HIV and AIDS

Question 1

how can HIV be spread?

Answer 1

Sexual transmission
Injection drug misuse
Blood products
Vertical transmission
Organ transplant

Question 2

when can a patient be tested for HIV?

Answer 2

Unconscious patients can be tested if you think it is in the patient’s interest to have the test

Question 3

what is good to mention to patients when having negative hiv test?

Answer 3

Having had a negative HIV test does not affect insurance premiums

Question 4

point of care testing?

Answer 4

blood sample from finger
60 seconds
confirmation of results

Question 5

describe the immunology of HIV

Answer 5

HIV infects and destroys cells of the immune system especially the T-Helper cells that are CD4+ (have a CD4 receptor on their surface)

CD4 receptors are not exclusive to lymphocytes – they are also present on the surface of macrophages and monocytes, cells in the brain, skin, and probably many other sites.

Question 6

over the course of infection what will happen to CD4?

Answer 6

CD4 count declines & HIV viral load increases

Increasing risk of developing infections and tumours

The severity of these illnesses is greater the lower the CD4 count (normal CD4 > 500)

Most AIDS diagnoses (severe infections) occur at CD4 count <200

Question 7

what symptoms are associated with symptomatic HIV?

Answer 7

Question 8

what classifies an HIV infections versus AIDS?

Answer 8

Certain infections and tumours that develop due to a weakness in the immune system are classified as AIDS illnesses. If you have no symptoms then you have HIV infection only.
Virtually everyone with an AIDS illness should recover from it and then be put on antivirals to keep them free from any future illness.

Question 9

what is primary HIV/seroconversion?

Answer 9

Approximately 30 - 60% of patients have a seroconversion illness (when HIV antibodies first develop)

Abrupt onset 2 – 4 weeks post exposure, self limiting 1 – 2 weeks

Symptoms generally non-specific and differential diagnosis includes a range of common conditions

Question 10

what are symptoms of primary HIV?

Answer 10

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

“looks like glandular fever but EBV serology not in keeping”

Question 11

what is Pneumocystis jiroveci pneumonia?

Answer 11

Commonest late stage (AIDS) infection
Formerly known as PCP (pneumocystis carinii pneumonia)
Opportunistic infection
CD4 cell count usually <200

Question 12

what I the classic history of Pneumocystis jiroveci pneumonia?

Answer 12

Classical history of dry cough and increasing breathlessness over seveal weeks

Question 13

what investigations should be done for Pneumocystis jiroveci pneumonia?

Answer 13

Chest X-Ray
Induced sputum or
broncoscopy for PCR

Question 14

how is Pneumocystis jiroveci pneumonia treated?

Answer 14

Cotrimoxazole
Pentamidine
Prophylaxis until CD4 > 200

Question 15

what is the antiviral therapy for HIV?

Answer 15

Different classes of drugs acting on different stages in HIV lifecycle

Combination antiretroviral therapy (cART) means at least 3 drugs from at least 2 groups

Adherence needs to be over 90% - support patient

cART can lead to a normal life but side effects can be significant eg metabolic, lipodystrophy,

Question 16

when should treatment be started in individuals with HIV?

Answer 16

Nowadays start all patients at diagnosis regardless of CD4 and viral load

If CD4 < 350 cells/mm3 patients at risk fo developing symptoms without being on treatment

If CD4 < 200 need to start as soon as possible

Any pregnant woman – start before third trimester

Three drug combination with treatment adjustment if viral load not adequately suppressed after 4-6 weeks

Question 17

how long is a patient required to be on treatment?

Answer 17

Once you start treatment you need to continue it for the rest of your life. The treatment may need to be changed from time to time but you will always need to be taking some form of antiviral medication.

In many ways, the treatment of HIV is similar to that of a chronic condition (like hypertension) rather than to the treatment of an infection.

Question 18

list the different antiviral drugs available?

Answer 18

Nucleoside reverse transcriptase inhibitors
marrow toxicity, neuropathy, lipodystrophy

Non-nucleoside reverse transcriptase inhibitors
skin rashes, hypersensitivity, drug interactions,
neuropsychiatric effects

Protease inhibitors
drug interactions, diarrhoea, lipodystrophy and hyperlipidaemia.

Integrase inhibitors
Rashes, disturbed sleep

Question 19

what are side effects of Nucleoside reverse transcriptase inhibitors?

Answer 19

marrow toxicity, neuropathy, lipodystrophy

Question 20

what are side effects of Non-nucleoside reverse transcriptase inhibitors?

Answer 20

skin rashes, hypersensitivity, drug interactions, neuropsychiatric effects

Question 21

what are side effects of Protease inhibitors?

Answer 21

drug interactions, diarrhoea, lipodystrophy and hyperlipidaemia.

Question 22

what are side effects of Integrase inhibitors?

Answer 22

Rashes, disturbed sleep

Question 23

what is lipodystrophy, how is it treated?

Answer 23

Change drugs
Less likely with newer
agents

Cosmetic procedures
-facelift
-liposuction
-fillers

Question 24

how can HIV be prevented?

Answer 24

Behaviour change and condoms
Circumcision
Treatment as prevention
VL undetectable = untransmissable
Pre-exposure prophylaxis (PrEP)
Post-exposure prophylaxis for sexual exposure (PEPSE)