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Diagnosis of HIV pts Flashcards

1
Q

What are the cells that HIV can hide out in?

A

Memory CD4+ T cells

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2
Q

What indicates that transition from HIV to AIDS?

A

CD4 less than 200

OR

AIDS indicator disease

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3
Q

What happens to the viral load with HIV infection? How does CD4 count relate to this?

A

Peaks initially, then drops to a “set point”

CD4 count is the inverse of this

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4
Q

How well does the viral load correlate to the progression of HIV to AIDS

A

Correlates well

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5
Q

What is the viral cause of Kaposi’s sarcoma? What are the s/sx of this?

A

HSV 8

erythematous macules on the posterior oropharynx

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6
Q

At what CD4 count are AIDS pts susceptible to pneumocystis?

A

Less than 200

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7
Q

At what CD4 count are AIDS pts susceptible to toxoplasmosis?

A

100

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8
Q

At what CD4 count are AIDS pts susceptible to Cryptococcosis?

A

100

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9
Q

At what CD4 count are AIDS pts susceptible to Kaposi’s sarcoma?

A

Over 400

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10
Q

At what CD4 count are AIDS pts susceptible to MAC?

A

Less than 50

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11
Q

At what CD4 count are AIDS pts susceptible to CMV?

A

Less than 50

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12
Q

What is the prophylaxis for toxoplasmosis?

A

TMP-SMX

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13
Q

What is the source of MAC?

A

Water sources

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14
Q

Does recurrent bouts of pyogenic pneumonia diagnose you with AIDS?

A

Yes

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15
Q

What is the cause of hairy tongue leukoplakia?

A

EBV caused growth that does not scrape away

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16
Q

What has happened to the incidence and prevalence of HIV?

A
  • Incidence lower

- Prevalence growing (people living longer)

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17
Q

In what high risk group is HIV incidence increasing? Which is declining?

A

MSM

IVDA is going down

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18
Q

What is the current strategy to target MSM population to prevent AIDS?

A

Preexposure prophylaxis

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19
Q

What ethnicity have the highest prevalence of HIV?

A

African Americans

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20
Q

What percent of people with HIV are unaware they have it? What percent of new infections are caused by people who don’t know they have it?

A

20% ish don’t know

50% of new infections from people who do not know they have it

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21
Q

What is the percentage of CD4 that is diagnostic of AIDS? What does this mean?

A

Less than 14%

This means that less than 14% of T cells are of the CD4 variety (the remainder being CD8)

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22
Q

What percent of newly diagnosed HIV have a strain that is resistant to ART?

A

15%

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23
Q

What are the first s/sx of HIV with initial infection?

A

Mono-like ssx

-Pharyngitis, rash, HA

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24
Q

What percent of patients with an EBV infection present with a rash?

A

Less than 5%

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25
Q

What percent of patients with initial HIV infection have aseptic meningitis?

A

24%

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26
Q

What percent of patients with an initial HIV Infection present with oral ulcers?

A

15%

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27
Q

What percent of patients with an initial HIV Infection present with genital ulcers?

A

10%

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28
Q

What is the viral markers followed for initial HIV infection?

A

p24 antigen

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29
Q

What is the first, second, and third rise in markers for HIV?

A
  1. HIV RNA first
  2. p24 antigen
  3. HIV ab last
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30
Q

Why does p24 antigen decline when HIV ab rise?

A

HIV ab binds to p24

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31
Q

How long can HIV-1 RNA be detected before the detection of HIV ab?

A

1-3 weeks

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32
Q

Do HIV antibodies assays detect HIV-1 or HIV 2?

A

Both

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33
Q

True or false: HIV antibody/antigen testing, if positive, needs to be followed up by a second test.

A

True

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34
Q

What is the gold standard for diagnosing HIV?

A

ELISA (99.7% sensitive, 99.9% specific)

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35
Q

How sensitive/specific are the rapid tests for HIV?

A

Very, both above 99.5%

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36
Q

What is the confirmatory tests for HIV?

A

-Multispot HIV-1/HIV-2

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37
Q

If the reactive HIV ag/ab test is positive, and the multispot confirmatory test is negative, what is the next step in diagnosis?

A

HIV-1 nucleic acid testing

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38
Q

What is the sequence of HIV testing?

A
  • HIV ab/ag screen
  • Multispot
  • HIV1 nucleic acid testing if multispot is negative
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39
Q

What is the role of HIV screening?

A
  • Opt-out testing

- Offered to all pregnant women

40
Q

Where, geographically, is HIV-1 found more often? HIV-2?

A 
HIV-1 = US
HIV-2 = Africa
41
Q

How does HIV-2 compare to HIV-1 in terms of virulence and transmissibility?

A

HIV-2 is less virulent, and less easily transmittable

42
Q

What are the two receptors on CD4 cells for HIV? Which is more common, and which progresses more rapidly?

A

-CCR5 or CXCR4

  • CCR5 = major one that is transmittable
  • CXCR5 = more rapid progression
43
Q

What is the role of gp120?

A

Antigen that varies–determines tropism

44
Q

What happens to the pathogenicity of an HIV virus if the tropism changes from CCR5 to CXCR4?

A

more virulent

45
Q

What is the role of delta 32 deletion in humans (hetero and homozygous)?

A

If have homozygous, then less susceptible to HIV virus

If heterozygous, then slower progression

46
Q

What is the ligand for CCR5 on cells?

A

beta-chemokine

47
Q

What is the treatment for kids born to HIV+ mothers? (3)

A
  • Have mom on HIV antiretrovirals
  • Do not breastfeed
  • Give baby post-exposure prophylaxis
48
Q

True or false: the placenta is a good barrier for the prevention of HIV positive infants

49
Q

What is the most common route of transmission of HIV from mother to fetus?

A

During vaginal delivery

50
Q

What is the viral load goal for mother’s who are HIV+? Can they deliver vaginally if they meet this requirement?

A
  • Less than 100

- Vaginal delivery okay if this is met

51
Q

Can breast milk transmit HIV?

52
Q

What is the normal CD4 count?

A

More than 750

53
Q

True or false: syphilis occurs at any CD4 count

54
Q

True or false: syphilis occurs mostly in women

55
Q

True or false: syphilis usually spares the eyes

56
Q

True or false: syphilis rarely involved the oral mucosa

57
Q

What are the ssx of secondary shyphilis?

A

Patchy rashes–condyloma lata

58
Q

How infectious are the condyloma lata of syphilis?

59
Q

In what risk group is syphilis incidence rising?

60
Q

Should you wait to treat suspected pneumocystis in order to obtain a good culture?

A

Nah–will not affect culture

61
Q

What is the difference between primary prophylaxis and secondary?

A

Primary - do not have disease, but prevent from getting

Secondary = have it, but prevent recurrence

62
Q

Do you use primary prophylaxis for CMV?

63
Q

What is the prognosis for late diagnosis of HIV?

A

10-30 years of life loss

64
Q

What fraction of new HIV diagnoses also have AIDS?

65
Q

What is the prognosis for HIV pts diagnosed early and have regular treatment?

A

normal life expectancy

66
Q

What is the most common AIDS defining illness?

A

Pneumocystis pneumonia

67
Q

How do you check for toxoplasmosis infx?

A

IgG antibody

68
Q

What is the CD4 count at which you start secondary prophylaxis for CMV?

A

Less than 100

69
Q

What are the components of the HAART therapy?

A

2 NRTIs + a protease inhibitor or NNRTI

70
Q

What are the goals of HIV treatment? (3)

A
  • Suppress HIV replication
  • Improve immune system
  • Prevent transmission
71
Q

What is the MOA of enfuvirtide?

A

Prevents fusion

72
Q

What is the MOA of maraviroc?

A

Prevents attachment of HIV to CCR5

73
Q

What is the suffix for the protease inhibitors for HIV?

A

“-navir”

74
Q

What is the caveat for prescribing abacavir?

A

Need to test HLA-b5701. If have, then will have hypersensitivity reaction to the drug

75
Q

What is IRIS? What is the treatment for this?

A

“Immune reconstitution inflammatory syndrome”–inflammatory disorder that occurs with sudden drop of viral load d/t HIV therapy

Usually self limiting, but may prescribe glucocorticoids if bad

76
Q

What type of HIV drugs have a high incidence of drug-drug interactions? Why?

A

Protease inhibitors d/t p450 inhibition

77
Q

True or false: HIV increases the risk of dyslipidemia

78
Q

True or false: HIV increases the risk of CV disease

79
Q

True or false: HIV increases the risk of squamous cell CA of the anus

80
Q

What is the metabolic syndrome that can be caused by HIV drugs?

A

Cushing like features, but with fat atrophy in the face

81
Q

What is the anal CA that HIV pts are susceptible to?

A

HPV-related

82
Q

Anal warts in an an AIDs pt should be suspicious for what?

A

HPV cancer

83
Q

Do you need to have anal sex to develop HPV-related anal cancer?

84
Q

What is the CD4 count at which you would begin prophylaxis for Cryptococcosis?

85
Q

What is the CD4 count at which you would begin prophylaxis for Histoplasmosis?

86
Q

What are the integrase inhibitors?

A

“-gravirs”

87
Q

What is the fusion inhibitor?

A

Enfuvirtide

88
Q

What are the two major NNRTIs?

A

Nevirapine

Efavirenz

89
Q

What type of drug is zidovudine?

90
Q

What type of drug is lamivudine?

91
Q

What type of drug is abacavir?

92
Q

What type of drug is tenofovir disoproxil?

93
Q

What type of drug is emtricitabine?

94
Q

What type of drug is nevirapine?

95
Q

What type of drug is Efavirenz?

96
Q

What AIDS drug decreases the effectiveness of birth control? Why?

A

Protease inhibitors

Inhibits p450

Infectious Disease (18 decks)

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