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RB Y3 3 Reproduction & Sexual Health > HIV > Flashcards

HIV Flashcards

1
Q

there are 2 types of HIV - 1 and 2

which is reponsible for the global epidemic

A

1 is reponsible for the global epidemic

2 is less pathogenic and is seen in west africa mainyl

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2
Q

outline the HIV life cycle

A
  • bind to surface of CD4 T cell
  • fusion of HIV and CD4 membranes
  • inside the T cell the HIV releases RT enzyme to converts its genetic material from RNA into DNA - this means that it can be combined with the T cell’s DNA
  • HIV DNA goes into T cell nucleus and combines with it’s DNA using integrase
  • HIV uses the T cell machinery to replicate itself
  • new HIV sits on the surface of the cell in long chains as immature (non infectious) HIV
  • this is cleaved by protease enzyme to form smaller infectious HIV
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3
Q

what happens to HIV and CD4 T cell numbers as with untreated disease progression

A

HIV increases and CD4 T cells decrease - worsening immunosuppression

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4
Q

outline the progression of HIV/development of AIDS

A
  • during primary infection, HIV levels are high in the bloodstream but no IS features as CD4 T cell levels are still high
  • HIV Ab have not yet been formed
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5
Q

waht is seen on a blood film of someone with HIV

A

aypical mononuclear lymphocytes

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6
Q

what is the T cell parameter for AIDS

A

<200 (normal is 500-1600)

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7
Q

how is HIV transmitted

A

exposure of mucosal surfaces to infection body fluids

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8
Q

where are the current pandemics?

A

sub sahran Africa, caribeean and SE Asia

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9
Q

who is screened for HIV

A
  • clinical situations:
    • antenatal care and assisted conception services
    • GUM clinics, abortion clinics, drug dependecy services
  • there is universal screening in some high prevalence areas
  • high risk groups - MSM, women w/ bisexual man, PWID, HIV partner
  • clinical indicators
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10
Q

what is the most common type of AIDS lung disease

A

pneumocystc jirovecii pneumonia

this is onyl really seen in the IC

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11
Q

how does PC pneumonia present

A

non specific, insidious onset, SOB and dry cough etc

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12
Q

managemenet of PC pneumonia

A

high dose co-trixomazole

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13
Q

is prophylaxis given for any OI

A

PC pneumonia - co-trixomazole (if CD4 <200)

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14
Q

what does toxoplasmosis cause in AIDS

A

focal CNS disease - brain abscesses etc

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15
Q

which 2 organisms cause chorioretiniis in IC patients

A

toxoplasma gondii and CMV

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16
Q

how does CMV present

A

ofte subclinical

causes retinitis, colitis and CNS disease

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17
Q

what are the associated depression and anxiety in HIV positive related to

A

partly due to psychosocial impact of disease but there may also be changes in mental state or congition due to an organic cause

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18
Q

what is the main CNS pathogen

A

toxoplasma gondii

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19
Q

name 3 manifestations of acute CNS disease

A

transient meningoencephalitis, myeloapthy and neuropathy

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20
Q

what are the chronic manifestations of CNS disease

A

dementia, vaious encephalopathies, motor dysfunction

21
Q

what is progressive multifocal leukoencephalopathy

A

progressive damage/inflammation of teh white matter

the JC virus infects the oligodendrocytes, leading to demyelination

22
Q

HIV associated wasting

A

unexplained loss of >10% of body weight - visible thinning of face, waist and extremities

23
Q

kaposi’s sarcoma

A

a vascular tumour, commonly found on mucocutaneous sites but can involve lymph nodes and organs

24
Q

what virus is Kaposi’s sarcoma also associated with

A

Human herpes virus 8

25
Q

there are 2 available tests for HIV: ELISA screening for HIV antibodies and 4th generation tests

what is the difference between them

A
  • ELISA looks for antibodies to HIV - IgG and IgM etc
    • Seroconversion may take up to 3 months, so in this period you may get a false negative result
  • 4th generation looks for antibodies and p24 antigen. the p24 antigen is prsent from around 10 days - reduces window period of inaccuracy
26
Q

what are the rapid tests

A

these are simplified ELISA tests that allow for testing in resource poor settings

they are looking for HIV Ab in the blood and the stick changes colour if positive

can use fingerprick specimen or saliva

27
Q

what are the disadvantages of rapid tests

A

they are expensive, quality control, may not be reliable in early infection, poor positive predictive value in low prevalence settings

28
Q

on discovering someone has HIV, what testing is done

A

pregnancy test before starting ART

STI testing - Hep b and c

CXR if TB/pneumonia symptoms

29
Q

what are the 3 aspects to management

A

psychological and emotional support

HIV treatment

primary prophylaxis

30
Q

what is HAART usually

A

a combination of 3 drugs from 2 different classes. often 2 NRTIs and 1 NNRTI

31
Q

what is the goal of HART

A

to inhibit viral replication and so decrease viral load and for CD4 count to increase –> reduces immunocompromise and patient wont have as bad symptoms??

32
Q

what is the single most importnat thing in terms of preventing drug resistance and why

A

adherence to treatment

if virus continues to replicate whilst person is still sometimes taking HAART, it can promote the selection of HIV strains with drug resistant mutations

if this gets out and is spread to other people - decreased ART effectiveness

33
Q

what is the 2nd most important thing to prevent drug resistance

A

combination therapy

34
Q

do people experience side effects on ARTs?

A

most people have diarrhoea

lots of other side effects

35
Q

what are the 4 main targets of HIV drugs

and which one is the most commonly used

A

NRTIs and NNRTIs

36
Q

is HIV infection always transmissible

A

no, if someone has an undetectable viral load on ART they cannot transmit virus

37
Q

can you take ART during rpegnancy

A

yes

38
Q

can you have a vaginal delivery without transmitting HIV to baby?

A

yes is UVL and there are no obstretric complications

39
Q

will pregnancy mother transmit HIV to baby?

A

no, not if UVl and procedures followed correctly

40
Q

giving birth and having HIV

A

vaginal delivery is fine if UVL and no obstretric complications

if DVL >50 - C section with Prep (Zidovudine started 4 hours before)

41
Q

is anything given to the baby after it has been born?

A

yes, gets PEP - start within 4 hours of delivery and continue for 4 weeks

single drug if UVL and combination if DVL/high risk

also do regular blood tests

42
Q

can you breastfeed with HIV

A

no - exclusive formula feeding

43
Q

give 3 options for sero discordant couples

A
  • treatment as prevention ± condomless sex during ovulation period
  • HIV PrEP for partner

remember, there is no risk of transmission with an UVL

44
Q

does PrEP work?

A

yes, it has an 86% risk reduction

45
Q

which drugs are used for PrEP

A

Tuvuda - a combination of 2 NRTIs

46
Q

who gets PreP

A
  • high risk factors
  • HIV positive partner with DVL
  • MSM/transwoman
    • UPAI ≥ 2 partners in 12/12 and likely to do so again in next 3/12
    • Confirmed bacterial rectal STI in last 12/12
47
Q

what are the 5 conditions for PrEP

A
  • >16
  • HIV negative
  • can commit to 3 monthly follow up
  • Willing to stop if eligibility and criteria no longer apply
  • Resident in Scotland
48
Q

what does PEP involve

A

3 ARV taken within 72 hours - around 80% effectiveness

RB Y3 3 Reproduction & Sexual Health (21 decks)

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