HIV

Question 1

What is a common GI side effect of HIV?

Answer 1

Diarrhoea linked to Cryptosporidium

Question 2

How to diagnose infective cause of HIV-related diarrhoea!

Answer 2

A modified Ziehl-Neelsen stain (acid-fast stain) of the stool may reveal the characteristic red cysts of Cryptosporidium

Question 3

How to manage hiv associated diarrhoea!

Answer 3

Treatment is generally supportive - for patients with advanced HIV and cryptosporidiosis, initiation of antiretroviral therapy (ART) is the primary intervention

Question 4

What to do for severe diarrhoea in HIV?

Answer 4

If diarrhoea is severe then the antimicrobial nitazoxanide may be used.

Question 5

What is a cause of diarrhoea in HIV with very low CD4 count?

Answer 5

Mycobacterium avium intracellulare is an atypical mycobacteria seen with the CD4 count is below 50

Question 6

How does diarrhoea caused by mycobacterium avium oresent?

Answer 6

. Typical features include fever, sweats, abdominal pain and diarrhoea. There may be hepatomegaly and deranged LFTs

Question 7

How is diarrhoe caused by mycobacterium diagnosed?

Answer 7

blood cultures and bone marrow examination.

Question 8

What is the managment of severe mycobacterium cause of diarrhoea!

Answer 8

Management is with rifabutin, ethambutol and clarithromycin

Question 9

What is HIV seroconversion?

Answer 9

the crucial, early phase (typically 1–3 weeks post-infection) when the body begins producing detectable HIV antibodies

Question 10

How does HIVZ seroconversion present?

Answer 10

sore throat
lymphadenopathy
malaise, myalgia, arthralgia
diarrhoea
maculopapular rash
mouth ulcers
rarely meningoencephalitis

Question 11

How is HIV seroconversion diagnosed.

Answer 11

Combined test for HIV antibody and HIV p24 antigen

Question 13

How is HIV antibody diagnosed?

Answer 13

ELISA test and western blot assay for HIV antibodies at 4-6 weesks of infection

Question 14

How is HIV antigen diagnosed!

Answer 14

p24 antigen, a viral core protein that appears early in the blood as the viral RNA levels rise.

It is usually positive from about 1 week to 3 - 4 weeks after infection with HIV

Question 15

What to do for positive combined HIV test!

Answer 15

Repeat combined test to confirm diagnosis

Question 16

How to test for HIV in asymptomatic person?

Answer 16

*testing for HIV in asymptomatic patients should be done at 4 weeks after possible exposure

Question 17

What to do for negative HIV test in asymptomatic person with suspected HIV?

Answer 17

after an initial negative result when testing for HIV in an asymptomatic patient, offer a repeat test at 12 weeks

Question 18

When can p24 antigen be detected?

Answer 18

2-3 weeks post exposure

Question 19

What isi the first line test for asymptomatic patients?

Answer 19

P24 antigen for patients with signs and symptoms of chronic infection

Question 20

What are the risks of HIV at CDV count 200-500?

Answer 20

Oral thrush
Shingles
Hairy leukoplakia
Kaposi sarcoma

Question 21

What is hairy leukoplakia caused by?

Answer 21

Epstein Barr virus

Question 22

What is Kaposi sarcoma caused by?

Answer 22

Human herpes virus 8

Question 23

What are the features of HIV infection at CD4 100-200 cells?

Answer 23

Brain and lung conditions

*Cryptosporidiosis diarrhoea
*Cerebral toxoplasmosis, Progressive multi focal leukoencephalopathy and HIV DEMENTIA
*Pneumocystitis jirovecci lung infection

Question 24

What is the cause of progressive multi focal leukoencephalopathy?

Answer 24

Secondary to JC virus

Question 25

Which infections occur at CD4 of 50-100?

Answer 25

Aspergillosis Oesophageal candiadis Cryptococcal meningitis Primary CNS lymphoma

Question 26

What causes primary CNS lymphoma?

Answer 26

Secondary to Epstein Barr virus

Question 27

Which infections occur at CD4 below 50?

Answer 27

Cytomegalovirus retinitis Mycobacterium avium-intracellulare infection associated with diarrhoea

Question 28

When does oesophageal candiadis is occur in HIV?

Answer 28

It is generally seen in patients with a CD4 count of less than 100

Question 29

How does oesophageal candiadis is present?

Answer 29

. Typical symptoms include dysphagia and odynophagia. Fluconazole and itraconazole are first-line treatments.

Question 30

What is pneumocystitis jirovecci?

Answer 30

unicellular eukaryote, generally classified as a fungus that primarily affects the lungs,

Question 31

When does penumocytitis jirovecci occur!

Answer 31

all patients with a CD4 count < 200/mm³ should receive PCP prophylaxis due to risk of infection

Question 32

How does penumocystitis jirovecci oresent?

Answer 32

*dyspnoea *dry cough *fever *very few chest signs Pneumothorax is a common complication

Question 34

What are the extrapulmonary manifestations of pneumocystitis pneumonia?

Answer 34

*hepatosplenomegaly *lymphadenopathy *choroid lesions

Question 35

What will CXR show in pneumocystitis?

Answer 35

typically shows bilateral interstitial pulmonary infiltrates but can present with other x-ray findings e.g. lobar consolidation. May be normal

Question 36

What is used for diagnosis of pneumocystitis?

Answer 36

Sputum with silver stain Exercise induced desaturation CXR

Question 37

How is pneumocystitis pneumonia treated?

Answer 37

Co-trimoxazole *Steroids are indicated if hypoxia to reduce risk of respiratory failure and death Prophylaxis is given with trimethoprim and sulphamethozadole at CD4 count of 200

Question 38

How is pneumocystitis pneumonia treated in severe cases?

Answer 38

IV pentamidine in severe cases which inhibits topoisomerase II and RNApolymerase

Question 39

What is the most common cause of cerebral lesions in HIV patinets?

Answer 39

Toxoplasmosis

Question 40

How is toxoplasmosis diagnosed!

Answer 40

CT: usually single or multiple ring enhancing lesions, mass effect may be seen

Question 41

How to manage toxoplasmosis infection?

Answer 41

sulfadiazine and pyrimethamine

Question 42

What will CT show in primary CNS lymphoma?

Answer 42

single or multiple homogenous enhancing lesions

Question 43

How to manage primary CNS lymphoma?

Answer 43

steroids (may significantly reduce tumour size), chemotherapy (e.g. methotrexate) + with or without whole brain irradiation. Surgical may be considered for lower grade tumours

Question 44

When to start antiretroviral therapy for aHIV?

Answer 44

as soon as they have been diagnosed with HIV

Question 45

What are the HIV drug classes?

Answer 45

*Entry inhibitor * nucleoside analogues reverse transcriptase inhibitor *non nucleoside reverse transcriptase inhibitor * protease inhibitor * integrase inhibitor

Question 46

How do entry inhibitors work?

Answer 46

prevent HIV-1 from entering and infecting immune cells by blocking interaction with gp41

Question 47

What are the entry inhibitors?

Answer 47

Maraviroc Enfuvirtide

Question 48

How does madaviroc act?

Answer 48

binds to CCR5, preventing an interaction with gp41

Question 49

How does enfuvirtide act?

Answer 49

binds to gp41, also known as a 'fusion inhibitor'

Question 50

What are the side effects of Nucleoside analogue reverse transcriptase inhibitors NRTI?

Answer 50

Peripheral neuropathy

Question 51

What are the examples of NRTI?

Answer 51

zidovudine (AZT), abacavir, emtricitabine, didanosine, lamivudine, stavudine, zalcitabine, tenofovir

Question 52

What is a side effect of tenfovir?

Answer 52

Adverse effects include renal impairment and ostesoporosis

Question 53

Which NRTI is associated with pancreatitis!

Answer 53

Didanosine

Question 54

What are the side effects of zidovudine?

Answer 54

anaemia, myopathy, black nails

Question 55

What are examples of non nucleoside reverse transcriptase inhibtors?

Answer 55

nevirapine, efavirenz

Question 56

What are the side effects of NNRTI?

Answer 56

P450 enzyme interaction (nevirapine induces), rashes

Question 57

What are the protease inhibitors?

Answer 57

indinavir, nelfinavir, ritonavir, saquinavir

Question 58

What are the side effects of protease inhibitors?

Answer 58

diabetes, hyperlipidaemia, buffalo hump, central obesity, P450 enzyme inhibition

Question 59

What is a specific side effect of Indian INR?

Answer 59

renal stones, asymptomatic hyperbilirubinaemia

Question 60

What is a specific side effect of ritonavir?

Answer 60

a potent inhibitor of the P450 system

Question 61

What is the examples of integrase inhibitors?

Answer 61

raltegravir, elvitegravir, dolutegravir

Question 62

How does kaposi’s sarcoma present?

Answer 62

multiple palpable purple nodular lesions

Question 63

How to manage kaposi’s sarcoma intiially?

Answer 63

Assess compliance with cART

Question 64

What to do for possible HIV exposure?

Answer 64

HIV testing is required to confirm that patients are not already HIV-positive when they start taking PEP

Question 65

What is the cause of kaposi’s sarcoma?

Answer 65

Human herpes virus 8

Question 66

What is Epstein Barr virus linked to in HIV?

Answer 66

Burkitt's lymphoma and nasopharyngeal carcinoma

Question 67

What causes rapidly growing purple plaque on side of neck?

Answer 67

Kaposi’s sarcoma, which can occur at any CD4 count

Question 68

What causes multiple ring enhancing lesions with HIV?

Answer 68

Toxoplasmosis

Question 69

How to treat toxoplasmosis infection!

Answer 69

Adminster sulphasalazine and pyramethamine

Question 70

How does CMV retinitis present?

Answer 70

Occurs at CD4 count below 50 with severe vision loss, haemorrhages like pizza slices. There is high risk of retinal detachment

Question 71

What testing for delayed presentation of suspected HIV?

Answer 71

Combined HIV antibody/p24 test

Question 72

What are the indications for PCP prophylaxis?

Answer 72

*CD4 count below 200 *patients with a history of the infection *those who are severely immunocompromised

Question 73

What are the AIDs defining illnesses?

Answer 73

Occurs when CD4 count falls below 200 such as: Pneumocystitis jirovecci pneumonia Candidiasis Histoplasmosis Kaposi sarcoma, Burkett lymphoma, Cervical cancer Mycobacterium avium complex Tuberculosis

Question 74

What is the management of oesophageal candidiasis?

Answer 74

Oral miconazole gel

Question 75

What does miconazole interact with?

Answer 75

it interacts with simvastatin by inhibiting CYP3A4, increasing the risk of statin-induced myopathy and rhabdomyolysis

Question 76

What is an alternative to miconazole?

Answer 76

Oral nystatin

Question 77

What is gold standard for PCP diagnosis?

Answer 77

Bronchoalveolar lavage

Question 78

What are the signs for primary HIV infection?

Answer 78

maculopapular rash on the upper areas and mucosal ulcers Flu like symptoms

Question 79

What is the prophylactic medication of PCP?

Answer 79

Co-trimoxazole in HIV patients with CD4 counts below 200 cells/µL

Question 80

In a HIV patient, what causes periventicualr lesion on MRI!

Answer 80

primary cerebral lymphoma, which is caused by the Epstein-Barr virus

Question 81

In HIV patient, what causes Asymmetrical demyelinating white matter lesions on MRI?

Answer 81

progressive multifocal leukoencephalopathy, which occurs due to the reactivation of the John Cunningham (JC) virus

Question 82

How does cryptococcal meningitis present on investigation in HIV?

Answer 82

Encapsulated yeast organisms on India ink stain, which is the most likely diagnosis in a HIV positive patient with a raised opening pressure on lumbar puncture Some patients will have a normal CSF

Question 83

What type of candidiasis is AIDS defining?

Answer 83

Oral candidiasis

Question 84

What are the AIDS defining malignancies?

Answer 84

Kaposi sarcoma, primary CNS lymphoma, and invasive cervical cancer

Question 85

What causes single lobulated lesion with single homogenous enhancement?

Answer 85

Primary CNS lymphoma