AIDS

Question 1

How long does it take for seroversion to detect HIV after inoculation

Answer 1

1wk to 9 months

Too early will give negative results

Question 2

Oral manifestations of AIDS

Answer 2

Infection:
Bacterial - ANUG/ANUP
Viral - oral papillomas (HPV), hairy leukoplakia (EBV), HSV
Fungal - candidiasis (psudeomenbranous, erythematous, angular cheilitis), histoplasmosis, cryptococcocis,

Neoplasm - Kaposi sarcoma (EBV), Non-Hodgkin lymphoma

Question 3

Labs for preoperative evaluation

Answer 3

CBC
Hb and platelet - low
Lymphocyte - low - susceptibility to opportunistic infections

Liver function - Direct liver injury by hiv or assoc with hep B/C

Coag factors - rarely depleted. But assoc with DIC

BUSE - urea:creatinine ration > 20 indicates volume depletion

Question 4

AIDS diagnosis

Answer 4

CD4+ count < 200

Question 5

Perioperative antibitoics

Answer 5

Cd4+ < 200; trimethoprim-sulfamethoxazole
(Pneumocystis jirovecci/carinii)

CD4+ <100: toxoplasmosis (trimethoprim-sulfamethoxazole)

Cd4+ <50: macrolides (clarithromycis/azithromycim) for Mycobacterium avium complex infection

Question 6

Intial tx of oral manifestations

Answer 6

Fluid resus
Analgesics
Antibiotics/antifungal/antiviral

Question 7

Complications of oral surgical procedures in AIDS

Answer 7

Complications assoc with. Neutropenia
(ANUG/ANUP)
- sepsis
- ulceration
- periodontal dz

Question 8

What is HIV, HIV1 and HIV2

Answer 8

Hiv - single stranded DNA virus from Retroviridae family

HIV-1 more common and contributes to worldwide distribution

HIV-2 in Western Africa with slower disease progression and lower risk of transmission

Question 9

Treatment for candidiasis in AIDS

Answer 9

Clotrimazole

• on antiretroviral therapy
• Cd4+ >50

Fluconazole (systemic)

• not receiving antiretroviral
• Cd4+ <50
• high viral load

Question 10

Phases of HIV- Infected

Answer 10

3 phases

1. Acute phase
2. Chronic phase (latency phase)
3. AIDS

Question 11

What is presentation of acute phase?

Answer 11

Acute retroviral syndrome
- 1-6weeks of exposure
- infection resemble infectious mononucleosis 
\+ generelized lymphadenopathy
\+ sorethroat
\+ fever
\+ maculopapular rash
\+ myalgia/athralgia
\+ photophobia
\+ peripheral neuropathis
- viral antibodies NOT YET detectable
- high viral load
- highly infectious

Question 12

What is latent period in HIV infected patients?

Answer 12

Viremia declines
Months to 15years
\+ antibodies
Asymptomatic
Persistent generalized lymphadenopathy (PGL) - need to differentiate with non-Hodgkin lymphoma
AIDS related comples (ARC)
- Chronic fever
- Weight loss
- Diarrhea
- Oral candidiasis
- Hairy leukoplakia

Question 13

What is full blown AIDS

Answer 13

Dramatic increase in viremia
CD4+ reduce
Opportunistic infections
- pneumocystic jirovecci (usually the leading presentation that leads to diagnosis of AIDS)
- disseminated cmv infection
- severe herpes simplex infection
- atypical mycobacterial 
- cryptococcal meningitis
- CNS toxoplasmosis
Progressive encephalopathy (AIDS dementia complex)

Question 14

Presentation of Kaposi sarcoma

Answer 14

Vascular endothelial neoplasm (assoc with HHV8)
Erythematous blue/brown macules/plaques/nodules (no blanching on pressure)
Pain, bleeding, necrosis

Question 15

Treatment of kaposi sarcoma

Answer 15

cART (in HIV infected patients)
Retinoid topical
Intralesional injection (chemotherapeutic/immunomodulatory agents - bleomycin, interferon alpha)
Radiation
Surgical excision
Cryotherapy
Sclerotherapy
Laser therapy

Question 16

Non-Hodgkin lymphoma in HIV infected ptns

Answer 16

Lymphoma specific to HIV 
- plasmablastic lymphoma
- primary effusion lymphoma
Lymphomas that can occur on other immunocompetent 
- burkitt lymphoma
- diffuse B cell lymphoma
- MALT lymphoma extranodal
Lymphomas in other immunodeficient 
- PTLD (post transplant lymphoproliferative disease)