HIV

Question 1

How can HIV be spread?

Answer 1

Sexual transmission
IV drug abuse
Blood products
Vertical transmission
Organ transplant

Question 2

When can you perform an HIV test on an unconscious patient?

Answer 2

If you think it is in the patients best interest

Question 3

What does HIV do to the immune system?

Answer 3

Destroys the cells, especially T-helper cells with CD4 receptors on their surface

Question 4

What is the natural history of HIV infection?

Answer 4

CD4 count declines and HIV viral loads increases

Question 5

What are patients with HIV at increased risk?

Answer 5

Infections

Tumours

Question 6

How can severity of illness in HIV be assessed?

Answer 6

Lower CD4 counts mark more severe infections

Question 7

When does an AIDS diagnosis occur?

Answer 7

CD4<200

Question 8

What occurs at stage 1 HIV?

Answer 8

Asymptomatic

Persistent generalised lymphadenopathy

Question 9

What occurs at HIV stage 2?

Answer 9

Weight loss <10% of body weight
Minor mucocutaneous infections
Herpes zoster within last 5 years
Recurrent Upper resp infections

Question 10

What occurs at HIV stage 3?

Answer 10

Weight loss >10% body weight
Unexplained chronic diarrhoea
Unexplained prolonged fever
Oral candidiasis
Oral hairy leukoplakia
Pulmonary TB
Severe bacterial infections

Question 11

What occurs at HIV stage 4?

Answer 11

HIV wasting syndrome
Pneumocystic carinii syndrome
Toxoplasmosis of the brain
Cryptosporidosis with diarrhoea
Cryptococcis extrapulmonary
Cytomegalovirus disease of organ other than liver, spleen, or lymph nodes
HSV infection mucocutaneous
Disseminated endemic mycosis
Candidiasis of oesophagus or resp tract

Question 12

What is the difference between HIV and AIDS?

Answer 12

HIV is an immune suppressant virus

AIDS is symptoms suffered as a result of the immune system being weakened by HIV

Question 13

What are respiratory AIDS defining conditions?

Answer 13

TB

Pneumocystitis

Question 14

What are neurological AIDS defining conditions?

Answer 14

Cerebral toxoplasmosis
Primary cerebral lymphoma
Cryptococcal meningitis
Progressive multifocal leucoencephalopathy

Question 15

What are neurological conditions where HIV testing should be offered?

Answer 15

Aseptic meningitis/encephaliltis
Cerebral abscess
Space occupying lesion of unknown cause
Guillan-Barre syndrome
Transverse myelitis
Peripheral neuropathy
Dementia
Leucoencephalopathy

Question 16

What is an AIDS defining dermatological condition?

Answer 16

Kaposi’s sarcoma

Question 17

What is a GI AIDS defining condition?

Answer 17

Persistent cryptosporidosis

Question 18

What oncological condition is AIDS defining?

Answer 18

Non-Hodgkin’s lymphoma

Question 19

What Gynaecological condition is AIDS defining?

Answer 19

Cervical cancer

Question 20

What is the natural history of HIV infection?

Answer 20

Acute infection
Asymptomatic
HIV related illness
AIDS defining illness
Death

Question 21

What is HIV seroconversion?

Answer 21

When HIV antibodies are first produced

Question 22

What are symptoms of HIV seroconversion?

Answer 22

Flu-like illness
Fever
Malaise and lethargy
Pharyngitis
Lymphadenopathy
Toxic exanthema

Question 23

What are features of pneumocystis jiroveci pneumonia?

Answer 23

Late stage AIDS infection
Opportunistic infection
CD4 cell count usually <200
Classical history of dry cough and increasing breathlessness over several weeks

Question 24

What investigations are done for pneumocystis jiroveci pneumonia?

Answer 24

CXR

Induced sputum or broncoscopy for Polymerase Chain Reaction

Question 25

What is used to treat pneumocystis jiroveci pneumonia?

Answer 25

Cotrimoxazole | Pentamidine

Question 26

How long is treatment given for pneumocystis jiroveci pneumonia?

Answer 26

Until CD4 >200

Question 27

What is used to treat HIV?

Answer 27

Combination Antiretroviral Therapy

Question 28

What is Combination Antiretroviral Therapy?

Answer 28

Pill containing 3 drugs from at least 2 groups

Question 29

What is the required patient adherence for combination antiretroviral therapy to work?

Answer 29

90%

Question 30

How long does HIV treatment need to be taken?

Answer 30

For life

Question 31

What are different types of antiviral drugs?

Answer 31

Nucleoside reverse transcriptase inhibitors Non-nucleoside reverse transcriptase inhibitors Protease inhibitors Integrase inhibitors

Question 32

What are side effects of nucleoside reverse transcriptase inhibitors?

Answer 32

Marrow toxicity Neuropathy Lipodystrophy

Question 33

What are side effects of non-nucleoside reverse transcriptase inhibitors?

Answer 33

Skin rashes Hypersensitivity Drug interactions Neuropsychiatric effects

Question 34

What are side effects of protease inhibitors?

Answer 34

Drug interactions Diarrhoea Lipodystrophy Hyperlipidaemia

Question 35

What are side effects of integrase inhibitors?

Answer 35

Rashes | Disturbed sleep

Question 36

What demographics have the most HIV prevalence?

Answer 36

Men who have sex with men | Black african population

Question 37

How can HIV be transmitted?

Answer 37

``` Sexual intercourse - anal/vaginal Vertical transmission - mother to baby via pregnancy, childbirth, or breastfeeding Sharing needles Needlestick injury Blood transfusion Organ transplant ```

Question 38

What is the virology of HIV?

Answer 38

HIV attaches to cells with CD4 which leads to low levels of CD4 cells

Question 39

How is HIV tested for?

Answer 39

``` Antibody Antigen Viral load CD4 count Typing ```

Question 40

What is the diagnostic window?

Answer 40

The point of infection before it can be detected by diagnostic tests - before antibodies are made

Question 41

How is HIV infection monitored?

Answer 41

CD4 cell count HIV viral load Clinical features

Question 42

What body fluids can spread HIV?

Answer 42

``` CSF Pleural/peritoneal/pericardial fluid Breast milk Amniotic fluid Vaginal secretions/semen Saliva Synovial fluid ```

Question 43

What should be done after exposure to HIV?

Answer 43

Wash off splashes on skin with soap and running water Exposed mucous membranes should be irrigated with water Encourage bleeding if skin broken Wash out splashes in the eye

Question 44

What is HIV PEP?

Answer 44

Post exposure prophylaxis

Question 45

What drugs are given for HIV PEP?

Answer 45

Truvada | Raltegravir

Question 46

When should HIV PEP be administered?

Answer 46

Within 72 hours of exposure for 28 days