23. HIV, AIDS Flashcards
What is HIV?
HIV is an RNA retrovirus that infects CD4 cells that causes varying levels of immunosuppression with the possible progression to AIDS
What is AIDS?
AIDS is the result of progressive HIV infection in which a person has a weakened immune system and meets specific diagnostic criteria
Diagnostic criteria for AIDS per the CDC
- A CD4+ T-cell count of 200 cells/uL or less
- A CD4+ T-cell percentage of total lymphocytes of 15% or less
- One or more of AIDS-defining illnesses
AIDS defining illnesses
Burkitt’s lymphoma
Candidiasis of bronchi, esophagus, trachea, or lungs
Coccidioidomycosis
Cryptococcosis, extrapulmonary
Cryptosporidoiosis, chronic intestinal for longer than 1 month
CMV
Encephalopathy
Herpes simplex
Histoplasmosis
Invasive cervical cancer
Kaposi sarcoma
Lymphoma
Mycobacterium avium
Mycobacterium tuberculosis
Pneumocystitis jirovecii pneumonia
Progressive multifocal leukoencephalopathy
Salmonella septicemia
Toxoplasmosis of the brain
Wasting syndrome
What is HAART?
Highly active, antiretroviral therapy - a combination of multiple antiretroviral medicines used to inhibit HIV replication.
- Usually 3 drugs - two nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor or non-nucleoside reverse transcriptase inhibitor (NNRTI)
What can be used to increase CD4 levels?
Immunotherapy: interleukin II or interferon alpha
If CD4 count falls below 100 cells/uL, _____ is recommended.
If CD4 count falls below 50 cells/uL, ____ is recommended.
CD4 < 100: Trimethoprim/sulfamethoxazole (Bactrim) to decrease risk of pneumocystis jirovecii pneumonia.
CD4 < 50:
Macrolide (azithromycin or clarithromycin) to decrease risk of mycobacterium avium complex (MAC) infection
Lab workup for HIV patient
CBC, CHEM 10, LFTs, glucose, coags, immunologic status via CD4+ lymphocyte cell count, and viral load during the previous 3 months
An absolute CD4 count below ____ cells/ul is an AIDS-defining feature in adults.
In pediatric patients, the ______ is more accurate.
An absolute CD4 count below 200 cells/ul is an AIDS-defining feature in adults.
In pediatric patients, the CD4 cell percentage is more accurate.
Surgical concerns HIV/AIDS
Hemoglobin level
Platelet count
Neither lymphocyte count nor the viral load alters maxillofacial surgical intervention. Nonetheless, a patient with a rapidly declining lymphocyte count or a rise in viral load should be reassessed before any surgical intervention.
At which CD4 count is pharmacotherapy typically started?
When CD4 count drops below 50 cells/ul
Regardless of CD4 count, treatment should be initiated ASAP for those with HIV nephropathy, pregnant patients, and those coinfected with hepatitis B.
HAART
Highly active antiretroviral therapy
- Nucleoside reverse transcriptase inhibitor (NRTI)
- Non-nucleoside reverse transcriptase inhibitor (NNRTI)
- Protease inhibitors
- Integrase inhibitors
- Fusion inhibitors
- CCR5 antagonists
CD4 below 200 cells/ul, started on:
CD4 below 100 cells/ul, started on:
CD4 <200 cells/ul: trimethoprim-sulfamethoxazole for pneumocystis jirvecii prophylaxis.
CD4 <50 cells/ul: higher risk for mycobacterium avium, empirically treated with clarithromycin or azithromycin (macrolide antibiotics).
Neutropenia vs. lymphopenia
Neutropenic: more susceptible to bacterial infection (more complications with oral surgical procedures)
T-lymphocyte deficiency: fungal, viral, and parasitic infections.
After inoculation with HIV, when does a patient typically seroconvert
3 weeks (although time period can range from 9 days to 6 months)
