hazel_121
Mind Map by , created over 5 years ago

Infectious and immunity Mind Map on HIV, created by hazel_121 on 01/25/2014.

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hazel_121
Created by hazel_121 over 5 years ago
Module 1 - Section 4
Steven Williams
Medical Problems in Pregnancy
Matthew Coulson
Algebra
Alex Maraio
SFDC App Builder 1 (26-50)
Connie Woolard
Infectious Disease
gordonbrad
Human Immunodeficiency Virus (HIV)
Matthew Coulson
Module 1 - Section 3
Steven Williams
Module 1 - Section 1
Steven Williams
Module 1 - Section 2
Steven Williams
HIV
1 Clinical features
1.1 Acute HIV / seroconversion

Annotations:

  • Self-limiting, lasts 1-2 weeks and occurs in 30-60% HIV pts
1.1.1 Sore throat, fever, malaise, arthralgia, mouth ulcer, maculopapular rash
1.2 Symptomatic HIV infection; clues
1.2.1 weight loss, fatigue, lymphadenopathy, night sweats, diarrhoea
1.2.2 Recurrent candidiasis
1.2.3 recurrent / extensive genital warts
1.2.4 shingles
1.2.5 oral hairy leucoplakia
1.2.6 Worsening eczema / psoriasis
1.3 AIDS

Annotations:

  • Mean time to progession - 7-10 years, CD4+ less than 200
1.3.1 Respiratory
1.3.1.1 TB

Annotations:

  • Early and late HIV present differently - early - normal presentation. advanced - malaise, fever, fatigue weight loss, CXR may be normal or pleural effusion, shadowing. tuberculin may bne negative and smear negative
1.3.1.1.1 Presents atypically; PUO, minimal respiratory features, extra-pulmonary / disseminated disease
1.3.1.1.2 CXR - cavitating lesions but atypical in HIV
1.3.1.1.3 HIV / TB co infection - have a deleterious affect on each other
1.3.1.2 pneumocystis pneumonia (PCP)

Annotations:

  • Pneumocystis jirovecii
1.3.1.2.1 Gradual onset breathlessness, fever, dry cough
1.3.1.2.2 exertional desaturation, bilateral crackles
1.3.1.3 Cryptococcal

Annotations:

  • Lung, meningeal or wound infection. pigeon droppings (neoformans)
1.3.1.4 Cryptosporidiosis

Annotations:

  • Infects intestine - diarrhoea - potentially fatal in AIDs
1.3.1.5 Lymphocytic interstitial pneumonia

Annotations:

  • Dry cough, breathlessness
1.3.2 Malignancy
1.3.2.1 Kaposis sarcoma

Annotations:

  • HHV 8 virus. commonly presents with lesions on tip of the nose - dermatological condition
1.3.2.2 Cervical carcinoma
1.3.2.3 Lymphoma
1.3.2.3.1 Systemic NHL

Annotations:

  • 30% of malignancy death in HIV - associated with EBV
1.3.2.3.1.1 Extranodal disease - meninges and bone marrow
1.3.3 CNS

Annotations:

  • usually at CD4 less than 100
1.3.3.1 Encephalitis

Annotations:

  • Diffuse brain disorder
1.3.3.1.1 CMV
1.3.3.1.2 HSV
1.3.3.1.3 HIV encephalopathy (AIDS-dementia complex)
1.3.3.2 Focal / meningeal
1.3.3.2.1 Tuberculous
1.3.3.2.2 Cryptococcal
1.3.3.2.3 CNS lymphoma

Annotations:

  • Single enhancing brain lesion - strongly associated with EBV. primary NHL
  • Associated with EBV - diagnosis by detection in CSF
1.3.3.2.3.1 Focal neurological deficits
1.3.3.2.4 Progressive multifocal leucoencephalopathy

Annotations:

  • focal areas of demylelination
1.3.3.3 Toxoplasmosis

Annotations:

  • Multiple ring enhanced brain lesions
1.3.4 others
1.3.4.1 Mucocutaneous herpes simplex
1.3.4.2 Peripheral neuropathy
1.3.4.3 HIV associated wasting
1.3.4.4 CMV retinitis

Annotations:

  • CD4 less than 100
1.3.5 GI disorders
1.3.5.1 Oral: herpes simplex, candida, apthous, hairy leucoplakia
1.3.5.2 Diarrhoea; bacterial; salmonella, campylobacter, mycobacterium avium complex, protozoa; cryptosporidiosis, microsporidia, CMV
1.3.5.3 Oesphageal; candidiasis, CMV oesophagitis, herpes simplex
1.3.6 Dermatological
1.3.6.1 Psoriasis, achnes, seborrhoeic dermatitis
1.3.6.2 itchy folliculitis
1.3.6.3 Dermatophtosis
1.3.6.4 crusted scabies
1.3.6.5 VZV / HSV
1.3.6.6 Molluscum contagiosum
1.3.6.7 Recalcitrant warts
1.4 Long term non progressors

Annotations:

  • 5-10% HIV patients - little / no detectable virus in blood
2 Diagnosis
2.1 investigations once diagnosed
2.1.1 cervical smears

Annotations:

  • Yearly smears as progression to malignancy to rapid
2.1.2 CD4 count

Annotations:

  • Indicates immune status. measure every 3 months
2.1.2.1 less than 200 cells /mm - AIDs
2.1.3 Plasma viral load

Annotations:

  • measure every 3 months
2.1.4 Screen for other STIs
2.2 ELISA - antibody detection

Annotations:

  • used in resource poor settings, window period - 3-6 months (need to wait for seroconversion?)
2.3 Combined test - ab and antigen detection

Annotations:

  • Window period 6 wks - 3 mnths (can be 15 days)
3 Treatment
3.1 HAART

Annotations:

  • Generally started at CD4 counts less than 350 or opportunistic infection - balance risks and benefits
3.1.1 Risks
3.1.1.1 drug toxicity
3.1.1.1.1 Immediate - hypersensitivity reaction, acute hepatitis, pancreatitis, lactic acidosis
3.1.1.1.2 Long term; increased MI risk, lipatrophy, lipodystrophy, nausea, diarrhoea
3.1.1.2 Drug resistance

Annotations:

  • Need compliance of 95% to prevent resistance
3.1.2 Benefits
3.1.2.1 Preservation of immune funtcion
3.1.2.2 Decrease risk of transmission
3.1.2.3 Prolonged disease free survival
3.1.2.4 Reduced mortality from liver disease and malignancy
3.1.3 Types
3.1.3.1 Nucleoside / tide reverse transcriptase inhibitors (NRTIs)
3.1.3.2 Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
3.1.3.3 Protease inhibitor
3.1.4 2 NRTIs and 1 NNRTI / PI

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