What is HIV?
Retrovirus that infects and replicates in human lymphocytes and macrophages, resulting in immunodeficiency
Where does HIV replicate primarily in?
Human CD4+ T cells and macrophages
What is HIV transmitted via? (3)
- Sexual fluids (majority of cases)
- Blood (IV drugs users sharing contaminated needles or blood transfusions)
- Breast milk
Risk factors of HIV? (4)
- HIV-infected blood transfusion
- IV drug use
- unprotected sexual intercourse
- percutaneous needle prick injury
what is Toxoplasmosis
an infection with a parasite called Toxoplasma gondii. People often get the infection from eating undercooked meat. You can also get it from contact with cat feces. The parasite can pass to a baby during pregnancy.
Happens in 50% of cerebral lesions in HIV patients
Symptoms of toxoplasmosis? (4)
- Constitutional symptoms
- Headache
- Confusion
- Drowsiness
what will imaging show for toxoplasmosis
CT showing single or multiple ring-enhanced lesions
Management of toxoplasmosis?
Pyrimethamine + sulphadiazine for 6 weeks
When does HIV seroconversion happen?
it’s symptomatic in most patients and presents 3-12 weeks after infection
How does HIV present? (10)
Glandular fever type illness
- Fevers, night sweats, weight Loss
- Skin Rashes → maculopapular rash
- Lymphadenopathy
- Sore Throat
- Oral Ulcers
- Diarrhoea
- TB
- Genital STIs
- Candidiasis → recurrent infections
- Shingles
What is first line investigation for HIV?
Combination test → HIV p24 antigen and HIV antibody test
What happens if combination test is positive for HIV?
Do it again to confirm diagnosis alongside starting treatment
What is the HIV p24 antigen?
Viral core protein that appears early in blood as viral RNA levels rise (earlier than antibodies)
How can we detect HIV antibodies?
Serum HIV Enzyme-Linked Immunosorbent Assay (ELISA) → positive for HIV antibodies (however antibodies may not be present in early infection)
How can we track immune status in HIV ppl?
CD4 count
What is first line treatment for HIV?
Antiretroviral therapy (ART) asap → 2 NRTIs and 1 INSTI
Can be 2 NRTIs and 1 PI/NNRTI if there are resistance issues, drug interactions or in some special situations such as pregnancy or intolerance
- What NRTIs are there? (3)
- Zidovudine
- Abacavir
- Tenofovir
What NNRTIs are there? (2)
- Nevirapine
- Efavirenz
What PI (Protease Inhibitors) are there? (3)
Navir tease a pro
- Indinavir
- Nelfinavir
- Ritonavir
How can we prevent HIV?
HIV Preexposure Prophylaxis (PrEP) for individuals at high risk of contracting HIV
What do we give to patients up to 72 hours after potential exposure to HIV?
HIV Postexposure Prophylaxis (PEP) which is a short course of ART for 4 weeks
What do we give if CD4 count <200/mm³ in HIV and why?
Co-trimoxazole as prophylaxis against Pneumocystis jirovecii pneumonia PJP
What complications are there for HIV? (2)
- Acute seroconversion
- AIDS
What is prognosis like for HIV?
if untreated, leads to death on average 8-10 years after infection
If receiving adequate ART, then no changes to life expectancy than healthy individuals
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