W7 - HIV

Question 1

how does HIV affect immune system

Answer 1

CD4 count drops
HIV RNA rises

Question 2

what does HIV increase the risk of

Answer 2

infections - proportional to CD4 drop
malignancies
cardiovascular disease

Question 3

at what point does HIV become aids

Answer 3

CD4 <200
illness/infection

Question 4

what is the natural history and progression of HIV

Answer 4

seroconversion
asymptomatic
HIV illness
AIDs illness
Death

Question 5

what occurs in HIV seroconversion

Answer 5

Acute onset 2-4 weeks post exposure, usually self limiting 1-2 weeks

Non-specific viral symptoms

Question 6

what are some of the nonspecific symptoms of HIV seroconversion

Answer 6

Flu like illness
Fever
Malaise/lethargy
Pharyngitis
Lymphadeopathy
Viral type rash – non-specific, generalised macules

Question 7

what are some of the indicator symptoms of HIV

Answer 7

Kaposi sarcoma
Oral hairy leukoplakia
Oro-pharyngeal candidiasis (without proven cause)
CMV ulcers

Other indicators:
Recurrent LRTIs
TB
Unexplained weight loss +/- diarrhoea
Persistent extra-inguinal lymphadenopathy

Question 8

what is this

Answer 8

herpes zoster
atypical shingles

Question 9

what is this

Answer 9

oral candidiasis

Question 10

what is this

Answer 10

oral hairy leukoplakia - EBV
white patch on side of tongue

Question 11

what is this

Answer 11

kaposi’s sarcoma
endothelial tumour

Question 12

what is this

Answer 12

also kaposi’s sarcoma
just dosseminated

Question 13

what is this

Answer 13

lymphadenopathy
persistent - biopsy (can be TB)

Question 14

what is this

Answer 14

normal

Question 15

what is this

Answer 15

PCP pneumonia

Question 16

what is this

Answer 16

TB - white patch in apex of left lobe

Question 17

what is this

Answer 17

R middle lobe consultation
recurrent pneumonia

Question 18

what is this

Answer 18

cerebral abscess - toxoplasmosis
can see ring enhancement
weakness in one side of the body

Question 19

what is this

Answer 19

CMV retinitis
blurring of vision - haemorrhages in the retina

Question 20

how does AIDs commonly present

Answer 20

PCP
TB
Non-Hodgkin’s lymphoma
Cryptococcal meningitis
Cerebral abscess ( toxoplasma)
Mycobacterium avium complex
CMV retinitis

Question 21

who routinely gets tested for HIV

Answer 21

MSM
Female sexual contacts of MSM
Black Africans
current/prior injecting drug use
Sex workers
Prisoners
Trans women

Question 22

what types of cancer do people with HIV get

Answer 22

Cervical cancer
Non-Hodgkin lymphoma
Kaposi’s sarcoma

Question 23

what bacterial infections do people with HIV get

Answer 23

Mycobacterium tuberculosis - pulmonary or extrapulmonary

Mycobacterium avium complex or Mycobacterium kansasii,

disseminated or extrapulmonary
Pneumonia, recurrent

Salmonella septicaemia

Question 24

what viral illnesses do people with HIV get

Answer 24

Cytomegalovirus retinitis

Herpes simplex, ulcer(s) >1 month/bronchitis/pneumonitis

Progressive multifocal leukoencephalopathy

Question 25

what parasitic infections do people with HIV get

Answer 25

Cerebral toxoplasmosis Isosporiasis, >1 month Atypical disseminated leishmaniasis Reactivation of American trypanosomiasis (meningoencephalitis or myocarditis)

Question 26

what should be discussed before testing for HIV

Answer 26

Risk and lifestyle Benefits of knowing HIV status and treatment possibilities What tests are available and which is recommended The window period for testing Seroconversion The difference between HIV and AIDS Confidentiality

Question 27

what is immune reconstitution inflammatory syndrome (IRIS)

Answer 27

TB CMV Cryptococcal Meningitis Genital Herpes Shingles after starting treatment from sudden increase immunity - reactivates infections steroids for a few days

Question 28

what drug treatments should a person be started on for new HIV diagnosis

Answer 28

2 NRTIs and 1 NNRTI 2NRTIs and 1 boosted PI 2NRTIs and 1 integrase inhibitor take lifelong virus can mutate and become resistant to medications

Question 29

what monitoring should be offered when not on treatment

Answer 29

CD4 and viral load every 3-6 months

Question 30

what monitoring should be offered when on stable treatment

Answer 30

Viral load and routine bloods 6 monthly 2 CD4 counts >350 1 year apart – don’t need another!

Question 31

what are some risk factors for HIV

Answer 31

MSM – particularly multiple UPAI, chemsex, High prevalence countries IV drug users Sex workers

Question 32

when should HIV viral load be tested for in pregnant women

Answer 32

at least every 3 months week 36 in women with established therapy

Question 33

can a woman have a vaginal delivery

Answer 33

yes - as long as viral load undetectable at 36weeks

Question 34

can someone who is HIV positive breast feed

Answer 34

not recommended can breast feed for as little time as possible if undetectable viral load and monthly testing for mother and baby

Question 35

when should someone use PEP

Answer 35

post-exposure: start within 72hrs follow up at 12 weeks Hep B vaccination

Question 36

what is the PEP drugs

Answer 36

Tenofovir disoproxil and emtricitabine 245/200mg OD Raltegravir 1200mg OD ALL for 28 days

Question 37

what are the drugs for Prep

Answer 37

pre-exposure prophylaxis Tenofovir disoproxil and emtricitabine 245/200mg Daily

Question 38

how effective is PEP

Answer 38

86% reduction in acquisition

Question 39

what is risks of prep

Answer 39

kidney damage osteoporosis give TAF10/FTC200 OD