Chapter 168 - Cutaneous manifestations of HIV And HTLV Flashcards
Acute HIV infection presents as mononucleosis-like syndrome that can induce a morbiliform exanthem ___ weeks after infection with HIV
3 to 6 weeks
As of 2015, ___ are candidates for antiretroviral therapy
All newly diagnosed HIV patients
Most common cause of HIV infection globally
HIV1
HIV 2 is associated with (3)
- Slower progression of immunosuppression
- Decreased infectivity
- Resistance to nonnucleoside reverse transcriptase inhibitors
Any cell that expresses ___ and an appropriate coreceptor (2) may be infected by HIV
CD4; CCR5/CXCR4
Prior to seroconversion, false negative HIV antibody tests might result, hence more sensitive direct tests such as (2) should be performed instead
HIV viral RNA test
P24 core structural protein test
Window period, delay of ___ weeks typically occurs between newly acquired HIV 1 infection and development of antibodies
3-4 weeks
Viral RNA assay detects infection ___ days earlier than p24 assay, hence appears to be more sensitive
5 days
AIDS is defined as HIV seropositive individual older than ___ years of age with a CD4 T cell count < ___ cells/ul, CD4 T cell percentage < ___%, or with any of several diseases considered ti be indicative of severe defect in cell-mediated immunity.
6 years;
200cells/ul;
14%
Examples of diseases (3) seen with CD4 T cell count > 500 cells/ul
- Acute retroviral syndrome
- Herpes zoster infection (nondisseminated)
- Seborrheic dermatitis
Examples of diseases (4) seen with CD4 T cell count 250-500 cells/ul
- Dermatophyte infections, recurrent or persistent
- Oral candidiasis
- Oral hairy leukoplakia
- Herpes zoster infection, disseminated
Period of clinical latency implies disease latency.
True or False
False, does not
More severe and life threatening complications of HIV disease typically occur when CD4 T cell count falls below ___ cells/ul
200
There is a ___ fold increase in adverse cutaneous drug reactions in setting of HIV/AIDS
100
Common causes of drug reactions in the setting of HIV/AIDS
Sulfonamides
Penicillin
___ are the most common manifestation of cutaneous drug reaction in the setting of HIV. (75% to 95%)
Morbiliform
In patients who are positive for HLA ___, DRESS may develop in patients treated with ___
B5701; abacavir
All nucleoside reverse transcriptase inhibitors present with hepatotoxicity except (2)
- Abacavir (systemic hypersensitivity reaction)
2. Tenofovir (renal toxicity)
NRTIs Presents with metabolic lactic acidosis (4)
Didanosine
Stavudine
Zalcitabine
Zidovudine
NRTIs Presents with lipohypotrophy
Stavudine
Zidovudine
NRTIs Presents with paronychia with nailfold granuloma (2)
Lamivudine
Zidovudine
NRTIs that presents with LCV (2)
Zalcitabine
Zidovudine
NRTIs that present with oropharyngeal and esophageal ulcerations
Zalcitabine
NRTIs that present with hyperpigmentation of nail bed, palms, and soles
Emtricitabine
NRTIs that presents with hyperpigmentation of nails, diffuse hyperpigmentation of skin and oral mucosa, hypertrichosis, anemia, granulocytopenia, nausea, myopathy
Zidovudine
All NNRTIs present with hepatotoxicity.
True or False
True
NNRTI that presents with highest incidence of SJS/TEN
Nevirapine
NNRTIs that present with lipodystrophy
Rilpivirine
Protease inhibitors that contain sulfa moieties and should be used in caution in sulfa allergic patients (4)
Fosamorenavir
Amprenavir
Tipranavir
Darunavir
Protease inhibitors with rare progression to SJS (3)
Fosamprenavir
Amprenavir
Tipranavir
Cause nephrolithiasis and hyperbilirubinemia
Indinavir
Protease inhibitors that cause spontaneous bleeding and hemorrhage
Ritonavir
PIs that cause rare FDE
Saquinavir
PIs that cause lipohypertrophy, dose dep. retinoid effects, acute porphyria, frozen shoulder, venous thrombosis
Indinavir
PIS that cause hepatotoxicity and intracranial hemorrhage
Tipranavir
PIs that cause PR prolongation and hyperbilirubinemia
Atazanavir
Increases frequency of bacterial pneumonia and injection site reactions
Enfuvirtide (Fusion inhibitor)
Cause pruritus along with hepatotoxicity
Integrase inhibitors (-gravir)
Presents with central obesity, cushingoid habitus, increased neck girth, increased abdominal girth, and breast enlargement
Lipohypertrophy
Presents with flattening of convex contours of the face
Lipoatrophy
Lipodystrophy is often sccompanied by (5)
Metabolic abnormalities in
- Fasting glucose levels
- Fasting insulin levels
- Hypertriglyceridemia
- Hypercholesterolemia
- Decreased HDL
Factors associated with increased drug eruption (4)
Female
CD4 cell count < 200 cells/ul
CD8 cell count > 460 cells/ul
History of drug eruptions in the past
Some drug reactions persist even ___ weeks after drug DC
2 weeks
Treatment for facial lipoatrophy
Soft tissue fillers
- Poly-L-lactic acid
- Calcium hydroxyapatite
HIV patients are more susceptible to EBV l- associated malignancies (3)
Burkitt lymphoma
Diffuse large B cell lymphoma
Leiomyosarcoma
Treatment for bacillary angiomatosis
Erythromycin 500mg QID x 4 weeks
Doxycycline 100 mg BID x 4 weeks
Palms, soles, oral cavity are areas usually affected by Bartonella quintana or Bartonella henselae.
True or False
False, spared
Most common opportunistic infection in HIV patients
Tuberculosis
Multibacillary forms eg. Scrofuloderma, gummatous tuberculosis, cutaneous miliary tuberculosis
Cutaneous dissemination of invasive mycoses usually occurs in patients with CD4 T cell count ___ cells/ul
<50 cells/ul
Variant of Histoplasma more prevalent with AIDS patients
Histoplasma capsulatum var. capsulatum
Leading cause of mortality amongst AIDS patients in Southeast Asia
Penicillium marneffei
Matching type
- Yellow white plaques removable by scraping
- Erythematous patches of the palate and dorsal tongue with associated depapillation
- Erythema with curdlike flecks or painful fissures at the angles of the lips
- White plaques of buccal mucosa that are not removable by scraping
A. Pseudomembranous
B. Hyperplastic
C. Erythematous
D. Angular cheilitis
A
C
D
B
___ should prompt an HIV test in patients whose HIV status is unknown
Proximal subungual onychomycosis
33% of advanced HIV patients with CD4 T cell counts < ___ cells/ul have molluscum contagiosum
100
Treatment for crusted scabies
Ivermectin 200ug/kg weekly for 7 weeks
Colonization with MRSA is ___ times more prevalent among HIV patients and relative risk of infection is ___ times that of HIV negative controls.
3; 6
Marker of profound immunosuppression and designated as AIDS- defining condition
Chronic herpetic ulcer lasting more than 1 month
___ imparts a 2-3 fold risk of HIV acquisition and enhances HIV viral replication hence increasing HIV plasma viral load and HIV shedding in genital mucosa
HSV2
Risk of herpes zoster amongst HIV patients is highest ___ after ART initiation due to ___
6 months; IRIS
Reduces herpes zoster risk in HIV patients by 62%
Prophylactic oral acyclovir 400 mg BID
Treatment for disseminated herpes zoster with visceral involvement
IV acyclovir 10mk TID
Acquired epidermodysplasia verruciformis are thin flat topped papules resembling verruca plana or tinea versicolor from unusual susceptibility to ___
Beta subtypes of HPV
HPV (5,8,9)
Lumbar puncture should be considered for: (2)
- New diagnosis of syphilis in patient with advanced HIV disease
- Patient with well controlled HIV who has syphilis of unknown stage or RPR of at least 1:32
Describe prozone phenomenon
HIV related immune dysrrgulation causing massively elevated titers of antibodies high enough to impair the assay
Frequent presenting sign of HIV
Kaposi sarcoma
All ART adherent patients have their healths fully restored, with zero incidence of Kaposi sarcoma.
True or False
False, not fully restored; not zero incidence
Treatment for severe Kaposi sarcoma
Immediate ART initiation in combination with systemic chemotherapy
(Bleomycin, vincristine/vinblastine, imiquimod, alitretinoin)
Quadrivalent or nonavalent HPV vaccine is recommended for:
All HIV + F 9-26 y/o and
All M 9-21 y/o
HIV patients have increased risk of developing the ff cutaneous lymphomas (3)
CD30+ anaplastic large cell lymphoma
Diffuse B cell lymphoma
Plasmablastic lymphoma
Primary cutaneous lymphomas in HIV patients have a poor prognosis with survival often ___
Less than 1 year
In pediatric patients, ___ are the second most common malignancy in patients with HIV
Smooth muscle tumors
Characterized by pruritic, symmetric papules of the distal extremities, and is more commonly found in tropical and subtropical zones
Papular pruritic eruption
High potency topical corticosteroids usage for plaque psoriasis in HIV patients require caution in the setting of ART regimens that include
Ritonavir
Cobicistat
PPE spares palms soles and mucous membranes.
True or False
True
Characterized by follicular pruritic papules and pustules favors midline of face, neck, scalp, trunk, and proximal extremities
Eosinophilic folliculitis
IRIS has been reported in ___% of patients receiving ART usually occurs in first ___ months ff the initiation of ART
20%；2 to 3
When a clinically unrecognized disease is noted after initiation of ART, ___ is used. In turn, when a previously recognized clinical entity flares, term ___ applies
Unmasking IRIS
Paradoxical IRIS
2 main factors related to development of IRIS
- Low CD4 count and/or percentage
2. High HIV RNA prior to initiation of ART
Criteria of IRIS
Major
1. Atypical presentation of opportunistic infection or tumors in patients responding to ART
2. Decrease in plasma HIV RNA level by at least 1 log 10 copies/ml
Minor
1. Increased blood CD4 T cell count after ART
2. Increase in immune response specific to relevant pathogen
3. Spontaneous resolution of disease without specidic antimicrobial therapy or tumor chemotherapy with continuation of ART
Systemic corticosteroids may be given in HIV patients, except in cases of ___
AIDS related Kaposi sarcoma
