AIDS/HIV

Question 1

To what family of viruses does HIV belong?

Answer 1

Retroviridae (retrovirus)
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 423-424.

Question 2

With relation to HIV, what does the acronym HAART

stand for?

Answer 2

Highly active antiretroviral therapy, which represents the current
drug regimen used to prevent the advancement of HIV infection
into AIDS.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 484.

Question 3

What are the potential cardiac complications of

AIDS?

Answer 3

An echocardiogram will be abnormal in about 50% of AIDS
patients. Approximately 25% will exhibit pericardial effusions.
Infections from opportunistic organisms such as cryptococcus,
coxsackie B virus, cytomegalovirus, toxoplasmosis, and
aspergillus can cause myocarditis with ventricular dilation.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 486.

Question 4

An HIV-positive patient takes a non-nucleoside
reverse transcriptase inhibitor. How might this affect
your anesthetic management plan?

Answer 4

All of the NNRTIs can prolong the half-life and effects of drugs
such as diazepam, midazolam, fentanyl, and meperidine.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 488.

Question 5

What are the five major classes of antiretroviral

drugs used in the treatment of HIV?

Answer 5

Nucleoside analogue reverse transcriptase inhibitors, nonnucleoside
reverse transcriptase inhibitors, protease inhibitors,
entry inhibitors, and integrase inhibitors.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1028.

Question 6

What is zidovudine and what is its principal side

effect?

Answer 6

Zidovudine is a nucleoside analogue reverse transcriptase
inhibitor used in the treatment of HIV. Its principal side effect is
bone marrow suppression.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1028.

Question 7

An anesthetist suffers a needle-stick that was
contaminated with blood from an HIV-positive
patient. According to current recommendations, how
soon should a postexposure prophylaxis medication
regimen be started?

Answer 7

Postexposure prophylaxis should be started within 1-2 hours if
possible..
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1030

Question 8

What type of lymphocyte is destroyed by the AIDS

virus?

Answer 8

T-helper lymphocytes (also called CD4 T cells)
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 485.

Question 9

Where are T-help lymphocytes predominantly

located?

Answer 9

98% of all T-helper lymphocytes are located within the lymph
nodes.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 485.

Question 10

What is the most common opportunistic pathogen

associated with AIDS?

Answer 10

Pneumocystis jiroveci (formerly Pneumocystis carinii)
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1029.

Question 11

What are the odds of seroconversion from an HIV

contaminated needlestick?

Answer 11

0.3%
Miller RD. Miller’s Anesthesia. 7th ed. Philadelphia: Churchill
Livingstone; 2010: 3058.

Question 12

What form of pneumonia is associated with AIDS?

Answer 12

Pneumocystis jiroveci (formerly known as pneumocystic carinii)
pneumonia
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 1029.

Question 13

What are the potential respiratory complications from

pneumocystis carinii pneumonia?

Answer 13

Breathlessness, night sweats, bacterial lung abscesses,
tuberculosis, fungal infections, pneumothorax, pulmonary
Kaposi’s sarcoma, and respiratory failure. Pulmonary
adenopathy can be so severe that it results in tracheobronchial
and pulmonary vessel compression. Kaposi’s sarcoma within
the lungs can result in massive hemoptysis. HIV can also lead
to an emphysematous destruction of the alveolar tissue.
Stoelting RK, Dierdorf SF. Anesthesia & Co-Existing Diseases.
5th ed. New York, NY: Churchill-Livingston; 2008: 489.

Question 14

Pneumocystic carinii pneumonia usually doesn’t
develop until the CD4 T cell count reaches what
level?

Answer 14

200 cell/mL
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 486.

Question 15

How does the chest xray of a patient with

pneumocystis carinii pneumonia appear?

Answer 15

It often appears normal. A ‘ground-glass’ appearance may be
apparent on xray, but often requires high-resolution CT to
identify. Pneumothoraces may sometime be present.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 487.

Question 16

A patient with AIDS has a positive acid-fast bacillus

test. What does this signify?

Answer 16

The patient is positive for tuberculosis.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 487