Exam 2 HIV Flashcards by Wendy Pitts

Primary HIV infection occurs when?

Initial presentation?

Infectious?

2-6 wks post exposure

flu-like sxs x 2 wks w/ spontaneous resolution

Highly contageous

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Primary HIV infection Lab results? (6)

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

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Primary HIV infection Retroviral Syndrome presentation? (6)

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

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Latency phase?

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

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Symptomatic infection process? (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

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HIV sxs? (5 initial)

10 advanced

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

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AIDS definition?

CD4 T cell count < 200

or 1 of 27 Defining Conditions

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Pneumocystis Jiroveci PNA: Type of microbe?

Seen w/ CD4 counts of?

p. jiroveci, airborne fungus
Reactivated infection

CD4 < 200

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Pneumocystis Jiroveci PNA presentation?

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

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Pneumocystis Jiroveci PNA labs?

Tx?

Sputum sample = ↑ LDH

Bactrim

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Toxoplasmosis: Type of microbe?

CD4 count?

Transmission?

t. gondii, parasite
U reactivated

CD4 < 200

Raw meat or cat poop

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Toxoplasmosis causes?

encephalitis

intracranial lesions

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Toxoplasmosis presentation? (6)

HA
Focal neuro deficits
Mental ∆s
Seizures
Retinitis
Pneumonitis

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Toxoplasmosis labs?

Imaging?

Serum cx = toxoplasmosis

Brain CT/MRI = multiple lesions

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Mycobacterium Avium Complex (MAC): Microbe?

CD4 count?

Transmission?

mycobacterium avium or intracellulare

CD4 < 50

Inhaled/ingested from soil/dust

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MAC presentation?

Systemic dz in advanced AIDS

Night sweats
Wgt loss
Abd pain
D
Anemia

MAC labs? (3)

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

Cytomegalovirus Retinitis: Microbe?

CD4 count?

Transmission?

herpes virus

<50

blood, sexual, perinatal

Cytomegalovirus Retinitis is most C what?

Retinal infection in AIDS

Cytomegalovirus Retinitis presentation?

Visual disturbance

Perivascular hemorr, cotton wool exudates

Cytomegalovirus Retinitis labs?

Sero = + for Cytomegalovirus

Esophageal or Vaginal Candidiasis

common fungal infections

Kaposi’s Sarcoma is?

Seen w/ what CD4 count?

Vascular neoplasm

Any CD4 count

Kaposi’s Sarcoma presentation?

Multi-focal, widespread lesions

LAD

HIV screening: tests? (3)

HIV Ab: for screening, not detectible until seroconversion (4-12wks post) Rapid HIV: saliva or blood, + result req's confirmation Ab/Ag combo

HIV screening: Who? (4)

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

Initial HIV W/U includes what? (8) Get baselines of what? (5)

``` 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 ```

HIV tx for which pts? Which CD4 counts see best results supporting tx guidelines?

ALL HIV-infected (P wait for infants) CD4 < 350

AntiRetroviral Therapy (ART) includes? Classes?

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

ART benefits? (5)

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

ART risks? (5)

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

HIV monitoring includes? (3)

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

HIV transmission to infants happens how? (3)

During pregnancy During delivery Breastfeeding

HIV transmission prevention in preggos? (3)

ART C-section if HIV RNA > 1000 No breastfeeding

HIV occupational post-exposure prophy considerations? (3)

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

HIV occupational post-exposure prophy initiation? Tx includes? (3)

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

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

Start w/i 72 hrs