AIDS II Flashcards
What are the three clinical stages of HIV-1 disease?
1) An acute retroviral syndrome (occurring shortly after acquisition of HIV-1), 2) a period of clinical latency, and 3) a period of symptomatic disease (due to onset of opportunistic infections/neoplasms).
What are the characteristics of an acute retroviral syndrome?
A mononucleosis-like syndrome that may present with fever, pharyngitis, lymphadenopathy, rash, oral candidiasis, Bells palsy, or aseptic meningitis. Differential diagnosis is broad, and it is often misdiagnosed or missed altogether. It characterizes the primary HIV-1 infection.
True or false: During the clinical latency period, there is continuous HIV-1 replication.
True. There is continuous HIV-1 replication, as well as CD4+ T-lymphocyte production and destruction. However, patient is usually asymptomatic.
What changes the case definition from one of HIV-1 infection to the acquired immunodeficiency syndrome (AIDS)?
A CD4+ T-lymphocyte count below 200 cells/microliter, as well as any of several opportunistic infections/malignancies.
What is the most common AIDS-defining opportunistic infection?
Pneumocystis jiroveci (formerly carinii) pneumonia (PCP).
What is the pathophysiology of Pneumocystis jiroveci pneumonia (PCP)? What is the most common infiltrate seen on a chest x-ray?
Air space consolidation due to protein rich exudate (consisting of trophozoites), which fills the alveoli and causes hypoxemia. A bilateral interstitial infiltrate is most common on a chest x-ray.
When tuberculosis presents in late-stage HIV-1 disease, the clinical manifestations may be atypical. What are they?
Extrapulmonary disease, unusual chest x-ray patterns, and hilar adenopathy.
The increasing incidence of tuberculosis in certain cities where HIV-1 infection is prevalent has been associated with alarming rates of what?
Multidrug-resistant strains of tuberculosis.
What characterizes a Mycobacterium avium complex (MAC) infection? In what stage of HIV-1 disease is it commonly found?
Continuous bacteremia and infection of numerous organs. Pathologically, there is little histologic response. MAC is very common in late stage disease, usually when the CD4+ T-lymphocyte count is under 50 cells/microliter.
What is the most common form of Cytomegalovirus (CMV) end-organ disease? At what point do latent CMV infections usually reactivate in compromised individuals?
Retinitis
True or false: Because Cytomegalovirus (CMV) can be transmitted sexually, those with sexually acquired HIV disease are invariably co-infected with CMV.
True.
When does a Toxoplasma gondii usually occur in HIV patients? What is the most common clinical presentation?
When the CD4+ T-lymphocyte count falls below 100 cells/microliter. Clinical presentation is most commonly an encephalitis.
When does a Cryptococcus neoformans infection usually manifest itself in AIDS patients? What is the most common presentation of the disease?
When the CD4+ T-lymphocyte count is under 100 cells/microliter. The most common presentation of the disease is meningitis, although pneumonia is also reported.
How is the diagnosis of Cryptococcus neoformans made?
Cerebrospinal fluid (CSF) exam. There is an elevated white blood cell count in the CSF, which is predominantly lymphocytic.
What causes progressive multifocal leukoencephalopathy (PML)? When do manifestations of this disease usually occur?
PML is a demyelinating disease of white matter caused by the JC virus (a papovavirus). Manifestations usually occur at profoundly low CD4+ T-lymphocyte counts (
