HIV and AIDS Flashcards Preview

Yr 3 Infection > HIV and AIDS > Flashcards

Flashcards in HIV and AIDS Deck (24):

5 Routes of transmission in HIV

-Sexual transmission
-Injection drug misuse
-Blood products
-Vertical transmission
-organ transplant


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 [4]
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
500-1500 cells/mm^3


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)
-Herpes Zoster
-Recurrent URTI
>>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 candidiasis
-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

-HIV toxoplasmosis
-CMV disease of organ other than liver/spleen/LN
-HSV infection
-Candidiasis incl. oesophague/trachea/bronchii/lungs
-HIV encephalopathy


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 [8]

-Cerebral toxoplasmosis
-Cryptococcal meningitis
-Kaposi's sarcoma
-Non-Hodgkins lymphoma
-Cervical cancer
-CMV retinitis


Name conditions when HIV testing should be offered? [11 but know 7]

-aseptic meningitis/encephalitis
-GBS Guillian-Barre
-transverse myelitis
-oral candidiasis
-unknown weight loss
-hep b/c infection
-lung cancer
-hodgkins lymphoma


What is the progression of HIV from initial infection? [5]

>acute infection (seroconversion)
>HIV related illnesses
>AIDS defining illness


What are the symptoms of seroconversion (when HIV antibodies first develop)? [6]
May look like........ and .........

-flu-like illness
-malaise and lethargy
-toxic exanthema

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? [2]

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
One con

-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
-Integrase inhibitors
-Protease inhibitors

-Entry 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? [4]

-inadequate potency
-inadequate drug levels
-inadequate adherence (leads to viral mutation and resistance)
-pre-existing resistance


4 SE of protease inhibitors
1 SE of integrase inhibitors

Protease Inhibitors SE:
Drug interactions

Integrase inhibitors SE:
Skin rashes


Cosmetic procedures to treat lipodystrophy? [3]



How can HIV be prevented?

-behaviour change and condoms
-treatment as prevention
-Pre-exposure prophylaxis
-Post exposure prophylaxis for sexual exposure