HIV

Question 1

what type of organism is HIV

Answer 1

retrovirus

Question 2

which strain of HIV is more virulent, type 1 or 2

Answer 2

HIV 1

Question 3

which immune cells are targeted by HIV

Answer 3

CD4 cells

Question 4

what effects on CD4 does HIV have

Answer 4

reduced circulating CD4 cells
reduced proliferation of CD4 cells
reduced CD8 cells
chronic immune activation

Question 5

what is the normal range of CD4 cells

Answer 5

500-1600 cells/mm3

Question 6

a CD4 cell count of what puts individuals at risk of opportunistic infection

Answer 6

<200

Question 7

how is HIV transmitted

Answer 7

through sexual contact - anal, vaginal, oral
transplacentally
via breast milk

Question 8

outline some of the clinical features of primary HIV infection

Answer 8

fever
maculopapular rash 
pharyngitis 
mucosal ulceration 
myalgia 
lymphadenopathy 
headache/aseptic meningitis

Question 9

what opportunistic infections are HIV patients at risk of

Answer 9

pneumocystis jirovecii 
TB
toxoplasma gondii 
CMV
EBV 
Kaposii's sarcoma 
Lymphoma

Question 10

how does pneumocystis jirovecii present

Answer 10

shortness of breath
malaise
dry cough
CXR shows perihilar infiltrates

Question 11

how does toxoplama gondii present

Answer 11

toxoplasma abscess - commonly in brain
focal neuro signs, seizures, features of raised ICP
ring enhancing lesions on MRI

Question 12

EBV increases risk of what conditions

Answer 12

non-hodgkins lymphoma

oral hairy leukoplakia, white patch on side of tongue

Question 13

describe Kaposii’s sarcoma

Answer 13

AIDS defining condition, due to human herpes virus 8

either cutaneous or mucosal lesion, patch, plaque or nodular

Question 14

which specific lymphomas are HIV patients at increased risk of

Answer 14

non-hodgkin lymphoma - Burkitt lymphoma

primary CNS lymphoma

Question 15

outline some groups at increased risk of developing HIV

Answer 15

men who have sex with men
women who have sex with MSM
people who inject drugs
children and adults from endemic countries such as South Africa, Thailand and Caribbean

Question 16

what are the 3 preventative measures to prevent HIV spread

Answer 16

barrier methods
pre-exposure prophylaxis
post-exposure prophylaxis

Question 17

how does PEP work

Answer 17

short term use of ART after potential exposure

can be given up to 72 hours after exposure

Question 18

how does PrEP work

Answer 18

similar to COCP, at risk groups can take regularly before exposure to prevent infection

Question 19

what is the main treatment for HIV and what is the aim of it

Answer 19

anti retroviral therapy

aim is to achieve an undetectable viral load and preserve immune function

Question 20

when is ART commenced in HIV patients

Answer 20

anyone with diagnosis of HIV irrespective of CD4+ count

Question 21

outline some of the drug classifications that are used as ART drugs

Answer 21

nucleoside reverse transcriptase inhibitors (NRTIs)
non-nucleoside reverse transcriptase inhibitors (NNRTIs)
protease inhibitors

Question 22

what is the first line treatment for HIV

Answer 22

HAART - highly active antiretroviral therapy

Question 23

what drugs are involves in HAART

Answer 23

2 nucleoside reverse transcriptase inhibitors as backbone combined with either 1 NNRTI or 1 PI
(3 drugs in total)

Question 24

give examples of NRTIs

Answer 24

tenofovir
zidovudine
abacavir

Question 25

give examples of NNRTIs

Answer 25

nevirapine
etravirine
rilpivirine

Question 26

give examples of protease inhibitors

Answer 26

darunavir

atazanavir

Question 27

what are some of the toxicity problems associated with HAART

Answer 27

GI effects
skin rash and steven johnston syndrome 
proximal renal tubulopathies 
osteomalacia - tenofovir 
increased risk of MI 
anaemia - zidovudine