Flashcards in HIV and AIDS Deck (24):
5 Routes of transmission in HIV
-Injection drug misuse
Ethics: can you test an unconscious patient for HIV?
Yes - if you think its in their best interest. Negative result doesn't affect insurance premium
Discuss the immunology behind HIV infection 
NB CD4 receptors also present on macrophages and monocytes, brain cells, skin, and more
At what CD4 count are most AIDs dx made
What is normal ref range of CD4 count
-HIV infects and destroys immune system cells, esp CD4+ T Helper cells
-CD4 count declines, HIV viral load increases
-Increased risk of opportunistic infections caused by impairment of cell-mediated immunity (not ab-mediated immunity)
-Also a B cell defect causing impaired ab production to new antigens > increased risk of infection with encapsulated bacteria esp strep penmoniae
CD4 count <200 - AIDs dx
How many clinical stages of HIV is there?
Discuss clinical stage I of HIV? WHO
-Asymptomatic, persistent generalised lymphadenopathy (PGL)
>>Performance scale 1: Asymptomatic, normal activity
Discuss clinical stage II symptoms of HIV? WHO
4 minor mucocutaneous manifestations
-weight loss (<10%)
-Minor mucocutaneous manifestations (seborrhoeic dermatitis, prurigo, fungal nail infections, recurrent oral ulcerations, angular cheritis)
>>and/or performance scale 2: symptomatic, normal activity
Discuss clinical stage III symptoms of HIV? WHO
3 unexplained systemic manifestations
5 infection-related manifestations
-Weight loss (>10%)
-Unexplained chronic diarrhoea (>1m)
-Unexplained fever (intermittent or prolonged) >1m
-Unexplained anemia or chronic thrombocytopenia
-oral hairy leukoplakia
-Pulmonary TB in last yr
-severe bacterial infections
-acute necrotising ulcerative stomatitis, gingivitis, periodontitis
>>and/or performance scale 3: bedridden <50% of day in last month
Discuss clinical stage IV symptoms of HIV? WHO
-CMV disease of organ other than liver/spleen/LN
-Candidiasis incl. oesophague/trachea/bronchii/lungs
Difference between AIDs illness and HIV infection
Certain infections/tumours that develop due to weakness in immune system are classified as AIDS illness.
If asymptomatic infection, you have HIV infection only
Name some AIDS-defining conditions 
Name conditions when HIV testing should be offered? [11 but know 7]
-unknown weight loss
-hep b/c infection
What is the progression of HIV from initial infection? 
>acute infection (seroconversion)
>HIV related illnesses
>AIDS defining illness
What are the symptoms of seroconversion (when HIV antibodies first develop)? 
May look like........ and .........
-malaise and lethargy
may look like glandular fever but negative EBV serology negative
How soon does seroconversion present?
2-4 weeks post exposure. 1-2 weeks is self limiting
What is the treatment for HIV? 
Combination antiretroviral therapy - cART
At least 3 drugs from at least 2 groups
Side effects of cART?
-3 SE of nucleoside reverse transcriptase inhibitors
-3 SE of non-nucleoside reverse transcriptase inhibitors
-NRTI - marrow toxicity, lipodystrophy, neuropathy
-NNRTI- skin rashes, hypersensitivity, drug interactions
-adherence needs to be 90%
What are the 3 drugs combined in HIV therapy? What other drug is also available?
-Reverse transcriptase inhibitors
When should you consider commencing treatment for HIV?
>consider all patients at diagnosis regardless of CD4 count
>if CD4<350 cells/mm3 encourage treatment
>if CD4 <200cells/mm3 start asap
>any pregnant woman - start before 3rd trimester
Is HIV treatment lifelong?
What does life expectancy depend on in HIV sufferers?
How early treatment is started from point patient is infected
Why do treatments fail? 
-inadequate drug levels
-inadequate adherence (leads to viral mutation and resistance)
4 SE of protease inhibitors
1 SE of integrase inhibitors
Protease Inhibitors SE:
Integrase inhibitors SE:
Cosmetic procedures to treat lipodystrophy?