Term
| mx plan for pregnancy and hIV |
|
Definition
Take same ART as before pregnancy
if viral load >50 then c-section
Formula feed baby
PEP for baby |
|
|
Term
| ARTs not recommended in pregnancy? |
|
Definition
|
|
Term
| why is mixed feeding not recommened in HIV mothers? |
|
Definition
| breast and formula milk makes lining of stomach more porus and this increases risk of transmission to the baby |
|
|
Term
| when might vaginal delivery be possible in HIv mother? |
|
Definition
|
|
Term
| PEP for infant when VL > 50 and < 50? |
|
Definition
VL < 50 = Zidovudine
VL > 50 = triple therapy |
|
|
Term
| which infections are exacerbated with AIDS? |
|
Definition
TB
Cryptococcus
Candidiasis
Toxoplasmosis |
|
|
Term
| which body fluids can transmit HIV? |
|
Definition
Breast milk
Blood
Semen
Saliva or tears cannot transmit HIV |
|
|
Term
| which infections increase risk of HIV transmission? |
|
Definition
Syphyllis
BV
Chlamydia
Herpes
Gonorrhoea |
|
|
Term
| how many people are living with HIV worldwide? |
|
Definition
|
|
Term
| what proportion of HIV pts are children? |
|
Definition
|
|
Term
| HIV - which enzyme required to make DNA from RNA? |
|
Definition
|
|
Term
| After new DNA made from RNA, the new DNA is intergrated into host cell genome using which enzyme? |
|
Definition
|
|
Term
| What does integration of hIv dna into host DNA result in? |
|
Definition
| Persistant or latent infection |
|
|
Term
| Which form of virus can ART drugs target? |
|
Definition
| Only the circulating form of the virus but not the integrated virus. This is why HIv cannot be cured |
|
|
Term
| which HIV type is more common? |
|
Definition
hiv 1
Most common and most virulent strain |
|
|
Term
| HIV 1 is split into major and minor groups. What are they and what are they responsible for? |
|
Definition
Major group (M) - pandemics
Minor groups (O and N) - confined to W africa |
|
|
Term
|
Definition
how tight the Ab are bound to each other. If its tight tight! then suggests estd infection
whereas loosely bound/easily seperated suggests recent infectin |
|
|
Term
| name the 5 HIV prevention pillars |
|
Definition
1. Programmes for young people in high prevalence locations
2. Prevention services
3. National condom programmes
4. Facilities for voluntary male circumcision in priority areas.
5.PEP for groups at higher risks |
|
|
Term
| what is the effect of voluntary medical male circucision? |
|
Definition
| Reduces risk of acquiring hIV |
|
|
Term
| Which integrase inhibitor is the preferre d first line treatment? |
|
Definition
Dolutegravir.
s/e neural tube defects |
|
|
Term
| what is criteria for starting ART |
|
Definition
| Start in all pts with HIV irrespective of clinical stage of CD4 cell counts |
|
|
Term
Zidovudine
Lamivudine
Didanosine
Abacavir are all examples of |
|
Definition
|
|
Term
Nevirapine
Etravirine
Efavirenz are all example of? |
|
Definition
|
|
Term
Protease inhibitors end in 'navir'
Give some examples |
|
Definition
Ritonavir
Amprenavir
Fosamprenavir
Saquinavir |
|
|
Term
Integrase inhibitors end in 'gravir'
give some examples |
|
Definition
Dolutegravir
Elvitegravir
Raltegravir |
|
|
Term
|
Definition
|
|
Term
| Recommended 1st line triple therapy? |
|
Definition
| Tenofovir/Lamivudine (or emtricitabine) + Dolutegravir |
|
|
Term
| WHta is Dolutegravir a/w in early pregnancy? |
|
Definition
| Neural tube defects in early pregnancy. Not recommended in those considering pregnancy |
|
|
Term
| what is immune reconstitution inflammatory syndrome? |
|
Definition
rapid restoration of pathogen specific immune responses to opportunistic infections.
Pardoxical IRIS - worsening of treated infection
Unmaskng IRIS - new presentation of previous subclinical infection |
|
|
Term
| when does IRIS occur after starting art? |
|
Definition
usually 4-6 weeks after starting art but can be months
No definitive test for it and should only be considered if more common causes for worsening have been ruled out |
|
|
Term
|
Definition
steorids.
treat underlying infection e.g tb AND hiv |
|
|
Term
|
Definition
|
|
Term
| Which herpes virus has a cheese and tomatoe pizza appearance on fundoscopy? |
|
Definition
CMV
rx: Ganciclovir or Valganciclovir or Foscarnet for 14-28/7 |
|
|
Term
| Ulceration shows Owls eye inclusion bodies... |
|
Definition
|
|
Term
| You can get end organ disease for which organs due to HIV? |
|
Definition
| End organ disease for any organ due to HIV |
|
|
Term
| what type of meningitis does cryptococcus caused in HIV +? |
|
Definition
with raised ICP/encephalitis.
Pt may need frequent LP to drain CSF |
|
|
Term
| how to diagnose cryptococcus? |
|
Definition
CrAg (cryptococcal Ag)
India stain on CSF
culture |
|
|
Term
|
Definition
Amphotericin B and 5 flucytosine 2/52
Followed by 8/52 of Fluconazole then prophylaxis |
|
|
Term
| How can CrAg be used to monitor rx response to cryptococcus? |
|
Definition
| CrAg should become -ve as rx progresses |
|
|
Term
| ring like lesion on MRI head in HIV + pt? |
|
Definition
Toxoplasmosis.
This needs to be distinguished from lymphoma by doing SPECT/PET scan |
|
|
Term
| Mx cerebral toxoplasmosis? |
|
Definition
Sulfadizine/Clindamycin/Azithromycin/Atovaquone with
PYRIMETHAMINE
OR SEPTRIN 6/52 |
|
|
Term
|
Definition
|
|
Term
| how many types of kaposis sarcoma? |
|
Definition
4
Classic - cutaneous
Endemic - african
Iatrogenic - exogenous immunosuppression
AIDs associated - disseminated |
|
|
Term
|
Definition
Septrin and Steroids are mainstay rx
21/7 |
|
|
Term
| How long do you need prophylactic septrin for to protect against PCP? |
|
Definition
|
|
Term
|
Definition
1 Asymptomatic CD4 >500
2 Minor symptoms 500-350
3 mod symptoms 350-200
4 AIDs defining < 200 |
|
|
Term
| tx for oral candidiasis in HIV + |
|
Definition
| flu/keto/itraconazole 7-14 days |
|
|
Term
|
Definition
topical corticosteroids
intralesional triamcinolone
systemic therapy with prednisolone or thalidomide |
|
|
Term
| oral hairy leukoplakia rx |
|
Definition
responds to HAART
Targeted therapy not recommended
Does not scrape with tongue blade |
|
|
Term
Hep B cannot be cured why
Hep C can be cured why? |
|
Definition
Hep B dna virus. many clear it but small amount become chronic. Cannot be cured but antivirals can suppress the virus.
Hep C an rna virus can be cured. Many become chornically infected. |
|
|
Term
| what is the difference between Hep C genotype 1 V 2,3 and 4? |
|
Definition
genotype 1 needs 48/52 therapy
2,3,4 need 24/52 therapy |
|
|
Term
|
Definition
Interferon
Tenofovir
Entecavir
Alternative: Pegylated IF 48/52 |
|
|
Term
| pegylated interferon is a treatment for Hep B. How long rx duration? |
|
Definition
|
|
Term
|
Definition
| Pegylated IF , Ribavirin and either telaprevir or boceprevir |
|
|
Term
|
Definition
Tenofovir
Interferon
Entecavir |
|
|
Term
| emergency contraception dose if on PI? |
|
Definition
|
|
Term
2018 changes to neonatal PEP?
stratified to very low/low and high |
|
Definition
Very low 2/52 AZT monotherapy
Low 4/52 AZT monotherapy
High 4/52 CART |
|
|
Term
| which type of genitourinary neoplasia more common in HIV + women? |
|
Definition
|
|
Term
| HIV1 originated in which animal? |
|
Definition
|
|
Term
| HIV2 originated in which animal? |
|
Definition
|
|
Term
| who recommends to start ART when? |
|
Definition
|
|
Term
| estimated % of pts with hep c but unaware? |
|
Definition
|
|
Term
| whats the difference between getting infected with HepB as a child than as an adult? |
|
Definition
infection as an infant more likely to be become chronic
where as infection as adult, only 10% become chronic infections |
|
|
Term
| vaccines are avaialable for which hepatitis? |
|
Definition
|
|
Term
| Globally how many people are living with chornic hepB+C? |
|
Definition
|
|
Term
| incubation period for hepatitis virus? |
|
Definition
2-6 weeks
except hep B where it can be 6months! |
|
|
Term
| All hepatitis except which one can cause chronic disease? |
|
Definition
|
|
Term
| in china there is also a vaccine for which hepatitis? |
|
Definition
|
|
Term
| which hep vaccine is relevant for travellers? |
|
Definition
hep A
2 x doses = lifelong immunity |
|
|
Term
| which hepatitis is transmitted more via blood and which is transmitted more via sex? |
|
Definition
|
|
Term
| infection with hep A leads to... |
|
Definition
|
|
Term
| hep E is bad in which state |
|
Definition
pregancy.
No immunity from getting Hep E |
|
|
Term
| Faecal-oral transmission in which hepatitis? |
|
Definition
Hep a/e
E also through ingestion of undercooked shellfish/pork |
|
|
Term
| In an outbreak amongst adults in LMIC where hepatitis is suspected which one is most likely? faecal-oral transmission suspected |
|
Definition
Hepatitis E
most adults would have got hep A prior and are now immune to it. So it has to be hep E
rx Ribavarin |
|
|
Term
|
Definition
| recovery and immunity or vaccination |
|
|
Term
| Vaccination gives Hep B Ab but... |
|
Definition
|
|
Term
| Hep B Ag is detected when? |
|
Definition
during acute/chronic infection
if present >6m = chornic
absent in recover/immunity |
|
|
Term
anti HbC
Hepatitis core Ab
Indicates.... |
|
Definition
current or past infection
appears at onset of symptoms in acute Hep B and persists for life!
If pt has HBSAb + but HBCAb - then theyhave been vaccinated but not infected |
|
|
Term
| Which hep Ab indicates current or past infection with Hep B and remains positive for life? |
|
Definition
|
|
Term
| HBS Ab + but HBC Ab - indicates what? |
|
Definition
| Immunisation with hep b vaccine but no infection |
|
|
Term
treatment for Hep B in adults
in children? |
|
Definition
Adults: tenofovir
Children: Entecavir
Both are NRTI |
|
|
Term
| is breast feeding ok in hep b? |
|
Definition
|
|
Term
Typical Hep C tx?
Genotype 3 |
|
Definition
|
|
Term
risk of needlestick injury transmission for
Hep B
Hep C
HIV |
|
Definition
hep B 30%
Hep C 3%
HIV 0.3% |
|
|
Term
| pregnant women with hep C? |
|
Definition
not treated during pregnancy
Breast feeding is fine |
|
|
Term
| WHO 7 steps to eliminate hepatitis |
|
Definition
global action
testing
rx
immunisation
prevent vertical transmission
Blood and needle saftey in healthcare
Harm reduction for IVDU |
|
|
Term
| hep b vaccine made from hep b surface antigen. we measure response by looking for .... |
|
Definition
| antibodies to the antigen |
|
|
