HIV and AIDS

Question 1

5 ways HIV can be spread

Answer 1

sexual transmission 
vertical transmission 
infection drug misuse 
blood products 
organ transplant

Question 2

Can unconscious patients be tested for HIV?

Answer 2

if you think it is in their best interests

Question 3

What cells of the immune system does HIV particularly infect and destroy?

Answer 3

T helper cells with CD4 surface receptors (CD4+)

Question 4

Apart from lymphocytes where else are CD4 receptors found in the body?

Answer 4

brain
skin
surface of macrophages and monocytes

Question 5

What happens to the CD4 count and viral load over the course of the infection?

Answer 5

CD4 count decreases and viral load increases

Question 6

Relationship between severity of disease and CD4 count

Answer 6

severity of illness is greater the lower the CD4 count

Question 7

normal CD4 count

Answer 7

> 500

Question 8

Most AIDS diagnoses CD4 count

Answer 8

<200

Question 9

What was the original classification of HIV and why?

Answer 9

clinical

estimate incidence in developing world where GIV testing less readily available

Question 10

Clinical stage 1 findings

Answer 10

asymptomatic

persistent general lymphadenopathy

Question 11

Clinical stage 2 findings

Answer 11

weight loss
minor mucocutaneous
HZV - shingles
URTI recurrent

Question 12

Clinical stage 3 findings

Answer 12

weight loss 
chronic diarrhoea 
fever 
thrush 
TB

Question 13

Clinical stage 4 findings

Answer 13

pneumonia
CMV
mucocutaneous
encephalopathy

Question 14

Define AIDS illnesses

Answer 14

certain infections and tumours that develop due to weakness in the immune system

Question 15

No symptoms usually means HIV or AIDS?

Answer 15

HIV only

Question 16

List some clinical indicator diseases for HIV

Answer 16

TB, pneumonia, cryptococcal meningitis, HZV, non Hodgkin lymphoma, cervical cancer, psoriasis

Question 17

What is the 1 year mortality based on?

Answer 17

CD4 count

Question 18

Describe the primary HIV and seroconversion illness

Answer 18

30-60% g=have illness when HIV antibodies first develop

abrupt onset 2-4 weeks post exposure and self limiting 1-2 weeks

Question 19

Symptoms of seroconversion illness

Answer 19

flu like illness 
fever 
lymphadenopathy 
pharyngitis 
malaise and lethargy

Question 20

Seroconversion illness and glandular fever link

Answer 20

look the same but EBV serology not in keeping with glandular fever

Question 21

What type of virus is HIV?

Answer 21

retrovirus

Question 22

Combination ART

Answer 22

atleast 3 drugs from atleast 2 groups

Question 23

Basis of ART

Answer 23

different classes of drugs acting on different parts of the HIV lifecycle

Question 24

Where do ART treatments act?

Answer 24

reverse transcriptase inhibitor
integrase inhibitor
protease inhibitor

Question 25

When should a pregnant woman with HIV start ART?

Answer 25

Before 3rd trimester

Question 26

3 reasons why treatment fails

Answer 26

poor adherence - viral mutation and resistance pre existing resistance inadequate potency or drug levels

Question 27

Side effects of nucleoside reverse transcriptase inhibitors

Answer 27

marrow toxicity neuropathy LIPODYSTROPHY

Question 28

Side effects of nucleoside reverse transcriptase inhibitors

Answer 28

skin rashes hypersensitivity drug interactions

Question 29

Side effects of protease inhibitors

Answer 29

drug interactions diarrhoea LIPODYSTROPHY hyerlipidaemia

Question 30

Side effects of integrase inhibitors

Answer 30

rashes

Question 31

What Is lipodystrophy?

Answer 31

lose fat in certain places and redistribute it change drugs as less likely with newer agents cosmetic procedures - facelift and filers etc

Question 32

7 challenges of HIV care in 2018

Answer 32

``` osteoporosis malignancy IHD DM cerebrovascular disease cognitive impairment renal disease ```

Question 33

5 ways to prevent HIV

Answer 33

``` behaviour change and condoms circumcision PrEP PEPSE treatment as prevention for pregnancy ```

Question 34

The future for HIV care

Answer 34

therapeutic vaccines cure - kick kill method long acting injectable drug treatments

Question 35

Spread of HIV in Africa

Answer 35

heterosexual mother to child contaminated blood products

Question 36

Strain of HIV causing worldwide epidemic

Answer 36

HIV1 group M

Question 37

How do we diagnose HIV?

Answer 37

antigen antibody test

Question 38

What is the window period?

Answer 38

time during which markers of infection are not detectable - can vary

Question 39

When do you have to tell your work about HIV diagnoses?

Answer 39

do they require a test for your work? - no then they do not need to know yes - visa or exposure prone procedures

Question 40

Risk of transmission with percutaneous exposure of Hep B,C and HIV

Answer 40

Hep b - 30% Hep C - 3% HIV - 0.3%

Question 41

risk of HIV transmission by mucocutaneous exposure?

Answer 41

<0.1%

Question 42

List some fluids which should be handled with same precaution as blood

Answer 42

synovial fluid, amniotic fluid, saliva, breast milk, CSF

Question 43

Actions taken after blood or body fluid exposure

Answer 43

wash skin with running water and soap encourage bleeding wash off splashes report to doctor and OHS

Question 44

How is the risk of transmission assessed?

Answer 44

vaccinations, source of contamination, likelihood of B/C/HIV, extent of injury, ideally test source with informed consent

Question 45

Does Hep B or C not have a vaccine?

Answer 45

C

Question 46

Ways to avoid exposure

Answer 46

``` hygiene safe disposal cleaning up blood protect mucous membranes cover wounds ```