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HIV: pathophysiology and presentations Flashcards

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1
Q

What can HIV cause/lead to?

A

AIDS - Acquired Immunodeficiency Syndrome
Opportunistic infections
AIDS-related cancers

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2
Q

What is the life expectancy of people with HIV?

A

“near normal”

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3
Q

What is HIV?

A

A retrovirus

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4
Q

Describe HIV-1

A

Originated in Central/West African chimpanzees

Responsible for pandemic starting in 1981

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5
Q

Describe HIV-2

A

Originated in West African Sootey mangabey (Simian ID virus)

Less virulent

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6
Q

What is CD4?

A

CD4+ receptors are the target site for HIV

A glycoprotein found on the surface of a range of cells

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7
Q

What cells are CD4 receptors found on?

A

T helperlymohocytes (CD4+ cells)
Dendritic cells
Macrophages
Microglial cells

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8
Q

What do CD4+ Th lymphocytes do?

A

Essential for induction of adaptive immune response
Recognition of MHC2 antigen-presenting cell
Activation of B-cells
Activation of cytotoxic T-cells (CD8+)
Cytokine release

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9
Q

What does HIV do to the immune response?

A

Reduced circulating and proliferating of CD4 cells
Dysregulation expression of cytokines
Increased susceptibility to viral infections
Reduced affinity of antibodies produced

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10
Q

What are HIV sufferers susceptible to?

A

Viral infections
Fungal infections
Mycobacterial infections
Infection-inducing cancers

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11
Q

What is the normal range of CD4+Th cells?

A

500-1600 cells/mm*3

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12
Q

What number of CD4+Th cells give risk to opportunistic infections?

A

<200 cells/mm*3

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13
Q

Describe HIV viral replication?

A

Rapid replication in early and late infection

New generation every 6-12 hours

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14
Q

What is the prognosis of HIV without treatment (on average)?

A

9-11 years

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15
Q

How does the infection take place?

A

Infection of mucosal CD4 cell (Langerhans and Dendritic cells
Transport to regional lymph nodes
Infection established within 3 days of entry
Dissemination of virus

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16
Q

How long after infection does it take for symptoms to present?

A

Usually 2-4 weeks

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17
Q

What are the symptoms of a primary HIV infection?

A 
Fever
Rash (maculopapular)
Myalgia
Pharyngitis
Headache/ aseptic meningitis
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18
Q

What occurs in asymptomatic HIV infection?

A

Ongoing viral replication
Ongoing CD4 count depletion
Ongoing immune activation
Risk of transmission

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19
Q

What is the definition of an Opportunistic infection?

A

An infection caused by a pathogen that does not normally produce disease in a healthy individual. But does when afforded the opportunity by a weakened immune system.

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20
Q

What organism causes Pneumocystis pneumonia and what CD4 count is needed for this?

A

Organism - Pneumocystis jiroveci

CD4 count: <200

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21
Q

What are symptoms and signs of Pneumocystis pneumonia

A

Symptoms: insidious onset, SOB, dry cough
Signs: Exercise desaturation

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22
Q

How do you diagnose Pneumocystis pneumonia?

A

BAL and immunoflourescence +/- PCR

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23
Q

What is the treatment and prophylaxis for Pneumocystis pneumonia?

A

Treatment: High dose co-trimoxazole (+/- steroid)
Prophylaxis: Low dose co-trimoxazole

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24
Q

What other opportunistic infection that effects the respiratory system can occur in HIV?

A

TB

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25
What organism causes Cerebral Toxoplasmosis and what CD4 level is needed?
Organism: Toxoplasma gondii | CD4 level: <150
26
What is cerebral toxoplasmosis?
reactivation of latent infection | Multiple cerebral abscess (Chorioretinitis)
27
What are symptoms/signs of cerebral toxoplasmosis?
``` Headache Fever Focal neurology Seizures Reduced conscioussness Raised ICP ```
28
What organism causes Cytomegalovirus and what CD4 count is needed?
Organism: CMV | CD4 level: <50
29
What is CMV?
Reactivation of latent infection.
30
What are causes of CMV?
Retinitis Colitis Oesophagitis
31
How does CMV present?
Reduced visual acuity Floaters Abdo pain, diarrhoea, PR bleeding
32
When is screening for CMV done?
Individuals with a CD4 level of <50
33
What skin infections can occur with HIV?
``` Herpes zoster Herpes simplex HPV Penicilliosis Histoplasmosis ```
34
What is HIV-associated neurocognitive impairment?
Caused by HIV-1 | Any reduced CD4 level
35
How does HIV-associated neurocognitive impairment present?
Reduced short term memory | +/- motor dysfunction
36
What is Progressive multifocal leukoencephalopathy?
Caused by JC virus | CD4 level of <100
37
How does Progressive multifocal leukoencephalopathy present?
Rapidly progressing Focal neurology Confusion Personality change
38
List some other neurological presentations of HIV?
``` Distal sensory polyneuropathy Mononeuritis multiplex Vacuolar myelopathy Aseptic meningitis Guillan-Barre syndrome Viral meningitis (CMV, HSV) Cryptococcal meningitis Neurosyphilis ```
39
What causes kaposi's Sarcoma and what is it?
Human Herpes virus 8 (HHV8) | Vascular tumour
40
What CD4 level is needed for Kaposi's sarcoma?
Any reduced level
41
How does Kaposi's sarcoma present?
Cutaneous Mucosal Visceral - pulmonary, GI
42
How do you treat Kaposi's sarcoma?
HAART Local therapies Systemic chemotherapy
43
What organisms cause non-Hodgkins lymphoma and what CD4 level is needed?
EBV (Burkitt's lymphoma), primary CNS lymphoma | Any reduced CD4 level
44
What is the presentation of non-Hodgkins lymphoma?
``` More advanced B symptoms Bone marrow involvement Extranodal diseaee Increased CNS involvement ```
45
What is the diagnosis and treatment of non-Hodgkins lymphoma?
Diagnosis - Same as HIV | Treatment: Same as HIV + HAART
46
What organism causes Cervical cancer?
HPV
47
What is cervical cancer?
Rapid progression to severe dysplasias and invasive disease
48
Name some non-OI of symptomatic HIV
``` Mucosal candidiasis Seborrhoeic dermatits Fatigue + diarrhoea Worsening psoriasis Lympadenopathy parotitis ```
49
What causes haematologic manifestations?
HIV OI's AIDS - malignancies HIV drugs
50
What are haematological manifestations of HIV?
Anaemia | Thrombocytopenia
51
What CD4 level is needed for haematological manifestations to present?
Any reduced CD4 level
52
What factors increase the risk of HIV transmission?
Anoreceotive sex Trauma Genital ulceration Concurrent STI
53
What ways can a mother pass HIV on to her child?
In utero/trans-placental Delivery Breast-feding
54
What is the prevalence of HIV in the UK?
1.5/1000
55
How many people are living with diagnosed HIV in Tayside?
366
56
What markers of HIV are used in labs to detect infection?
``` RNA (viral genome) Envelope proteins (gp120) Capsule protein (p24) ```
57
When were HIV antibody tests first introduced?
1985
58
What is the window period for HIV antibody testing?
~63 days
59
What antibodies are detected in 3rd generation HIV?
IgG and IgM
60
What is the window period for 3rd generation HIV antibody testing?
~average of 20-25 days
61
Describe 4th generation HIV tests
Combined antibody and antigen (p24) Shortens window period by ~5 days (around 14-28 days) Variability between assays and between labs
62
What is POCT?
A rapid HIV test results in 20-30 mins 3rd generation (ab only) 4th generation (ab/ag)
63
What are the advantages of POCT?
``` Simple to use No lab needed No venepuncture needed No anxious wait Reduce follow up Good sensitivity ```
64
What are the disadvantages of POCT?
``` Expensive -£10 Quality control Clinical governance Poor +ve predictive value in low prevalence settings Not suitable for high volume Cant be relied on in early infection ```
65
What does RITA stand for?
Recent Infection | Testing Algorithm
66
Describe RITA?
Used to identify if an infection occured within the preceeding 4-6 months Measure different types of antibodies or strength of antibody binding
67
What are the advantages of RITA?
``` Surveillance Local epidemiology Assess HIV testing programmes Inform partner notification Safer sex advice Interpretation of CD4 ```
68
What are the disadvantages of RITA?
Accuracy Patient distress Criminilisation

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