AIDS

Question 1

How is HIV similar to TB?

Answer 1

Can have latent stage

Question 2

What is the likely cause of peak AIDS diagnoses during 1993?

Answer 2

Expansion of the AIDS surveillance

Question 3

What is likely the decline in new AIDS cases and deaths due to?

Answer 3

Success of HAART

Question 4

What is the male predominance due to?

Answer 4

Sex with men and IV drug use

Question 5

Why has sharing of needles decreased in IV drug uses?

Answer 5

Needle distrubtion programs

Question 6

What are the 3 leading causes of HIV transmission from greatest to least in males?

Answer 6

1. Males having sex with males
2. IV drug use
3. Heterosexual contact

Question 7

In women, what is the greatest cause of HIV?

Answer 7

Heterosexual contact

Question 8

What is the typical CD4 count where you are relatively okay?

Answer 8

~ 500

Question 9

When hovering around a CD4 of 500, what conditions are typically seen?

Answer 9

Skin conditions (Seborrheic Dermatitis, papulopruritic eruptions - Nodular prurigo - People commit suicide because so itchy)

Question 10

Condition of white film on tongue?

Answer 10

Oral Hairy Leukoplakia

Question 11

Cause of oral hairy leukoplakia?

Answer 11

EBV

Question 12

What is the condition in which the mouth is covered in a white film? Cause?

Answer 12

Oral thrush; Candida albicans

Question 13

What is an AIDS-defining cancer that occurs in AIDS?

Answer 13

Kaposi sarcoma

Question 14

Serious pneumonia that can occur in a patient with AIDS?

Answer 14

Pneumocystis jirovecii

Question 15

Where else can candida occur in a patient with AIDS?

Answer 15

Mouth and Esophagus

Question 16

What CNS conditions can occur in a person with AIDS?

Answer 16

Toxoplasmosis, Progressive Multifocal Leukoencephalopathy (JC Virus)

Question 17

What is a serious ocular complication of HIV?

Answer 17

CMV retinitis

Question 18

What are the major goals of HIV Tx?

Answer 18

• Suppress HIV replication
• Prevent/delay destruction of immune system
• Achieve normal survival

Question 19

In a patient with Symptomatic AIDS, what CD4 count is recommended that Tx begin?

Answer 19

Any Value

Question 20

WHen do you treat an asymptomatic AIDS patient?

Answer 20

At a CD4 < 350

Question 21

When is HIV Tx typically deferred?

Answer 21

When patient is asymptomatic, >350 cells/uL and > 100,000 plasma HIV RNA copies/mL

Question 22

What is the benefit of treating CD4 counts of < 500?

Answer 22

Morbidity and Mortality benefit with ART

Question 23

What is the proper step when considering treating a patient with ART with a CD4 > 500?

Answer 23

Discuss this with the patient; Data in treating this population is not consistent

Question 24

What are the concerns with early ARt?

Answer 24

• ART-related toxicities
• Non-adherence to ART (patient likely asymptomatic)
• Drug resistance
• Cost

Question 25

When would one consider more rapid initiation of ART?

Answer 25

• Pregnancy
• AIDS-defining condition
• Acute opportunisitic infection
• Low CD4
• Rapid CD4 decline
• High viral load (>100K)
• HIV associated nephropathy
• HBV, HCV

Question 26

What are the basic groups of ART?

Answer 26

• Entry Inhibitors (CCR5/CXCR4 blockers, fusion inhibition)
• Reverse Transcriptase Inhibitors (NRTIs, NNRTIs)
• Protease Inhibitors
• Integrase inhibitors