1
Q
How is HIV spread?
A
sexual transmission - multiple partners - MSM Injection drug misuse Blood products (haemophiliacs etc) Vertical transmission Organ transplant
2
Q
What does HIV do to the body?
A
Infects and destroys of the immune system, especially T helper cells that are CD4+
3
Q
What does CD4+ mean?
A
Have a CD4 receptor on their surface
4
Q
What are CD4 receptors present on the surface of?
A
LYMPHOCYTES macrophages and monocytes Cells in the brain skin probably many other sites
5
Q
Over the course of the infection, relationship between CD4 count and HIV viral load
A
CD4 declines and viral load increases
6
Q
Normal CD4 count
A
> 500
7
Q
What CD4 count do most AIDs diagnoses occur at?
A
< 200
8
Q
As the viral load increases, what is there an increased risk of?
A
Developing infections and tumours
9
Q
Levels of CD4 over time of infection
A
The immune system brings the virus under control after a while -> until the HIV RNA increases
Then the CD4 starts to plummet -> this is where you get symptoms and opportunistic infections
10
Q
What does AIDs stand for?
A
Acquired immune deficiency syndrome
11
Q
Clinical stages and their presentations of HIV
A
Clinical stage I
- asymptomatic
- persistent generalised lymphadenopathy
- performance scale 1 (asymptomatic, normal activity)
Clinical stage II
- weight loss < 10% of body weight
- minor mucocutaneous manifestating (fungal nail infections, recurrent oral ulcerations, seborrheic dermatitis)
- herpes zoster (within last 5 years)
- recurrent URTIs
- and/or performance scale 2 (symptomatic, normal activity)
Clinical stage III
- weight loss > 10% of body weight
- unexplained chronic diarrhoea > 1 month
- oral candidiasis (thrush)
- oral hairy leucopenia
- pulmonary TB within past year
- severe bacterial infections
- and/or performance score 3 (bedridden <50% of the day during the last month)
Clinical stage IV
- HIV wasting syndrome
- Toxoplasmosis of brain
- pneumocystic cariniipneumonia
- Cryptospiridosis with diarrhoea > 1 month
- CMV disease of an organ other than liver, spleen or lymph nodes
- HSV (mucocutaneous > 1 month, visceral any duration)
- PML
- candidiasis of oesophagus, trachea, bronchi or lungs
- atypical mycobacteriosis, disseminated
- extrapulmonary TB (lymphoma)
- HIV encephalopathy
- And/or performance score 4 (bedridden > 50% of the day during the last month)
12
Q
What is the average time on average from getting HIV to progressing to AIDs?
A
7-8 years
13
Q
What is the time on average from AIDs to dying?
A
Roughly 2 years
14
Q
What would be classified as an AIDs illness?
A
Certain infections and tumours that develop due to weakness in the immune system
15
Q
If have no symptoms, do you have an HIV or an AIDs illness?
A
No symptoms = HIV illness only
16
Q
AIDs defining conditions for an adult infection
A
TB, pneumocisitis Cerebral toxoplasmosis, PML Cryptococcal meningitis Kaposi's sarcoma Peristen cryptosporidiosis Non-hogkin's lymphoma Cervical cancer Cytomegalovirus retinitis
17
Q
Relationship between CD4 count and mortality
A
The lower the CD4 count, the higher the mortality
18
Q
Natural history of HIV infection
A
- acute infection
- asymptomatic
- HIV related illness
- AIDs defining condition
- Death
19
Q
What happens during a seroconversion illness?
A
The HIV antibodies are first developing
20
Q
Presentation of HIV seroconversion illness
A
Like a dose of glandular fever that lasts longer and has associated features Diarrhoea Rashes liver dysfunction malaise lethargy pharyngitis lymphadenopathy toxic exanthema
21
Q
When after exposure does seroconversion illness occur?
A
2-4 weeks after exposure time
22
Q
What does ART stand for?
A
Antiretroviral therapy
23
Q
Before the CD4 count drops to what do you want to start ART?
A
approx. 320
24
Q
what is key to ART to work?
A
Adherence needs to be over 90%
25
Types of antivirals
```
AZT
DDI
DDC
3TC
D4T
```
26
When to start ART?
consider starting all patients at diagnosis regardless of CD4
If CD4 > 350 = can start later depending on circumstance e.g. going off shore
If pregnant = start before the third trimester
27
Can pregnant women with HIV have normal vaginal delivery?
Yes - if the viral load is undetected
28
Treatments of HIV fail due to....
```
Poor adherence (leading to viral mutation and resistance)
Incomplete suppression
- inadequate potency
- inadequate drug levels
- inadequate adherence
- pre existing resistance
```
29
What does CD4 nadir mean?
Lowest CD4 before starting on therapy
30
Life expectancy of a patient diagnosed at 20 with a CD4 nadir of <100
52 y/o
31
Life expectancy of a patient diagnosed at 20 with a CD4 nadir of 100-200
62 y/o
32
Life expectancy of a patient diagnosed at 20 with a CD4 nadir of > 200
70+ y/o
33
Even in well controlled HIV, what seems to accelerate and what does this result in?
```
Your ageing is accelerated
Results in more likely to develop the following at a younger age
- osteoporosis
- cognitive impairment
- malignancy
- cerebrovascular disease
- renal disease
- ischaemic heart disease
- DM
```
34
HIV prevention
```
Behaviour change
Condoms
Circumcision (resource poor settings)
Treatment as a prevention
Pre-exposure prophylaxis (PrEP)
Post-exposure prophylaxis (PePSE)
```
35
Treatment of PJP
Co-trimoxazole
36
Treatment of toxoplasmosis
Co-trimoxazole
| Steriods
37
When to test for HIV after sex?
3 months
38
What is in an ART for HIV?
Nucleotide reverse transcriptase inhibitor
Non nucleotide reverse transcriptase inhibitor
Protease inhibitor
Integrade inhibitor
39
Side effects of ART
GI upset
Rash
Neuropathy
40
What is the most common opportunistic infection in AIDs?
PJP
41
What does PJP stand for?
Pneumocystitis jiroveci
42
Who should receive PJP prophylaxis?
All HIV patients with CD4+ count < 200
43
Presentation of PJP
SOB
Dry cough
Fever
Very few chest signs
44
Complications of PJP
Pneumothorax
45
How common is extra pulmonary manifestations of PJP and what are they?
RARE - 1-2%
| Hepatosplenomegaly, lymphadenopathy, choroid lesions
46
Investigations of PJP
CXR
Exercise induced desaturation
BAL
47
Treatment of PJP
Co trimoxazole
IV pentamidine in severe cases
Steroids if hypoxic
48
Causative organism of Kaposis sarcoma
HHV-8 (human herpes virus 8)
49
Who is kaposis sarcoma seen in?
HIV patients
50
Presentation of kaposis sarcoma
Purple plaques or paperless on skin or mucosa (e.g. GI or resp tract)
Resp involvement may lead to massive haemoptysis and pleural effusion
51
Treatment of kaposis sarcoma
Radiotherapy
| Resection
52
What are the HIV neuro complications?
```
Toxoplasmosis
Primary CNS lymphoma
TB
Encephalitis
Crypto coccus
PML
AIDs dementia complex
```
53
What % of cerebral lesions in patients with HIV are due to toxoplasmosis?
50%
54
Presentation of toxoplasmosis
Systemic symptoms
Headache
Confusion
Drowsiness
55
Investigation of Toxoplasmosis
CT
| Thallium spect
56
What is seen on CT in toxoplasmosis?
Ring enhancing lesions
| Mass effect may be seen
57
Thallium spect status in toxoplasmosis
-ve
58
Treatment of toxoplasmosis
Sufadiazine and Pyrimethamine
59
What % of cerebral lesions does primary CNS lymphoma make up?
30%
60
What is primary CNS lymphoma assosiated with?
EBV
61
Investigation for primary CNS lymphoma
CT
62
What is seen on CT for primary cerebral lymphoma?
Single or multiple homogenous enhancing lesions
63
Treatment of primary CNS lymphoma
Steroid (decrease tumour size)
Chemo
+/- whole brain irridation
Surgery may be considered for lower grade tumours
64
Thallium spect status of primary CNS lymphoma
+ve
65
TB brain effects due to HIV - is it common and what is the investigation and what would it show?
Much less common than toxoplasmosis or primary CNS lymphoma
| CT - single enhancing lesion
66
What may encephalitis be due to?
CMV or HIV itself
67
How common is HSV encephalitis in the context of HIV
Relatively rare
68
Investigation of encephalitis in HIV and what would it show?
CT - oedematous brain
69
What is the most common fungal infection of the CNS?
Crypto coccus
70
Presentation of cryptococcus
```
Headache
Fever
Malaise
N + V
Seizures
Focal neurological deficit
```
71
Investigations of cryptococcus
LP
| CT
72
What would LP and CT show in cryptococcus?
LP - increased opening pressure and India ink test +ve
| CT - meningeal enhancement, cerebral oedema
73
Typical presentation of cryptococcus but what can it also present as?
Meningitis but can also present as a SOL
74
What does PML stand for?
Progressive multifocal leukoencephalopathy
75
Pathology of PML
Widespread demyelination due to infection of oligodendrocytes by JC virus
76
Presentation of PML
```
Subacute onset
Behavioural change
Speech
Motor
Visual impairment
```
77
Investigations for PML and what would be seen
CT - single or multiple lesions, no mass effect, doesn’t usually enhance
MRI - high signal demyelination white matter lesions seen
78
What is AIDs dementia complex caused by?
HIV itself
79
Presentation of AIDs dementia complex
Behavioural changes
| Motor impairment
80
Ix for AIDs dementia complex and what would it show
CT - cortical and subcritical atrophy
81
PEP for HIV
Oral ARVT for 4 weeks
Infection
flashcards
Decks in class (16)
# Cards
-
Diarrhoea105
-
Sepsis and Septic Shock50
-
Pyrexia of Unknown Origin19
-
Health Care Acquired Infections (HAI)30
-
Influenza37
-
Zoonoses47
-
Fungal Infections46
-
Viral Infections40
-
Bacterial Infections103
-
Immunisation and Prophylaxis55
-
Travel Related Infection65
-
Skin and Soft Tissue Infections87
-
HIV81
-
Meningitis59
-
Hepatitis51
-
Antimicrobial Therapy and Prescribing16
