CH7 - Viral Infections - HIV / AIDS

Question 1

What is the difference between HIV-1 and HIV-2?

Answer 1

HIV-1: worldwide distrubution, responsible for majority of cases

HIV-2: Western Africa, lower risk of transmission, slower disease progression

Question 2

What was the first HIV publication about in 1981?

When was cART therapy introduced?

Answer 2

Pneumocystis jiroveci pneumonia in 5 men from LA (it took a few years to then see HIV as the cause) (It is today still one of the most common presentations leading to an AIDS diagnosis)

cART = 1996

Question 3

Where are 70% of the worlds HIV infections?

Answer 3

Sub-Saharan Africa

Question 4

What are the three main ways of transmission of HIV in the US? What body fluids can it be found in?

Answer 4

Male-to-male sexual contact (2/3 of annual infections)

heterosexual contact

IV drug use

most bodily fluids: serum, blood, saliva, semen, tears,
urine, breast milk, ear secretions, and vaginal secretions

Question 5

Which cell is the primary target of HIV? Which glycoproteins are critical to this process?

Answer 5

Helper T4 cells…gp120, gp41

Question 6

What other infection does acute HIV infection present like?

What are two oral signs of acute HIV infection?

Answer 6

infectious mononucleosis (LAD, sore throat, fever, maculopapular rash, etc)

1. mucosal erythema
2. focal ulcerations

Question 7

What is the term for lymphadenopathy during latency in HIV patients?

Answer 7

Persistent Generalized Lymphadenopathy (PGL)

Question 8

Oral candidiasis is not itself diagnostic of AIDS in an HIV patient, but if left untreated, how long does it usually take to reach AIDS after seeing oral candidiasis?

Answer 8

within 2 years

Question 9

HIV patients: Erythematous candidiasis typically appears when the CD4+ lymphocyte count drops below ___ cells per mm3, whereas the pseudomembranous pattern usually develops when the count drops below ____ cells per mm3.

Answer 9

erythematous = 400

pseudomembranous = 200

Interesting! So the weaker the immune system the more pesudomemranous candidiasis. I guess this is also why erythematous candidiasis is so much more common in the general population?

Question 10

What is the treatment of choice for HIV candidiasis patients without esophageal involvement and a CD4 count above 50?

What about with esophageal involvment and CD4 below 50, high viral load?

Answer 10

without esophageal involvement and a CD4 count above 50: Clotrimazole..nystatin is ineffective

with esophageal involvment and CD4 below 50, high viral load: fluconazole

Question 11

What are the two cytologic buzzwords for OHL?

Answer 11

1. “balloon cells” in the upper spinous layer

2. nuclear beading (margination of chromatin) in superficial epithelial cells

Question 12

Where are cutaneous KS cases most often found? (2)

Answer 12

1. face

2. lower extremities

Question 13

What are the two clinical differentials for KS?

Answer 13

1. bacilliary angiomatosis (cat-scratch bacillus)

2. lymphoma

Question 14

Persistent generalized lymphadenopathy (PGL) is not itself diagnostic of AIDS in an HIV patient, but if left untreated, how long does it usually take to reach AIDS after seeing PGL?

Answer 14

5 years

Question 15

What two viruses are the suspected culprits for both plasmablastic lymphoma and primary effusion lymphoma in HIV patients?

Answer 15

EBV and HHV8

Question 16

Where does lymphoma in AIDS patients typically present?

Answer 16

extra nodal locations (4% oral presentation gingiva, palate, tongue)

Question 17

What are the three types of periodontal disease strongly associated with HIV?

Answer 17

1. Linear gingival erythema
2. NUG
3. NUP

Question 18

What are common pathogens associated with necrotizing stomatitis? (extention of NUG onto the palate or alveolus)

Answer 18

HSV,CMV,EBV

Question 19

TB detection in HIV patients is difficult, what is the best way?

Answer 19

Liquid culture or PCR

Question 20

Which age group has a higher prevalence of HIV-associated salivary gland disease?

Answer 20

children

Question 21

Another one to add to the bilateral parotid swelling differential: HIV-associated salivary gland disease. What does it show on histology?

Answer 21

lymphocytic infiltration, hyperplasia of intraparotid

lymph nodes, and, in long-standing cases, lymphoepithelial cyst formation.

Question 22

HIV-associated salivary gland disease is considered a localized manifestation of what syndrome?

What is the triad of signs?

What is the treatment?

Answer 22

DILS: diffuse infiltrative lymphocytosis syndrome

1. salivary gland enlargment
2. LAD
3. intersitial pneumonia

Oral prednisone and cART therapy

Question 23

What % of HIV patients have thrombocytopenia?

Not in Neville, but good to know: What is the threshold?

Answer 23

40%

Thrombocytopenia: normal range platelets 150K-450K. Emergency treatment <50K

Question 24

Persistence of active HSV infection for more than HOW LONG in a patient infected with HIV is one accepted definition of AIDS

Answer 24

1 month

Question 25

HIV patients can present with unusual strains of HPV…what are 3 examples?

Answer 25

besides the usual’s (6,11 for sqam paps and cond acuminata, 2 for VV’s)

HPV 7 (butchers warts)

HPV 13,32 (Heck dz)

Question 26

What is the most common deep fungal infection in AIDS patients?

Answer 26

Histoplasmosis

How do Crypto and Candida fit into this?

Question 27

What is the risk for HIV patients to develop oral or pharyngeal SCC compared to the general population?

Answer 27

2x

Question 28

What is the most common method for HIV testing?

How are positive and false positives verified?

Answer 28

antibody: enzymoe immunoassay (EIA) on blood, oral fluid (saliva? lol), and urine

verifiy with Western blot

Question 29

What is the AIDS diagnostic criteria?

What are the 9 AIDS defining conditions that an Oral Pathologist may see or diagnose (there are 27 of them total)?

Answer 29

1. laboratory evidence of HIV plus any one of the following
2. CD4+ T lymphocyte count less than 200 per mL
3. CD4+ T lymphocyte percentage less than 14% of total lymphocytes
4. Documentation of an AIDS defining condition

AIDS defining conditions:

1. Esophageal Candidiasis
2. Coccidiomycosis (Dissemniated/extrapulm)
3. Histoplasmosis
4. Cryptococcus
5. CMV
6. HSV chronic ulcer(s) more than 1 month duration
7. KS
8. Lymphoma (Burkitt, Immunoblastic)
9. TB

Question 30

What is the term for paradoxical worsening of HIV patients after initiating cART during advanced stages of disease?

Answer 30

immune reconstitution syndrome (IRS)

Question 31

What is the theory for why cART therapy is unable to cure HIV infection?

Answer 31

persistence of the virus in the peripheral blood and lymphoid tissues