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HIV physiology and Management Flashcards

1
Q

What is CD4

A

A glycoprotein found on the surface of a range of cells.

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2
Q

What immune complex cells express CD4 on their surface?

A

T helper lymphocytes
Dendritic cells
Macrophages
Microglial cells

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3
Q

What receptors are a target site for HIV?

A

CD4+

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4
Q

Give 4 actions CD4+ Th lymphocytes carry out

A

Cytokine release
Activation of B-cells
Activation of cytoxic T cells (CD8+)
Recognition of MHC2 antigen presenting cells

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5
Q

What effect does HIV have on immune response?

A 
Reduces circulating CD4+ cells
Reduces proliferation of CD4+
Reduces CD8+ activation
Reduces antibody class switching 
Chronic immune activation
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6
Q

What impact does CD8+ reduction have?

A

There is dysregulated expression of cytokines leading to increased susceptibility of viral infection

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7
Q

What 4 categories does an HIV infected individual become susceptible to?

A

Viral Infection
Fungal Infection
Mycobacterial Infections
Infection-induced cancers

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8
Q

What is the normal parameters of CD4+ Th cells?

A

500-1600 cells/mm3

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9
Q

At what level of CD4+ does an individual become at risk to “opportunistic infections”

A

<200 cells/mm3

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10
Q

Define “opportunistic infections”

A

An infection caused by a pathogen which would not normally produce disease in a healthy individual

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11
Q

When does HIV undergo rapid replication?

A

In the very early and very late stages of infection?

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12
Q

What % of patients with primary HIV present with symptoms?

A

80%

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13
Q

What is the average time onset of symptoms post infection

A

2-4 weeks

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14
Q

HIV has high risk of transmission. True/False?

A

True

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15
Q

What type of rash is common in those infected by HIV

A

Maculopapular

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16
Q

What symptoms might someone with HIV present with?

A 
Fever 
Rash
Myalgia 
Pharyngitis 
Headache
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17
Q

What is the biggest risk in patients with asymptomatic HIV?

A

Transmission

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18
Q

What pneumonia-causing organism is common in HIV infected patients?

A

Pneumocystis Jiroveci

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19
Q

How do you treat pneumocystis pneumonia?

A

High dose co-trimoxazole

20
Q

How do you diagnose pneumocystis pneumonia?

A

BAL and immunofluorescence

21
Q

What X-ray changes may be seen in pneumocystis pneumonia?

A

Interstitial infiltrates

Reticulonodular markings

22
Q

What is the CD4+ threshold for infection by pneumocystis jiroveci?

A

<200cells/mm3

23
Q

What is the CD4+ threshold for infection by toxoplasma gondii?

A

<150cells/mm3

24
Q

What are the symptoms/signs of Cerebral Toxoplasmosis?

A 
Headache
Fever 
focal Neurology
Seizures
Reduced consciousness
Raised ICP
25
Q

What does the organism toxoplasma gondii cause?

A

Cerebral Toxoplasmosis

reactivation of a latent infection causing multiple cerebral abscesses

26
Q

What virus has a CD4+ threshold of <50cells/mm3

A

Cytomegalovirus

27
Q

What can CMV cause?

A

Retinitis
Colitis
Oesophagitis

28
Q

How does a CMV infection present?

A 
Reduced visual acuity
Floaters
Abdo pain
PR bleeding
Diarrhoea
29
Q

What should be carried out in all patients with a CD4+ <50

A

Ophthalmic screening

30
Q

What is significant about a Herpes Simplex infection in HIV patients?

A

Often Aciclovir resistant and extensive Hypertrophic

31
Q

Give 2 abnormal skin infections found in HIV patients?

A

Penicilliosis

Histoplasmosis

32
Q

Which skin infection common in HIV + patients is known to be dysplastic?

A

Human Papilloma Virus

33
Q

Which strain of HIV is associated with neurocognitive impairment?

A

HIV-1

34
Q

What is meant by “slims disease”?

A

HIV impacts metabolism and absorption which often leads to patients becoming anorexic

35
Q

Give 3 examples of AIDs-related cancers:

A

Kaposi’s Sarcoma
Non-Hodgkin’s Lymphoma
Cervical Cancer

36
Q

What virus is responsible for AIDs related Non-Hodgkin’s Lymphoma?

A

EBV

37
Q

What cancer can HHV8 (herpes virus) cause in HIV patients?

A

Kaposi’s Sarcoma

vascular tumour

38
Q

How many HIV patients suffer from anaemia?

A

90%

39
Q

What is the main method of HIV transmission?

A

Sexual Transmission

especially anoreceptive

40
Q

What is the other method of HIV transmission (less common)

A

Parenteral

Through drug injection and infected blood products

41
Q

What is the risk of mother to baby transmission of HIV if no treatment?

A

1/4

42
Q

Define highly active anti-retroviral therapy: (HAART)

A

A combination of 3 drugs from at least 2 classes, to which the virus is susceptible.

43
Q

Give 4 reasons why we use HAART

A

Reduce viral load to undetectable level
Restore immunocompetence
Reduce morbidity/mortality
Minimise Toxicity

44
Q

Give an example of a class of HIV drugs?

A

Nucleoside Analogues Reverse Transcriptase Inhibitors

NRTI

45
Q

What methods of delivery are used with HIV mother?

A

Vaginal if undetectable viral load

C-section is detectable viral load

46
Q

How long should a neonate be given PEP therapy?

A

4 weeks

Triple load if detectable, 1 drug if undetectable

47
Q

HIV infected mothers can breast feed. True/False

A

False

Infant must be formula fed only!

Reproduction (19 decks)

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