Exam 2 HIV

Question 1

Primary HIV infection occurs when?

Initial presentation?

Infectious?

Answer 1

2-6 wks post exposure

flu-like sxs x 2 wks w/ spontaneous resolution

Highly contageous

Question 2

Primary HIV infection Lab results? (6)

Answer 2

HIV Ab U negative
HIV RNA (viral load) U very high
LFT = ↑transam
Leukopenia
Anemia
Thrombocytopenia

Question 3

Primary HIV infection Retroviral Syndrome presentation? (6)

Answer 3

Flu sxs
LAD
Sore throat
HA
RASH (up trunk, neck, face)
Mucocutaneous ULCERS

Question 4

Latency phase?

Answer 4

Initial immune response resolves acute phase ->

Seroconversion w/i 3 mo of infection ->

Viral load ↓ to setpoint ->

Slowly ↑ again (HIV stays active in lymph nodes) ->

CD4 T-cell count slowly ↓ ->

Pt asympt or LAD for ~10YRS

Question 5

Symptomatic infection process? (5)

Answer 5

Immune system deteriorates:

• Lymph burns out
• Virus becomes more pathogenic
• Body can’t maintain CD4 cell replacement
• HIV RNA load ↑
• CD4 count ↓ even more

Question 6

HIV sxs? (5 initial)

10 advanced

Answer 6

Flu sxs
Night sweats
LAD
Weight loss
Prolonged D

Oral Hairy Leukoplakia (from EBV)
Thrush
Cervical dysplasia
Molluscums
Chronic fungal infect
Seborrheic dermatitis
Kaposi's Sarcoma
Zoster
ITP (thrombocyto)
TB

Question 7

AIDS definition?

Answer 7

CD4 T cell count < 200

or 1 of 27 Defining Conditions

Question 8

Pneumocystis Jiroveci PNA: Type of microbe?

Seen w/ CD4 counts of?

Answer 8

p. jiroveci, airborne fungus
Reactivated infection

CD4 < 200

Question 9

Pneumocystis Jiroveci PNA presentation?

Answer 9

Fever, cough, SOB
P severe hypoxemia
CXR = diffuse or perihilar infiltrates

Question 10

Pneumocystis Jiroveci PNA labs?

Tx?

Answer 10

Sputum sample = ↑ LDH

Bactrim

Question 11

Toxoplasmosis: Type of microbe?

CD4 count?

Transmission?

Answer 11

t. gondii, parasite
U reactivated

CD4 < 200

Raw meat or cat poop

Question 12

Toxoplasmosis causes?

Answer 12

encephalitis

intracranial lesions

Question 13

Toxoplasmosis presentation? (6)

Answer 13

HA
Focal neuro deficits
Mental ∆s
Seizures
Retinitis
Pneumonitis

Question 14

Toxoplasmosis labs?

Imaging?

Answer 14

Serum cx = toxoplasmosis

Brain CT/MRI = multiple lesions

Question 15

Mycobacterium Avium Complex (MAC): Microbe?

CD4 count?

Transmission?

Answer 15

mycobacterium avium or intracellulare

CD4 < 50

Inhaled/ingested from soil/dust

Question 16

MAC presentation?

Answer 16

Systemic dz in advanced AIDS

Night sweats
Wgt loss
Abd pain
D
Anemia

Question 17

MAC labs? (3)

Answer 17

Sputum Acid-Fast Bacillus Stain = +
Sputum cx = +
Blood cx = +

Question 18

Cytomegalovirus Retinitis: Microbe?

CD4 count?

Transmission?

Answer 18

herpes virus

<50

blood, sexual, perinatal

Question 19

Cytomegalovirus Retinitis is most C what?

Answer 19

Retinal infection in AIDS

Question 20

Cytomegalovirus Retinitis presentation?

Answer 20

Visual disturbance

Perivascular hemorr, cotton wool exudates

Question 21

Cytomegalovirus Retinitis labs?

Answer 21

Sero = + for Cytomegalovirus

Question 22

Esophageal or Vaginal Candidiasis

Answer 22

common fungal infections

Question 23

Kaposi’s Sarcoma is?

Seen w/ what CD4 count?

Answer 23

Vascular neoplasm

Any CD4 count

Question 24

Kaposi’s Sarcoma presentation?

Answer 24

Multi-focal, widespread lesions

LAD

Question 25

HIV screening: tests? (3)

Answer 25

HIV Ab:
for screening, not detectible until seroconversion (4-12wks post)

Rapid HIV:
saliva or blood,
+ result req’s confirmation

Ab/Ag combo

Question 26

HIV screening: Who? (4)

Answer 26

All pts 13 - 64 yo
All TB pts
Every STD pt
Preggos early

Question 27

Initial HIV W/U includes what? (8)

Get baselines of what? (5)

Answer 27

Confirm HIV Ab
CD4 count
HIV RNA viral load
Genotypic resistance prior to ART
STDs
TB PPD test
Pap
Lipids

Baselines: 
CBC
CMP
IgG (for P reactived infections)
Hep A/B/C
RPR

Question 28

HIV tx for which pts?

Which CD4 counts see best results supporting tx guidelines?

Answer 28

ALL HIV-infected (P wait for infants)

CD4 < 350

Question 29

AntiRetroviral Therapy (ART) includes?

Classes?

Answer 29

3 drug from 2 different classes

1) Non-nucleoside reverse transcriptase inhib
2) Nucleoside reverse transcriptase inhib
3) Protease inhib
4) Integrase inhib
5) Other

Question 30

ART benefits? (5)

Answer 30

1) Prevent progression of immune destruction
2) Restore immunity
3) Delay HIV infection
4) Improve life expectancy
5) ↓ transmission

Question 31

ART risks? (5)

Answer 31

1) Drug reactions
2) CROSS RESISTANCE
3) Transmission of drug-resistant virus
4) Long-term toxicity
5) Unknown duration of effectiveness

Question 32

HIV monitoring includes? (3)

Answer 32

1) CD4 count Q 3-6 mo
2) Viral load Q 3-6 mo
3) Med toxicities (CBC, CMP, lipids)

Question 33

HIV transmission to infants happens how? (3)

Answer 33

During pregnancy
During delivery
Breastfeeding

Question 34

HIV transmission prevention in preggos? (3)

Answer 34

ART
C-section if HIV RNA > 1000
No breastfeeding

Question 35

HIV occupational post-exposure prophy considerations? (3)

Answer 35

1) Test source for + HIV
2) Type of body fluid blood vs low risk fluids
3) Adverse effects of prophy meds

Question 36

HIV occupational post-exposure prophy initiation?

Tx includes? (3)

Answer 36

W/I hours!

2 med regimine x 4 wks
Monitor for s/e Q 2 wks
Monitor for HIV 3 wks, 3 mo, 6 mo

Question 37

HIV post-exposure prophy for sexual/IV/injury exposure?

Answer 37

Start w/i 72 hrs