection stage of HIV?

Answer 6

Huge amount of virus causes a rapid depletion in CD4 count

Question 7

After primary infection, why does CD4 count start to rise?

Answer 7

As immune cells are produced against HIV

Question 8

What is the average time to death if not treated for HIV?

Answer 8

9-11 years

Question 9

Give some symptoms seen in primary HIV infection

Answer 9

Fever
Rash
Myalgia
Pharyngitis
Headache

Question 10

What occurs in asymptomatic HIV infection?

Answer 10

Ongoing viral replication causes CD4 to reduce

Question 11

Give some examples of opportunistic infections seen in HIV

Answer 11

Pneumocystic pneumonia
TB (certain types)
Cerebral toxoplasmosis
CMV
Herpes simplex/zoster
Progressive multifocal leukoencephalopathy

Question 12

What is the most common opportunistic infection in HIV?

Answer 12

Pneumocystis pneumonia

Question 13

How is pneumocystis pneumonia treated?

Answer 13

Co-trimoxazole

Question 14

Give some signs of cerebral toxoplasmosis

Answer 14

Headache
Fever
Focal neurology
Seizures
Raised ICP

Question 15

How does CMV present?

Answer 15

Reduced visual acuity
Floaters
Abdo pain, diarrhoea and PR bleeding

Question 16

Which virus causes progressive multifocal leukoencephalopathy?

Answer 16

JC virus

Question 17

Give some examples of AIDS-related cancers

Answer 17

Kaposi’s sarcoma
Non-Hodgkins lymphoma
Cervical cancer

Question 18

How does Kaposi’s sarcoma present?

Answer 18

Cutaneous/mucosal vascular tumour

Question 19

Which virus causes non-Hodgkins lymphoma?

Answer 19

Epstein-Barr virus

Question 20

Why does cervical cancer commonly occur in AIDS?

Answer 20

As there is persistence of HPV infection

Question 21

Give some clinical features seen in “asymptomatic” HIV

Answer 21

Mucosal candidiasis
Seborrhoeic dermatitis
Diarrhoea
Fatigue
Lymphadenopathy
Worsening psoriasis

Question 22

What is the main mode of transmission of HIV?

Answer 22

Sex

Question 23

Give some factors which increase transmission risk?

Answer 23

Anoreceptive sex
Trauma
Genital ulceration
STI

Question 24

How else may someone acquire HIV?

Answer 24

Injection drug use
Infected blood products
Mother-to-child

Question 25

What is the risk of mother to child transmission of HIV in the UK when viral load is undetectable?

Answer 25

<0.1%

Question 26

Which population group have the highest % of people living with undiagnosed HIV?

Answer 26

Heterosexual men

Question 27

Which population group have the highest proportion of HIV?

Answer 27

MSM

Question 28

What markers of HIV are tested for?

Answer 28

Viral RNA Antigen Antibody

Question 29

How is HIV most commonly tested for?

Answer 29

Test for combined antibody-antigen

Question 30

Why is it better to test for combined antibody-antigen rather than antibody?

Answer 30

As it shortens the window period where infection may not be detected

Question 31

What test can be used to test for HIV rapidly?

Answer 31

POCT

Question 32

Give some targets for anti-retroviral drugs

Answer 32

Reverse transcriptase Integrase Protease

Question 33

What strategy is used to treat HIV?

Answer 33

HAART - highly active anti-retroviral therapy

Question 34

What is HAART?

Answer 34

A combination of 3 drugs from at least 2 drug classes to which the virus is susceptible

Question 35

How can a patient prevent drug resistance in HIV?

Answer 35

Adherence Lifestyle changes Avoiding drug-drug interactions

Question 36

Give some common side effects of HAART therapy

Answer 36

``` Diarrhoea Rash Psychosis Proximal renal tubulopathy Osteomalacia Anaemia ```

Question 37

What effect does protease inhibitors have on liver enzymes?

Answer 37

They inhibit them

Question 38

What effect does NNRTIs have on liver enzymes?

Answer 38

They induce them

Question 39

Are HIV patients legally required to notify their partner?

Answer 39

No

Question 40

What are the best ways to prevent onward HIV transmission sexually?

Answer 40

Condom use STI screening Pre/post-exposure prophylaxis

Question 41

An undetectable viral load means the virus is still transmissible. True/false?

Answer 41

False - undetectable viral load = untransmissable virus

Question 42

What method of delivery is done if viral load is detected in a pregnant mother?

Answer 42

Caesarean section

Question 43

Why are all HIV patients treated even if they are not symptomatic?

Answer 43

As it means they cannot transmit the virus

Question 44

Which patients are eligible for pre-exposure prophylaxis?

Answer 44

HIV+ partner with detectable viral load | MSM or transwoman that has UPAI >2 partners in last year