HIV

Question 1

how is HIV spread?

Answer 1

> sexual transmission
> vertical transmission
> blood products
> injection misuse
> organ transplant

Question 2

what immune cells specifically does HIV disrupt?

Answer 2

t helper cells

Question 3

what is the normal CD4 count?

Answer 3

> 500

Question 4

at what CD4 level is the diagnosis of AIDS?

Answer 4

<200

Question 5

how is the disease progression monitored?

Answer 5

> symptoms and signs
CD4 lymphatic count
HIV viral load

Question 6

how is the HIV viral load measured?

Answer 6

PCR to monitor the number of copies

Question 7

true or false

HIV viral load is low during acute infections

Answer 7

false it is high

Question 8

what are the symptoms of a patient with primary HIV?

Answer 8

abrupt onset and self limiting (2weeks)
> fever
> flu
> malaise/lethargy
> pharyngitis
> lymphadenopathy
> toxic exanthema

Question 9

how soon after exposure do symptoms of primary HIV/seroconversion begin?

Answer 9

2-4 weeks

Question 10

describe the 6 stages of HIV replication in the human cell starting from binding and entry

Answer 10

1. Binding and entry
2. Reverse transcriptase
3. Integration
4. Transcription
5. Assembly
6. Release and protease

Question 11

what are the 4 stages that HIV medications can act on?

Answer 11

> entry inhibition
reverse transcriptase inhibitors
integrase inhibitor
protease inhibitor

Question 12

what does combination therapy of anti-retrovirals entail?

Answer 12

3 drugs from 2 different groups
> reverse transcriptase inhibitors
> protease inhibitor
> integrase inhibitor

Question 13

when should HIV treatment be commenced?

Answer 13

> consider in all patients at diagnosis
encourage at <350 cells/mm^2
CD4 count <200 ASAP
3rd trimester in pregnancy

Question 14

when might you readjust HIV medication?

Answer 14

if their viral load is not sufficiently suppressed at 4-6 weeks

Question 15

what stages do antivirals act on?

Answer 15

> integrase inhibition
protease inhibition
non-nucleoside reverse transcriptase inhibitors
nucleoside reverse transcriptase inhibitors

Question 16

what are the side effects of nucleoside reverse transcriptase inhibitors?

Answer 16

> neuropathy

> lipodystrophy

Question 17

what are the side effects of non-nucleoside reverse transcriptase inhibitors?

Answer 17

> rashes

> drug interactions

Question 18

what are the side effects of protease inhibitors?

Answer 18

> lipodystrophy
diarrhoea
hyperlipidaemia

Question 19

what is a side effect of integrase inhibitors?

Answer 19

rashes

Question 20

what is lipodystrophy?

Answer 20

redistribution of fat

Question 21

how is lipodystrophy managed?

Answer 21

> changing drugs

> face lift/fillers/liposuction

Question 22

what can poor adherence to treatment lead to?

Answer 22

> viral mutation and resistance

Question 23

what preventative measures are there for HIV?

Answer 23

> circumcision?
behavioural change
treatment (undetectable viral load means transmission is impossible in pregnancy)
post exposure prophylaxis

Question 24

what is the life expectancy of an individual with a CD4 count of <100?

Answer 24

52 years

Question 25

what is the life expectancy of an individual with a CD4 count of 100-200?

Answer 25

62 years

Question 26

what is the life expectancy of an individual with a CD4 count of >200?

Answer 26

70+years

Question 27

you become exposed to blood from and HIV positive person. | what are your immediate actions?

Answer 27

> wash with soap and running water > encourage bleeding if skin is broken > wash out splashes in eyes nose and mouth > report incident

Question 28

what is the risk assessment to blood and bodily fluid exposure (not just for HIV)?

Answer 28

> source of contamination > extent of injury > vaccination status of the victim

Question 29

how can blood/bodily fluid exposure be avoided?

Answer 29

> disposing of contaminated waste safely > clear spillage and body fluids promptly > avoid sharp usage where possible > use good hand hygiene > cover pre-existing wounds with dressings > protect mucous membranes of eyes, mouth and nose

Question 30

what are the risk of infection if exposed to Hep B with surface antigens and e antigens?

Answer 30

30%

Question 31

what is the risk of infection if exposed to hep c antigens?

Answer 31

3%

Question 32

what is the risk of infection if exposed to HIV blood and bodily fluids?

Answer 32

0.3%