HIV

Question 1

What type of virus is HIV?

Answer 1

retrovirus

Question 2

What is a retrovirus?

Answer 2

when it makes DNA it uses an enzyme called reverse transcriptase

Question 3

Out of HIV 1 and 2, what is the most common?

Answer 3

HIV 1

Question 4

What is the pathophysiology of HIV?

Answer 4

HIV infects CD4 cells
CD4 t helper cells are vital for the induction of the active immune response
therefore there is a disregulated cell response

Question 5

What effects does HIV have on the immune system?

Answer 5

SUPPRESSION
reduced proliferation of CD4 cells
sequestration of cells in lymphoid tissue leading to reduced circulating CD4 cells
reduction of CD8 cell activation causing dyregulation of cytokine expression and increased susceptibility to viral infections
reduction in antibody class switching
chronic immune activation

Question 6

What is a normal CD4 count?

Answer 6

500-1600

Question 7

How does the infection spread in HIV?

Answer 7

infection of the mucosal CD4 cells which is then transported to regional lymph nodes and infection is established within 72 hours

Question 8

How long do you have to give post exposure prophylaxis for HIV?

Answer 8

72 hours

Question 9

How does a primary HIV infection present?

Answer 9

2-4 weeks after infection - HIGH RISK OF TRANSMISSION
fever 
maculopapular rash
myalgia
pharyngitis
headache
aseptic meningitis

Question 10

What are some opportunistic infections that are associated with HIV?

Answer 10

pneumocystis pneumonia
tuberculosis
cerebral toxoplasmosis
cytomegalovirus 
neurocognitive impairment
PML - progressive multifocal leukoencephalopathy
Skin infections

Question 11

What organism causes pneumocystis pneumonia?

Answer 11

pneumocystis jiroveci

Question 12

What is the CD4 threshold in pneumocystis pneumonia?

Answer 12

<200

Question 13

What is the presentation of pneumocystis pneumonia?

Answer 13

SOB
cough
exercise desaturation - sats go down after 5 mins of exercise

Question 14

What can be seen on a CXR of pneumocystis pneumonia?

Answer 14

OFTEN NORMAL
interstitial infiltrates
reticulonodular markings

Question 15

How is pneumocystis pneumonia diagnosed?

Answer 15

bronchioalveolar lavage +/- PCR

Question 16

How is pneumocystis pneumonia treated?

Answer 16

high dose co-trimoxazole

Question 17

How is pneumocystis pneumonia prevented?

Answer 17

low dose co-trimoxazole

Question 18

When does TB occur in those with HIV?

Answer 18

if they are HIV positive when you start anti retrovirals - immune system wakes up and causes TB flare up

Question 19

What organism causes cerebral toxoplasmosis?

Answer 19

toxoplasma gondii

Question 20

What is the CD4 threshold in cerebral toxoplasmosis?

Answer 20

<150

Question 21

What is the pathology of cerebral toxoplasmosis?

Answer 21

reactivation of latent infection
chorioretinitis
multiple cerebral abscesses

Question 22

What is the presentation of cerebral toxoplasmosis?

Answer 22

headache
fever
focal neurology
seizures 
reduced conciousness
rasied ICP

Question 23

What is the CD4 threshold for cytomegalovirus?

Answer 23

<50

Question 24

What does the cytomegalovirus cause?

Answer 24

retinitis
colitis
oesophagitis

Question 25

What symptoms does cytomegalovirus present with?

Answer 25

``` reduced visual acuity floaters due to retinitis abdo pain diarrhoea PR bleeding ```

Question 26

What must you do for all patients with a CD4 <50?

Answer 26

opthalmic screening

Question 27

What skin problems are common in those with HIV? How are they different in HIV?

Answer 27

herpes zoster - multidermal and recurrent herpes simplex - extensive, hypertrophic and aciclovir resistant HPV - extensive, dysplastic Penicilliosis Histoplasmosis

Question 28

How does HIV associated neurogcognitive impairment present?

Answer 28

HIV 1 | reduced short term memory +/- motor dysfunction

Question 29

What organism causes PML?

Answer 29

JC virus - reactivation of latent infection

Question 30

What CD4 threshold for PML?

Answer 30

<100

Question 31

How does PML present?

Answer 31

rapidly progressing focal neurology, confusion and personality change

Question 32

What is Slims disease?

Answer 32

HIV associated wasting anorexia due to malabsorption - gut gets disseminated so is leaky hypogonadism

Question 33

What are AIDS related cancers?

Answer 33

Kaposi sarcoma Non Hodgkins lymphoma Cervical cancer

Question 34

What is kaposi sarcoma?

Answer 34

vascular tumour - purply tinge | purple lesions on cutaneous, mucosal or visceral surfaces (GI or pulmonary)

Question 35

What organism causes kaposi sarcoma?

Answer 35

human herpes virus 8

Question 36

What treatment can be given for kaposi sarcoma?

Answer 36

HAART | systemic chemo

Question 37

What organism causes non hodgkins lymphoma?

Answer 37

EBV

Question 38

How does non hodgkins lymphoma present?

Answer 38

B symptoms - weight loss, fever, night sweats bone marrow involvement extra nodal disease increased CNS involvement

Question 39

What does every patient with lymphoma get?

Answer 39

HIV test

Question 40

How is non hodgkins lymphoma treated?

Answer 40

HAART

Question 41

How is HIV transmitted?

Answer 41

sexual - 95% of infections parenteral - PWID mother to baby - 1 in 4 babies get infected

Question 42

What % of MSM have HIV in the UK?

Answer 42

1 in 17

Question 43

Who gets tested for HIV?

Answer 43

any medical admission or new patient in a GP in a high prevelance area - subsaharan africa, carribean and Thailand opt out in clinical settings - TOP, GUM clinics, drug dependency services screening in high risk groups - PWID, MSM, sex workers, partners of those with HIV or bisexual men

Question 44

What is an HIV test?

Answer 44

rapid HIV test - finger prick sample, results within 20-30 mins can do 3rd gen (antibody) or 4th gen (antigen and antibody)

Question 45

What is the other HIV test?

Answer 45

take a venous sample and look for p24 antigen

Question 46

How is HIV treated?

Answer 46

HAART - highly active anti-retroviral therapy

Question 47

What is HAART?

Answer 47

combination of 3 drugs from at least 2 different drug classes from which the virus is susceptible eg 2 NRTIs and a NNRTI or protease inhibitor

Question 48

How do antiretrovirals work?

Answer 48

reduce the replication of HIV-1 by targeting = reverse transcriptase, protease, integrase and entry and maturation

Question 49

How is resistance to antiretrovirals prevented?

Answer 49

adherence stop-start method of taking them leads to viral breakthrough if they are going to stop - give them a protease inhibitor

Question 50

What interactions do HAART have?

Answer 50

Hep C and TB drug regimes increase cholesterol affect liver enzymes

Question 51

How are HIV comorbidities prevented?

Answer 51

``` HPV vaccinations for women and more regular cervical smears flu vaccine Hep A/B vaccine smoking cessation STI screening ```

Question 52

What are the methods of partner notification?

Answer 52

partner referral - partner tells them provider referral - doctor tells them conditional referral - doctor tells them if the person doesnt within a certain time etc

Question 53

At what viral load can HIV not be transmitted?

Answer 53

<200

Question 54

How can HIV transmission be prevented?

Answer 54

``` post exposure prophylaxis - PEP pre exposure prophylaxis - PrEP condom use circumcision - reduces by 60% HIV treatment ```

Question 55

How can HIV transmission from partner to partner be prevented?

Answer 55

treatment as prevention to the HIV neg partner PrEP for neg partner self insemination if male -ve and female +ve = want a baby

Question 56

How can HIV transmission from mother to baby be prevented?

Answer 56

``` HAART during pregnancy undetectable load = vaginal delivery detectable load = c/section 4 weeks of PEP for neonate formula feeding only ```

Question 57

Where is PrEP avaliable?

Answer 57

only scotland, not england

Question 58

What is the elidibility criteria for PrEP?

Answer 58

``` high risk for HIV HIV +ve partner MSM or transwoman >/=16 years HIV negative can commit to 3 monthly follow up reside in scotland ```

Question 59

What medication is used in PrEP?

Answer 59

Tenoforir disoproxil/emtricitabine

Question 60

What is the average effectiveness of PrEP?

Answer 60

86% HIV incidence reduced

Question 61

How is PEP used for HIV?

Answer 61

3 antiretrovirals 80% effective start within 72 hours 28 days total

Question 62

How is PEP used for Hep B?

Answer 62

HBV vaccine up to 7 days later | immunoglobulin if doesnt respond to vaccine