HIV + immunocompromised Flashcards
Mrs Y is a 28 year old woman who has recently been screened for infections as she is into her 2nd trimester of pregnancy (G=1, P=0). Her results showed a positive a positive PCR for HIV and she is worried about what this will mean for her and the baby.What advice can you give her?
Question 11Select one:
Treatment should have been started in the first trimester in order to prevent vertical transmission to the baby
It is safe to have a vaginal delivery if on anti-retroviral treatment with full suppression of the virus
Not to worry, this is likely a false negative and further testing will be required
When the baby is born it can be screened for HIV +ve using an ELISA tests
Appropriate management reduces vertical transmission of HIV to 10%
It is safe to have a vaginal delivery if on anti-retroviral treatment with full suppression of the virus
Elisa will be positive no matter what due to antibodies
Jamie is a 24 year old female with a history of intravenous drug use, who presents to your GP clinic with a 5 day history of low-grade fever, generalised lymphadenopathy and “achy muscles”. On further questioning, you discover that she has a sexual relationship with multiple partners, sometimes without protection, which has been going on for a year or so. You decide to do an enzyme immunoassay EIA for HIV, which comes back positive, and a confirmatory HIV RNA test is also positive. Which of the following statements is false with regards to anti-retroviral therapy (ART)?
Question 12Select one:
One of the main principles of ART is to suppress the viral load
ART is safe to use in HIV-infected pregnant women
Patients on ART should be monitored every 3-4 months for toxicity
ART should only be initiated in certain patients, depending on their CD4 count as CD4 count can affect treatment outcomes
ART has been shown to reduce mortality and serious HIV/AIDS-associated complications
ART should only be initiated in certain patients, depending on their CD4 count as CD4 count can affect treatment outcomes
Mr JB is a 45 year old pakeha man presenting to the GP with a number of lesions over his body but mainly on his lower limbs and around his face/neck. They’ve been there for awhile but have become more numerous recently and one has started to ulcerate becoming quite painful on his foot. Jim also comments that he has some difficulty swallowing. Aside from these lesions Jim is pretty well though he has had a slew of sicknesses over the past few years but attributes this to getting older.Jim’s past medical history is unremarkable aside from surgery for a broken leg in India around 6 years ago which required a blood transfusion and he finds his leg is still a bit stiff. No medications, NKDA. No relevant Family History. Non smoker, Drinks a bottle of wine over the course of a weekend. On examination the lesions vary in size from several mm to several cm, they appear as dark palpable lesions.They are mostly maculopapular but some have a nodular appearance. They are non itchy and aside from the ulcerated lesion they are painless. To the left is a non-ulcerating lesion on Jim’s foot.The GP orders a number of blood tests, which of the below diagnoses and results would fit Jim’s picture the best?
Pyogenic Granuloma - Blood results would be normal
Karposi’s Sarcoma due to HIV infection - Low CD4+ cell count <200, positive HIV antibodies, increasing HIV viral load
Leishmaniasis due to protozoal parasite from a sandfly whilst in India - Normocytic normochromic anaemia, leukopenia
Leprosy due to Mycobacterium leprae - Bloods normal, skin smear positive for acid fast bacilli
Immune Thrombocytopenic Purpura due to Systemic Lupus Erythematosus - thrombocytopenic, anaemic, positive ANA
Karposi’s Sarcoma due to HIV infection - Low CD4+ cell count <200, positive HIV antibodies, increasing HIV viral load
A 28 year old man presents to a GP clinic with a 4 month history of weight loss and malaise. He is not forthcoming in response to your questions. He looks dishevelled. He is cachetic, you notice has track marks on both arms. He also has a purple papular rash on his arms, similar to the one below.What is the agent responsible for the rash?
HHV-8
Mr Z is a 56 year old man with HIV. Sadly, he was lost to follow-up from HIV clinic over a decade ago. While you are on your ED placement, he presents to ED with marked hypoxia, shortness of breath and a non-productive cough. His chest x-ray reveals a diffuse, bilateral ground-glass appearance. You strongly suspect PJP. Following stabilisation of Mr Z, your consultant asks you to re-assess Mr Z for clues of other AIDS-defining illnesses, which may present in patients who are profoundly immunosuppressed (secondary to their HIV). Which of the following is not considered an AIDS-defining illness?
Question 1Select one:
Oesopageal candiasis
Kaposi sarcoma
CMV retinitis
HIV encephalopathy
Subacute bacterial endocarditis
Subacute bacterial endocarditis
George is a pleasant, happy-go-lucky young man that you see in your GP clinic while on placement there. He is 22 and at university studying psychology.George tells you that he is a little worried about a sexual encounter he had a couple of days ago. On further questioning you find out that George is a man-who-has-sex-with-men (MSM) and that he had unprotected anal sex with a man he knows 2 days ago. You order an HIV test and the result is positive. George asks you if this means he has caught it from his escapades two days ago. As it has only been two days since this potential exposure and the testing, you tell him (choose the most correct answer);
Question 2Select one:
it is possible that you have caught the virus due to this potential exposure
It is highly unlikely that you caught the virus from this potential exposure
It is almost definite that you have caught the virusdue to this potential exposure
It is highly unlikely that you caught the virus from this potential exposure
Alex comes to the GP practice for a check-up following his return from overseas 4 days ago. He disclosed that he had unprotected sex with a sex worker on his last day there. He is now anxious and wants to be tested for STIs and HIV. Which of the following statements is FALSE?
Question 3Select one:
Venous HIV tests detect the majority of infections within 4 weeks of exposure
Rapid or point-of-care tests are less likely to pick up infection that occurred less than 3 months ago
He does not need further testing if today’s result is negative
The presence of another sexually transmitted infection (STI) substantially increases the risk of contracting HIV
He does not need further testing if today’s result is negative
Rachel is a 28-year-old woman who requested an STI screen upon starting a relationship. She previously lived in a high HIV prevalence country and had sex without condoms there.
Her HIV results came back as:HIV EIA = positive, CD4 count = 625 cells/mm3, HIV viral load = 4.0 x 10^5. Rachel has come back to the GP for her results. Which of the following is true and the GP can say to Rachel during their explanation of her current status and management?
Question 4Select one:
Longterm, if Rachel wants to have a child she will need to stop her antiretrovirals as they aren’t safe in pregnancy but her vertical transmission risk can be reduced greatly by having a caesarean section and bottle feeding rather than breast feeding
“Drug holidays” or “structured treatment interruptions” have been shown to not increase AIDS related complications as long as they don’t happen more than once a year.
Due to her high viral load and low CD4 count she has AIDS and death is imminent
With early intervention of anti-retroviral drugs, she can have the same life expectancy as an uninfected patient
When she commences treatment her viral load should be undetectable within 5-8 weeks. If not, she is either not being adherent or has resistance to the regiment and may need resistance testing.
With early intervention of anti-retroviral drugs, she can have the same life expectancy as an uninfected patient
You are seeing Mr. S in your GP practice. He is a long - standing patient of your with HIV. He has however had poor compliance with his anti-retroviral medications in the past. His current CD4 count is in the range of 170 cells/mm3.He has been doing some googling about HIV and in particular AIDS-defining illness, that he is aware can occur with decreasing CD4 counts. He pulls out a piece of paper from his pocket and reads a list of these illnesses. Which of these can you reassure him he is unlikely to be at risk of given his current CD4 count (170).
Question 5Select one:
Oesophageal candidiasis
PJP pneumonia
Pulmonary TB
Primary CNS lymphoma
Kaposi sarcoma
Primary CNS lymphoma
Mr L, a 25-year-old male, has come in to your infectious diseases clinic to discuss management of his newly diagnosed HIV. After receiving the news, he appears anxious and has lots of questions about the treatment. In regard to anti-retroviral treatment, which of the following is false?
Question 6Select one:
Anti-retrovirals in an asymptomatic patient should be commenced when the CD4 count drops below 500 cells/mcL
Life expectancy of a person with HIV is almost equivocal to that of a person without HIV
Combination therapy with at least 3 anti-retrovirals from at least 2 different classes is necessary
In a patient who is adherent to an effective regimen, viral loads should be undetectable within 12-24 weeks
Anti-retrovirals in an asymptomatic patient should be commenced when the CD4 count drops below 500 cells/mcL
ARV at EVERY count!
45 year old man has worsening shortness of breath over the past couple of weeks. He currently also has balanitis and oral candidiasis. PMHx: Shingles 3 years ago O/E: cachetic, sats<90% and palpable lymph nodes in the neck. Chest clear, no crackles or wheeze. What is the likely cause of his shortness of breath?
Question 7Select one:
Faulty oxygen sats monitor. The x-ray is clear so he can be discharged.
Pulmonary embolism treat with anticoagulation
PJP infection treat with high dose co-trimoxazole
pneumococcal pneumonia treat with ceftriaxone and azithromycin
PJP treat with high-dose co-trimoxazole
Immunocompromised (shingles, candida infections)
Mr L McRudy is a 45 year old man who comes into your general practice with a flu-like illness. He reports he has been feeling exhausted over the past couple of days, as well as having a headache and “generally feeling crap”.On examination, you discover a rash on Mr McRudy’s back, and swollen lymph nodes around the neck and groin.After taking further history, you discover that Mr McRudy had a sexual encounter with another man 3 weeks ago, including receptive anal intercourse, and does not remember if a condom was used.What is the most appropriate next step in management?
Question 8Select one:
Refer on to infectious diseases specialist and send him off for blood testsincluding HIV viral load and CD4 count.
Perform an HIV screen and tell him to come back and see you when the results get back
Commence on anti-retroviral therapy immediately
A+B
A+C
Perform an HIV screen and tell him to come back and see you when the results get back
Mr Smith comes to see you in the sexual health clinic, he is a 23 yo man who has been engaging in chem sex parties and having unprotected sex with multiple unknown male partners for the past 2 years. He is regularly tested for STIs including HIV. His most recent party was 6 weeks ago, and about 1 weeks after he developed a fever with a rash, headache, and pharyngitis with cervical lymphadenopathy. He has come in for his routine STI tests.
Outcome: plasma HIV-RNA 7 x 10^6, CD4 count = 330 cells/mm3
What is the most likely result of repeat viral load and CD4 count in 2 months if he doesn’t start treatment before then?
Question 9Select one:
Both CD4 and Viral load will increase
CD4 will plummet and he will develop AIDS
This is likely a false positive test and doesn’t require further testing.
Both CD4 and Viral load will decrease
CD4 count will increase and viral load will decrease
CD4 count will increase and viral load will decrease
A 30 year old man travelled overseas about 3 weeks ago and has engaged in unprotected sex with various sex-workers. He also admits to using IV drugs on some of these occasions. He presents to you with fever, sore throat, some rashes on the body and an ulcer on his genital area. On examination he has a temperature of 38C, has an inflamed oropharynx with candidiasis and cevical and inguinal lymphadenopathy. You suspect this is primary HIV infection (seroconversion illness). How does HIV viral load change over the course of HIV infection, if untreated.
Question 10Select one:
During seroconversion, Viral load increases rapidly to reach a maximum level and declines to a set point. It will increase at advanced stages of AIDS.
Viral load is initially high at infection and decreases overtime.
Viral load increases rapidly during seroconversion phase and remains high throughout the disease.
Viral load does not change during HIV disease progression.
During seroconversion, Viral load increases rapidly to reach a maximum level and declines to a set point. It will increase at advanced stages of AIDS.
After finishing the filming for Love Island, Grant went on a bender through Asia where he had copious amounts of unprotected sex with both men and women. On his return to Australia, he visited his doctor complaining of a fever, sore throat and muscle pain which he’d had for several weeks. His GP recognised that Grant was at risk of several STIs so did all of the appropriate tests. Unfortunately, he tested positive to HIV with tests showing a CD4 count of 300 cells/mm3 and a viral load of 7 x 10^5 copies/mL. There are several important aspects to GrantÕs long-term management, including administration of certain vaccines: Influenza, pneumococcal, Hepatitis A and B (if not immune), HPV and Varicella (if no VZV IgG i.e. no previous exposure).Which of these vaccines would you definitely NOT give him if his CD4 count had been even lower at 150 cells/mm3?
Question 15Select one:
Hepatitis A/B
Pneumococcal
Varicella
Influenza
HPV
Varicella
