Infection Diseases > HIV > Flashcards

HIV Flashcards

(25 cards)

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1
Q

Describe HIV structure

A

ssRNA retrovirus

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2
Q

How can HIV be transmitted?

A
  • unprotected sex
  • vertical transmission
  • infection of HIV positive bodily fluids e.g. needle sharing, blood splashed in an eye
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3
Q

How can you prevent HIV transmission during birth?

A

Dependent on the mother’s viral load:
- <50copies/ml: normal vaginal delivery
- >50copies/ml: consider pre-labour C section
- over 400copies/ml: pre-labour C section recommended.
.
- IV zidovudine given during labour + delivery if viral load is unknown or >1000copies/ml
.
- prophylaxis for the baby: zidovudaine, lamivudine + nevirapine for 4 weeks

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4
Q

What are the two forms of prophylaxis for HIV?

A
  • PrEP: truvada (emtricitabine/tenofovir)
  • PEP: truvada (emtricitabine/tenofovir) and raltegravir for 28 days
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5
Q

How does HIV infect the cell?

A
  • infects with CD4 surface receptor
  • replicates inside the cell > kills the cell > inflammation > infects more cells
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6
Q

Presentation of HIV

A
  • fever
  • weight loss
  • malaise
  • myalgia, arthalagia
  • lymphadenopathy
  • headache
  • thrush
  • maculopapular rash
  • diarrhoea
  • sores in mouth
  • 3-12 weeks after infection
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7
Q

Diagnosis of HIV

A
  • nucleic acid test (PCR)
  • antigen/antibody test (serology)
  • antibody rapid tests
  • do tests 4 weeks after exposure
  • if initial result is negative, offer repeat test at 12 weeks
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8
Q

When do AIDs defining illnesses occur?

A

when CD4 count drops <200 which allows for opportunistic infections + malignancies to occur

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9
Q

Examples of AIDs defining illnesses

A
  • pneumocystis jirovecii pneumonia PCP (most common)
  • TB
  • Kaposi’s sarcoma
  • candidiasis
  • lymphomas
  • cytomegalovirus infection
  • mycobactium avium-intracellulare infection
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10
Q

What do patients with a CD4+ count of <200 need + why?

A

co-trimoxazole OD as primary prophylaxis for PCP

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11
Q

What do patients with a CD4+ count of <50 need + why?

A
  • azithromycin once weekly to protect against mycobacterium avium-intracelluare infection
  • ophthalmology assessment with dilated fundoscopy to look for evidence of intra-ocular infections
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12
Q

Baseline investigations for all patients with newly diagnosed HIV

A
  • confirmatory HIV test
  • CD4 count + viral load
  • HIV resistance profile
  • HLA B*5701 status
  • serology for syphilis, hep A/B/C
  • IgG for measles, varicella, rubella + toxoplasma
  • FBCs, U&Es, LFTs, bone + lipid profile
  • annual cervical cytology for women
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13
Q

Monitoring of HIV

A

_CD4 count_
- normal: 500-1200 cells/mm^3
- risk of AIDs defining illnesses: <200cells/mm3
.
_viral load_
- testing for HIV RNA per ml of blood
- undetectable: 20 copies/ml

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14
Q

Treatment of HIV

A

combination antiretroviral therapy offered irrespective of viral load or CD4 count:
two nucleoside reverse transcriptase inhibitors e.g. truvada (tenofovir + emtricitabine) + a 3rd agent e.g. bictegravir

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15
Q

Aims of HIV treatment

A

normal CD4 count (500-1200)
undetectable viral load (<20)

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16
Q

What vaccinations should someone with HIV have?

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A
  • hepatitis B
  • pneumoccous
  • flu
  • avoid live vaccines e.g. BCG
17
Q

Monitoring of CD4 in HIV

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A
  • 500-1200 cells/mm3 - normal
  • <200 cells/mm3 > patient is at high risk of opportunistic infections
18
Q

Additional management of HIV (on top of antiretroviral therapy)

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A
  • prophylactic co-trimoxazole: if CD4 <200 to protect against pneumocystis jirovecii pneumonia
  • close monitoring of CVD risk factors due to increased risk
  • yearly cervical smears due to increased HPV + cervical cancer risk
  • vaccinations: yearly flu, pneumococcal, HPV, hepatitis A/B - avoid live vaccines
  • condom use
19
Q

General side effect of NRTIs

Study These Flashcards
A

Peripheral neuropathy

20
Q

Features f pneumocystis jiroveci pneumonia

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A
  • dyspnoea
  • dry cough
  • fever
  • minimal chest signs on examination
21
Q

Chest x ray in pneumocystis jiroveci pneumonia

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A

Bilateral interstitial pulmonary infiltrates

22
Q

Management of pneumocystis jiroveci pneumonia

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A

Co trimoxazole
Steroids if hypoxic

23
Q

Ways to reduce vertical transmission of HIV

Study These Flashcards
A
  • maternal antiretroviral therapy - zidovudine
  • C section
  • neonatal antiretroviral therapy
  • bottle feeding
24
Q

5 key features of HIV associated nephropathy

Study These Flashcards
A
  • massive proteinuria > nephrotic syndrome
  • normal or large kidneys
  • focal segmental glomerulosclerosis
  • elevated urea + creatinine
  • normotension
25
First line test for HIV screening
Combined HIV antibody/antigen test
Infection Diseases
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