168: Human Immunodeficiency Virus Flashcards
What is the primary mechanism by which HIV causes immune suppression?
HIV primarily causes immune suppression through the depletion of CD4+ lymphocytes and CD4+ cells of monocytic lineage.
What are the common clinical features of acute HIV infection?
Common clinical features of acute HIV infection include:
- Mononucleosis-like syndrome (fever, etc.)
- Laboratory findings: leukopenia, thrombocytopenia, transaminitis
- Morbilliform Rash: asymptomatic macules and papules on the face and upper trunk, which may be diffuse and pruritic (3-6 weeks after infection with HIV)
- Symptoms duration: lasts 2 to 3 weeks and resolves as plasma viremia decreases.
What is the significance of the ‘window period’ in HIV infection diagnosis?
The ‘window period’ refers to a delay of 3 to 4 weeks that typically occurs between newly acquired HIV-1 infection and the development of antibodies, making it critical for early diagnosis.
How does the clinical course of HIV infection change with access to antiretroviral therapy (ART)?
Access to combination ART significantly alters the course of HIV disease by:
- Markedly reducing the incidence of opportunistic infections
- Improving immune restoration if successfully achieved
- However, certain neoplasms, particularly those induced by sun exposure or virus-induced dysplasia, may still pose significant dermatologic burdens.
What are the implications of a CD4+ T-cell count of less than 200 cells/μL in an HIV-seropositive individual?
An HIV-seropositive individual with a CD4+ T-cell count of less than 200 cells/μL, or a CD4+ T-cell percentage of less than 14%, is considered to have AIDS, indicating a severe defect in cell-mediated immunity.
A 35-year-old HIV-seropositive individual has a CD4+ T-cell count of 180 cells/μL. What stage of HIV is this patient in, and why?
The patient is considered to have AIDS (HIV Stage 3) because a CD4+ T-cell count below 200 cells/μL is indicative of severe immunosuppression.
T or F: Efficient infection of a target cell by HIV requires not only expression of a CD4 molecule on the cell surface, but also the presence of a coreceptor (such as CXCR4 and CCR5). Any cell that expresses CD4 and an appropriate coreceptor may be infected by HIV.
True.
A patient with HIV presents with a diffuse morbilliform rash 3-6 weeks after infection. What is the likely diagnosis, and what is its significance?
The likely diagnosis is acute retroviral syndrome, which provides an opportunity for early HIV diagnosis during high levels of viremia.
What is the significance of CD4+ T-cell levels in HIV infection and treatment guidelines?
CD4+ T-cell levels are crucial in HIV infection; levels below 200 cells/μL indicate severe complications. Guidelines recommend initiating ART upon diagnosis regardless of CD4 count, reflecting the importance of early treatment.
What are common adverse cutaneous drug reactions associated with antiretroviral medications in HIV patients?
Common adverse reactions include morbilliform eruptions, urticaria, retinoid-like effects, and vasculitis. These reactions can complicate over 20% of prescriptions and are more severe in patients with HIV due to immune reconstitution.
What is HIV-related lipodystrophy and what are its clinical manifestations?
HIV-related lipodystrophy is characterized by abnormal fat distribution, including lipohypertrophy (central obesity, buffalo hump) and lipoatrophy (flattening of facial contours). It is associated with metabolic abnormalities like hypertriglyceridemia and hypercholesterolemia.
What factors increase the risk of drug eruptions in HIV-infected individuals?
Factors include female gender, peripheral CD4+ T-cell count <200 cells/μL, CD8+ T-cell count >460 cells/μL, and a history of drug eruptions. These factors relate to the pathogenesis of severe reactions like SJS/TEN.
How is the diagnosis of drug reactions in HIV patients typically approached?
Diagnosis is primarily clinical and often a diagnosis of exclusion. It involves identifying the culprit medication, as reactions can occur even weeks after discontinuation. New-onset hypersensitivity may also develop in HIV-infected individuals.
What is the role of HLA-B5701 testing in HIV treatment?
HLA-B5701 testing is used to screen for hypersensitivity reactions to abacavir, a common antiretroviral drug.
A patient with HIV presents with a buffalo hump and increased abdominal girth. What is the likely diagnosis, and what is the cause?
The likely diagnosis is lipohypertrophy, often caused by protease inhibitors (PIs) used in ART.
What are the management strategies for lipodystrophy in HIV patients?
Management of lipodystrophy remains challenging. Strategies include:
- Substitution of ART regimens containing stavudine and zidovudine for partial benefit in lipoatrophy.
- Switching to NRTI-sparing regimens may improve fat distribution but can lead to lipid anomalies.
- Facial lipoatrophy treatment options include soft-tissue fillers like poly-l-lactic acid or calcium hydroxylapatite.
- Liposuction has been used to treat dorsocervical lipomatosis.
What are the common mucocutaneous infections associated with advanced HIV disease?
In advanced HIV disease, patients are at risk for several opportunistic infections, including:
- Oral hairy leukoplakia: A benign Epstein-Barr virus infection presenting as corrugated white plaques on the tongue.
- Bacillary angiomatosis: Caused by Bartonella species, presenting as red-to-violaceous papules or nodules.
- Cutaneous tuberculosis: Often presents as disseminated red-brown macules and papules.
- Invasive mycoses: Can arise from local invasion or reactivation of latent infections, often in patients with CD4+ T-cell counts <50 cells/μL.
What is bacillary angiomatosis and how is it treated in HIV patients?
Bacillary angiomatosis is caused by Bartonella henselae and Bartonella quintana, typically occurring in HIV patients with a CD4+ T-cell count <200 cells/μL. It presents as red-to-violaceous dome-shaped papules or nodules. Treatment includes:
- Antibiotics: Erythromycin (500 mg 4x/day) or doxycycline (100 mg BID) for 4 weeks or until lesions resolve.
- Lifelong secondary prevention may be indicated for patients with recurrent bacillary angiomatosis.
What are the clinical features of mycobacterial infections in HIV patients?
Mycobacterial infections in HIV patients include:
- Tuberculosis (TB): The most common opportunistic infection, with cutaneous manifestations being rare. Common presentations include scrofuloderma and cutaneous miliary tuberculosis.
- Miliary tuberculosis: Presents with asymmetric red-brown pinpoint macules and papules, treated with multidrug antituberculosis therapy.
- Non-TB mycobacterial infections: Such as M. avium complex, may disseminate to the skin in immunocompromised individuals.
What are the characteristics of invasive mycoses in advanced HIV disease?
Invasive mycoses in advanced HIV disease may arise from:
- Local invasion of the skin or mucosa with secondary lymphatic or hematogenous dissemination.
- Reactivation of a latent pulmonary focus of infection.
Clinical features include a wide variety of skin lesions such as:
- Cellulitis-like plaques
- Pink or skin-colored nodules
- Deep ulcerations
- Acneiform papules and pustules
- Umbilicated papules resembling molluscum, typically favoring the face and upper trunk.
What is the most common opportunistic infection in HIV, and what are its typical cutaneous manifestations?
Tuberculosis (TB) is the most common opportunistic infection in HIV. Cutaneous manifestations include scrofuloderma, gummatous tuberculosis, and cutaneous miliary tuberculosis.
A patient with HIV presents with red-to-violaceous dome-shaped papules resembling cherry angiomas. What is the likely diagnosis, and what is the causative organism?
The likely diagnosis is bacillary angiomatosis, caused by Bartonella henselae or Bartonella quintana.
What is the significance of bacillary angiomatosis in HIV patients, and how is it treated?
Bacillary angiomatosis is caused by Bartonella species and indicates severe immunosuppression (CD4+ T-cell count <200 cells/μL). It is treated with erythromycin or doxycycline.
What are the common fungal pathogens associated with AIDS that can lead to cutaneous infections?
Common fungal pathogens include Cryptococcus, Histoplasma, and Penicillium species, which are significant due to their potential for angioinvasion and high mortality rates in AIDS patients.
What is the typical presentation of cryptococcosis in AIDS patients?
In AIDS patients, cryptococcosis typically presents with umbilicated papules on the skin, occurring in about 10% of cases with disseminated disease.
How does disseminated histoplasmosis present in immunocompromised patients?
Disseminated histoplasmosis presents with fevers, weight loss, pulmonary symptoms, lymphadenopathy, and mucocutaneous lesions such as umbilicated papules and necrotic ulcers.
What is the treatment approach for penicilliosis in AIDS patients?
Treatment for penicilliosis typically involves amphotericin or itraconazole, although relapse is common, especially in advanced cases.
What are the four clinical patterns of oropharyngeal candidiasis in HIV-infected individuals?
The four clinical patterns of oropharyngeal candidiasis are:
- Pseudomembranous (thrush) - yellow-white plaques on the tongue, removable by scraping.
- Hyperplastic - white plaques on the buccal mucosa, not removable by scraping.
- Erythematous (atrophic) - erythematous patches on the palate and dorsal tongue.
- Angular cheilitis - erythema with curd-like flecks or painful fissures at the angles of the lips.
What is the significance of proximal subungual onychomycosis in HIV patients?
Proximal subungual onychomycosis is a specific fungal infection in advanced immunocompromised patients and should prompt an HIV test if the patient’s status is unknown.
What are the characteristics of severe molluscum contagiosum in advanced HIV patients?
Severe molluscum contagiosum in advanced HIV patients is characterized by umbilicated papules with yellow-white cores that can coalesce into large confluent plaques and nodules, particularly on the face.
How does scabies present in individuals with advanced HIV disease?
In individuals with advanced HIV disease, scabies typically presents with pruritus, interdigital burrows, and excoriated papules, but may also lead to severe hypersensitivity reactions resulting in widespread scabetic nodules, vesicles, and pustules.
A patient with HIV develops umbilicated papules on the face and upper trunk. What is the likely diagnosis, and what is the primary treatment?
The likely diagnosis is molluscum contagiosum. The primary treatment includes topical cidofovir, imiquimod, or other therapies, but lesions often resolve with immune reconstitution via ART.
A patient with HIV presents with umbilicated papules and necrotic ulcers on the face and nasal mucosa. What is the likely fungal infection, and how is it diagnosed?
The likely fungal infection is histoplasmosis. It is diagnosed by identifying 2-4 μm intracellular yeast forms within parasitized macrophages on histopathologic examination.
What is the significance of a CD4+ T-cell count below 50 cells/μL in the context of fungal infections in HIV?
A CD4+ T-cell count below 50 cells/μL is associated with cutaneous dissemination of opportunistic fungi, including cryptococcosis, histoplasmosis, and penicilliosis.
A patient with HIV presents with erythematous patches on the palate and dorsal tongue. What is the likely diagnosis, and what are the treatment options?
The likely diagnosis is erythematous (atrophic) candidiasis. Treatment options include topical antifungals or systemic antifungals for severe cases.
What is the risk associated with crusted scabies in advanced AIDS patients?
Advanced AIDS patients are at risk for developing crusted scabies, a highly infectious variant characterized by thousands or millions of mites, leading to extensive thick hyperkeratotic plaques. These plaques may be nonpruritic or minimally pruritic. Treatment typically involves multiple doses of ivermectin combined with a topical scabicide and a keratolytic cream for better penetration.
How do HIV and Leishmania species interact in co-infected patients?
In co-infected patients, HIV and Leishmania species interact in complex and often symbiotic ways, leading to:
1. More rapid progression to AIDS.
2. Higher HIV viral loads.
3. Increased infectivity.
The HIV-induced shift in cytokines toward a TH2-dominant milieu impairs the TH1 response critical for controlling leishmaniasis, while Leishmania activation of immune cells creates more target cells for HIV infection.
What is the dosing regimen for ivermectin for crusted scabies in a patient infected with HIV?
200 ug/kg weekly for up to 7 weeks.
What is the implication of well-controlled HIV on infections?
Patients with well-controlled HIV can avoid or recover from profound immunosuppression but remain susceptible to typical infections.
What is the prevalence of S. aureus colonization in HIV-infected individuals?
The prevalence of S. aureus nasal carriage among HIV-infected individuals is significantly higher than in the general population, with estimates as high as 30% to 50%.
What are the characteristics of HSV infections in advanced HIV disease?
In advanced HIV disease, primary and recurrent HSV 1 and 2 infections are often more severe, longer lasting, and refractory to therapy.
What is the relationship between VZV infections and CD4+ T-cell counts in HIV patients?
In advanced HIV disease, atypical presentations of VZV reactivation, such as recurrent dermatomal herpes zoster, are common.
How has ART affected the incidence of HPV-related diseases in HIV patients?
The introduction of effective ART has reduced the incidence of AIDS-defining malignancies, including HPV-induced cervical cancer.
What is the likely diagnosis for a patient with HIV presenting with a chronic verrucous plaque resistant to acyclovir?
The likely diagnosis is verrucous HSV or herpes vegetans. Alternative treatments include topical imiquimod, IV foscarnet, or cidofovir.
What is the diagnosis and treatment for a patient with HIV presenting with diffuse, thick hyperkeratotic plaques involving the scalp and palms?
The diagnosis is crusted scabies. Treatment includes multiple doses of ivermectin combined with a topical scabicide and keratolytic cream.
What is the relationship between HPV infections and HIV-infected individuals?
HPV infections are more prevalent in HIV-infected individuals due to both sexual transmission and the immunocompromised state caused by HIV.
What are the common manifestations of HPV in HIV patients?
Common manifestations include extensive and refractory warts, oral florid papillomatosis, and anogenital giant condyloma.
What is the significance of screening for anal and cervical dysplasia in HIV-positive patients?
Screening is particularly important due to the higher prevalence of HPV-induced dysplasia and squamous cell carcinoma in this population.
What is Kaposi sarcoma and its association with HIV?
Kaposi sarcoma is a vascular and lymphatic neoplasm caused by human herpesvirus-8 and is one of the most common HIV-associated malignancies.
How does ART affect the incidence of Kaposi sarcoma in HIV patients?
ART decreases the incidence of Kaposi sarcoma but does not eliminate it completely.
What are the diagnostic methods for Kaposi sarcoma?
Diagnosis is made based on clinical appearance and biopsy, with tissue confirmation strongly recommended.
What are the treatment options for HIV-related Kaposi sarcoma?
Treatment options include ART for mild to moderate cases, chemotherapy for more severe cases, and local therapies.
What is the prevalence of anal HPV infection in HIV-positive individuals compared to HIV-negative individuals?
In HIV-positive MSM, anal HPV infection is present in up to 94%, compared to 40% to 60% in HIV-negative individuals.
What are the implications of syphilis co-infection in HIV patients?
Syphilis co-infection can lead to more severe manifestations, increased risk of treatment failure, and impacts HIV disease progression.
What is the recommended age range for HPV vaccination in HIV-positive individuals?
The quadrivalent or nonavalent HPV vaccine is recommended for HIV-positive females aged 9 to 26 years and males aged 9 to 21 years.
What are the recommendations for anal cytology in HIV-positive individuals?
Anal cytology should be obtained at baseline and annually in all HIV-positive MSM and any HIV patient with a history of anogenital condyloma.
How does the incidence of non-Hodgkin lymphoma in HIV patients compare to the general population?
In the ART era, the risk of lymphoma in HIV patients is at least 11 to 15 times that of the general population.
What are the clinical features of primary cutaneous lymphomas in HIV patients?
They can present as singular nodules or tumors that may have ulceration.
What is the prognosis for primary cutaneous lymphomas in HIV patients compared to HIV-negative individuals?
They tend to be aggressive, with survival often less than 1 year in HIV patients.
What is the mainstay of therapy for papular pruritic eruption (PPE) and eosinophilic folliculitis (EF) in HIV patients?
The mainstay of therapy for both PPE and EF is antiretroviral therapy.
What unusual presentations of psoriasis in HIV patients should raise concern for concomitant HIV infection?
Unusual presentations include:
- rupioid psoriasis
- sebopsoriasis
- reactive arthritis with keratoderma blenorrhagica with palmoplantar manifestations
- acute onset of severe psoriasis
- severe exacerbations of existing psoriasis
- psoriasis with multiple morphologies in 1 patient
T or F: The quadrivalent or nonvalent HPV vaccine should be given to males 22-26 years of age if not vaccinated at younger ages.
True.
T or F: Mycosis fungoides has a similar presentation, clinical course and management paradigm among HIV-infected and -uninfected individuals.
True.
What is the paradoxical relationship between psoriasis and HIV infection?
Psoriasis can worsen in HIV patients, particularly when severely immunosuppressed.
What are the mainstays of treatment for seborrheic dermatitis in HIV patients?
Topical and systemic antifungals, topical or oral corticosteroids, and oral antibiotics when needed.
What is the prevalence of papular pruritic eruption (PPE) in adults and children with HIV?
The prevalence of PPE may be as high as 46% in adults and 42% in children.
What is the mainstay of treatment for papular pruritic eruption (PPE) in HIV patients?
The mainstay of treatment for PPE is ART.
What are the characteristics of eosinophilic folliculitis (EF) in HIV patients?
EF is characterized by follicular pruritic papules and pustules, favoring the midline of the face and trunk.
What are the current WHO recommendations for treating eosinophilic folliculitis (EF) in HIV patients?
Start with an oral antihistamine, followed by topical steroids, and if no response, use oral itraconazole.
Clinically significant dermatologic reactions of IRIS that may lead to patient nonadherence may be treated with what dosing regimen of prednisone? What condition is the notable exception to this management?
- Prednisone up to 1 mg/kg, rapidly tapered
- Kaposi sarcoma is the exception (systemic steroids may lead to worse outcomes)
What is the significance of seroprevalence in HTLV-1 and its transmission routes?
HTLV-1 has a high seroprevalence in certain regions (Japan, the Carribean, equatorial Africa, South America), with main transmission routes including breastfeeding, sexual intercourse, drug use and blood transfusion.
What is IRIS and what factors contribute to its occurrence?
IRIS is a condition of robust inflammatory reactions following ART, influenced by high viral load and low CD4 counts.
How is IRIS diagnosed and what are the key criteria for its diagnosis?
IRIS is diagnosed clinically with a case definition of:
1. A previous diagnosis of AIDS with low pretreatment count
2. A positive virology and immunologic response to ART
3. A temporal association between the initiation of ART and disease development.
What are the management strategies for IRIS reactions?
Most IRIS reactions are self-limited; significant reactions may be treated with prednisone.
What is the likely diagnosis for a patient with HIV presenting with a pruritic rash and eosinophilic folliculitis after starting ART?
The likely diagnosis is IRIS-associated eosinophilic folliculitis. Management includes continuation of ART.
When does IRIS usually happen?
On the 1st 2-3 months following the initiation of ART.
What are the common clinical manifestations of infective dermatitis associated with HTLV-1?
Infective dermatitis presents as recalcitrant, relapsing eczema, blepharoconjunctivitis, involvement of the scalp, neck, and intertriginous areas, periorbital papules with seborrheic scale near the eyebrows, possible rhinorrhea, bacterial pustulosis, and foul-smelling discharge. It is associated with a marked TH1 response and can be severely pruritic.
What is the prognosis of acute T-cell leukemia (ATL) associated with HTLV-1?
The prognosis of ATL is very poor, particularly in the acute form, where resistance to multiple chemotherapeutic agents is rapidly demonstrated.
How is infective dermatitis associated with HTLV-1 diagnosed?
Infective dermatitis is diagnosed through serologic confirmation of HTLV-1 in at-risk patients, clinical manifestations such as recalcitrant eczema, and histopathology is rarely necessary and often nonspecific.
What are the recommended management strategies for infective dermatitis associated with HTLV-1?
Management strategies include treatment with antibiotics (Trimethoprim-sulfamethoxazole is the agent of choice), use of high-potency topical steroids and immunomodulators for symptomatic control, chronic management as the disease is not curable and is relapsing, and screening programs are important due to the lack of available vaccines for HTLV-1.
What are the important differential diagnoses for infective dermatitis associated with HTLV-1?
The important differential diagnoses include seborrheic dermatitis, atopic dermatitis, folliculitis, contact dermatitis, ichthyosis, xerosis, and impetigo.
What are the important dermatological manifestations of HTLV-1 virus?
- Infective dermatitis
- Acute T-cell leukemia/lymphoma
What are the defining illnesses for AIDS (HIV stage 3)?
The defining illnesses for AIDS (HIV stage 3) include:
- candidiasis
- invasive cervical cancer
- disseminated coccidioidomycosis
- extrapulmonary cryptococcosis
- chronic intestinal cryptosporidiosis
- cytomegalovirus disease
- cytomegalovirus retinitis
- HIV-related encephalopathy
- chronic herpes simplex ulcers
- disseminated histoplasmosis
- chronic intestinal isosporiasis
- Kaposi sarcoma
- Burkitt lymphoma
- primary brain lymphoma
- disseminated mycobacterium avium complex
- mycobacterial tuberculosis
- recurrent pneumonia
- progressive multifocal leukoencephalopathy
- recurrent salmonella septicemia
- toxoplasmosis of the brain
- wasting syndrome attributed to HIV
What are the major and minor criteria for Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV patients?
The major criteria for IRIS include:
- atypical presentation of opportunistic infections or tumors in patients responding to ART
- decrease in plasma HIV RNA level by at least 1 log10 copies/mL
Minor criteria include:
- increased blood CD4+ T-cell count after ART
- increase in immune response specific to the relevant pathogen
- spontaneous resolution of disease without specific antimicrobial therapy or tumor chemotherapy with continuation of ART
T or F: In the case of maternal HTLV-1 seropositivity, cesarean section is not recommended, but breastfeeding is allowed.
False. Cesarean section is recommended to prevent vertical transmission. Avoidance of breastfeeding and cross-feeding is also recommended, particularly if the serological status of the mild mother is unknown.
What are the systemic side effects associated with Nucleoside Reverse Transcriptase Inhibitors (NRTIs)?
The systemic side effects of NRTIs include pancreatitis, peripheral neuropathy, lactic acidosis (Abacavir), steatorrhea, pancreatitis, hepatotoxicity (Didanosine), hepatotoxicity (Lamivudine), renal toxicity (Stavudine), renal toxicity (Tenofovir), oropharyngeal and esophageal ulcers (Zidovudine), and hepatotoxicity (Zalcitabine).
What dermatological side effects are associated with Nucleoside Reverse Transcriptase Inhibitors (NRTIs)?
The dermatological side effects of NRTIs include hypersensitivity with rare instances of Stevens-Johnson syndrome (Abacavir), toxic epidermal necrolysis (Didanosine), leukocytoclastic vasculitis (Stavudine), and hyperpigmentation of nails and mucous membranes, leukocytoclastic vasculitis, and hypertrichosis (Zidovudine).
What are the common systemic side effects of Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)?
The common systemic side effects of NNRTIs include hepatotoxicity (Delavirdine, Etravirine, Nevirapine, Rilpivirine) and depression and mood changes (Efavirenz).
What are the dermatological side effects associated with Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)?
The dermatological side effects of NNRTIs include hypersensitivity reactions (Delavirdine), rash with a risk of progression to Stevens-Johnson syndrome (Efavirenz), a high incidence of severe hypersensitivity reactions (Nevirapine), and lipodystrophies (Rilpivirine).
What are the systemic side effects of Protease Inhibitors (PIs)?
The systemic side effects of PIs include nausea, vomiting, diarrhea, headaches, lipodystrophy (Amprenavir), anomalies and hyperbilirubinemia (Atazanavir), hepatotoxicity (Darunavir, Fosamprenavir), nephrolithiasis and hyperbilirubinemia (Indinavir), gastrointestinal side effects (Lopinavir, Ritonavir), diarrhea and hyperlipidemia (Nelfinavir), spontaneous bleeding and hematomas (Saquinavir), and rare cases of fixed drug eruptions (Tipranavir).
What are the dermatological side effects associated with Protease Inhibitors (PIs)?
The dermatological side effects of PIs include rash with progression to SJS (Amprenavir, Fosamprenavir, Tipranavir), lipohypertrophy and dose-dependent retinoid-like effects (Indinavir), spontaneous hematomas (Ritonavir), rare cases of fixed drug eruptions (Saquinavir), and sulfa-allergies (Darunavir, Tipranavir, Fosamprenavir, Amprenavr).
What are the systemic side effects of Fusion Inhibitors?
The systemic side effects of Fusion Inhibitors include increased frequency of bacterial pneumonia (Enfuvirtide).
What are the dermatological side effects associated with Fusion Inhibitors?
The dermatological side effects of Fusion Inhibitors include systemic hypersensitivity reactions in <1% of patients and injection-site reactions in up to 98% of patients (Enfuvirtide).
What are the common systemic side effects of Integrase Inhibitors?
The common systemic side effects of Integrase Inhibitors include well-tolerated, nausea, diarrhea, headache (Raltegravir), insomnia, hepatotoxicity (Dolutegravir), and hepatotoxicity (Elvitegravir).
What are the dermatological side effects associated with Integrase Inhibitors?
The dermatological side effects of Integrase Inhibitors include rare case of skin hypersensitivity (Dolutegravir).
How is ATL diagnosed?
- initial: ELISA (showing anti-HTLV1 antibodies)
- confirmation: Western blot
- PCR (proviral DNA insertion)
- biopsy (flower cells which may be CD25+ or CD25-) is also helpful
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The acute retroviral syndrome typically occurs 2-4 weeks after HIV infection.
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The most common opportunistic infection in HIV is Pneumocystis pneumonia (PCP).
What are the criteria for an individual to be considered to have AIDS based on CD4+ T-cell count and percentage?
An HIV-seropositive individual >6 years of age with a CD4+ T-cell count <200 cells/μL, a CD4+ T-cell percentage <14%, or with any of several diseases indicative of a severe defect in cell-mediated immunity is considered to have AIDS.
What are five infections associated with well-controlled HIV?
- staphylococcal pyodermas
- herpes simplex
- herpes zoster reactivation
- syphilis
- HPV-related diseases
The organism in bacillary angiomatosis may be seen in tissue biopsy with what stains?
Silver stains (Warthin-Starry).
Spared areas in bacillary angiomatosis?
Palms, soles, oral cavity.
What CD4 T lymphocyte counts (cells/uL) are usually exhibited in patients with invasive mycoses, severe molluscum contagiosum and bacillary angiomatosis?
- invasive mycosis: <50
- severe molluscum contagiosum: <100
- bacillary angiomatosis: <200
ARTs known to cause lipoatrophy?
Stavudine and Zidovidune (thymidine analogs, NRTIs)
Is cutaneous TB considered an AIDS-defining illness?
True, cutaneous TB is considered an AIDS-defining illness.
Is toxoplasmosis at birth considered an AIDS-defining illness?
No, Toxoplasmosis of the brain, with disease onset at age >1 month is AIDS-defining.
T or F: The most common type of psoriasis in AIDS patients is pustular psoriasis.
False. Plaque psoriasis is still the most prevalent variant in HIV-associated psoriasis.
What is the mainstay of treatment for Seborrheic Dermatitis in AIDS?
- Topical and systemic antifungals
- Topical or PO corticosteroids
- PO antibiotics
Ketoconazole may have more activity against M. furfur.
ART itself may improve seborrheic dermatitis, or may help its response to other treatments.
What are the WHO recommendations for the treatment of eosinophilic folliculitis?
In addition to ART:
1. PO antihistamine
2. Topical steroid
3. PO itraconazole
4. Permethrin 5% applied above the waist
T or F: A first-line treatment for moderate to severe psoriasis in HIV that may be used as monotherapy is Methotrexate.
False. For moderate to severe HIV-exacerbated psoriasis:
- 1st line: ART
- 2nd line: acitretin + phototherapy, or phototherapy alone after risk evaluation
- Refractory cases: methotrexate, cyclosporine, hydroxyurea
Not recommended:
- TNF-inhibitors (worsening immunosuppresion)
- Biologics (progressive multifocal leukoencephalopathy)
What antiretroviral drug may cause Fixed Drug Eruption (FDE)?
Saquinavir (PI)
What ART drug class can all cause hepatotoxicity?
NNRTI (Non-Nucleoside Reverse Transcriptase Inhibitors)
ARTs associated with paronychia and nailfold pyogenic granuloma?
Lamivudine and Zidovudine.
T or F: Only the HTLV-1 strain has been definitively linked to disease in humans.
True.
A patient presents with a chronic herpetic ulcer lasting more than one month. What does this indicate, and what is its significance in HIV?
A chronic herpetic ulcer lasting more than one month is a marker of profound immunosuppression and is designated as an AIDS-defining condition.
ART that causes SJS-TEN?
Nevirapine.
This is a malignancy that is virtually unseen outside of AIDS.
Plasmablastic lymphoma.
