HIV Flashcards
True or false
 Even if the ED evaluation is unrevealing, admit all patients with new or changed neurologic signs or symptoms.
True
Since the introduction of ART,__________________ remains the most commonly reported neurologic opportunistic infection
toxoplasmosis encephalitis
In toxoplasmosis encephalitis  unenhanced CT scan, toxoplasmosis typically appears as 
multiple subcortical lesions with a predilection for the basal ganglia and corticomedullary junction
In toxoplasmosis encephalitis  Contrast-enhanced CT scan typically shows
multiple ring-enhancing lesions with surrounding areas of edema
True or false
 MRI is more sensitive than contrast-enhanced CT scan in detecting toxoplasmosis
 True
Admit patients with suspected toxoplasmosis and treat with a combination of
IV pyrimethamine plus
sulfadiazine plus
leucovorin (folinic acid).
Clindamycin is a substitute for sulfadiazine.
trimethoprim-sulfamethoxazole may have equal efficacy
In toxoplasmosis encephalitis occurs most commonly in patients with CD4+ cell counts_______ cells/mm3 as latent bradyzoites acquired early in life reactivate
<100
Cryptococcal infection occurs most commonly in patients with CD4+ counts of______ cells/mm3
<50
Patients with CNS cryptococcosis require hospital admission and the following medications
IV amphotericin B and
oral flucytosine for 14 days, followed by
fluconazole for 8 weeks to clear the CSF
Diagnosis of CNS cryptococcal infection in HIV patients relies on
CSF cryptococcal antigen testing (92% sensitive and 83% specific),
fungal culture (95% to 100% sensitive), or
staining with India ink (60% to 80% sensitive)
Cytomegalovirus on neuroimaging
nonspecific periventricular enhancement
Cytomegalovirus means state of treatment
Ganciclovir
CD4+ T-cell counts of______ cells/mm3 generally have causes of fever similar to those in nonimmunocompromised patients
> 500
CD4+ T-cell counts between__________ cells/mm3 are more likely to have infections that are associated with early immune compromise, including bacterial pneumonia, herpes zoster, and tuberculosis.
200 and 500
CD4+ T-cell counts of________ cells/mm3, the most common causes of fever without obvious localizing findings are early Pneumocystis jirovecii pneumonia (formerly known as Pneumocystis carinii); central line infection; infection with Mycobacterium avium complex, Mycobacterium tuberculosis, or cytomegalovirus; drug fever; and sinusitis. Other causes of fever include endocarditis, lymphoma, and infection with Histoplasma capsulatum or Cryptococcus neoformans.
<200
infection occurs predominantly in patients with CD4+ T-cell counts of ≤100 cells/mm3 who are not on ART or azithromycin prophylaxis.
Persistent fever and night sweats are typical symptoms.
Associated symptoms include weight loss, diarrhea, malaise, and anorexia
Disseminated M. avium complex
Treatment for disseminated mycobacterium avium complex infection
clarithromycin combined with ethambutol and rifabutin
Azithromycin is an alternative therapy
mimics an autoimmune event, with lymphadenitis, fever, and other symptoms starting weeks to months after beginning ART, often during tuberculosis therapy. There is no definitive diagnostic test for this condition. Treatment guidelines advise continuing ART; use nonsteroidal anti-inflammatory agents for mild to moderate cases; in severe cases, use corticosteroids (prednisone 1 to 2 milligrams/kg or equivalent for 1 to 2 weeks)
Immune reconstitution inflammatory syndrome
The most important CMV manifestation is
retinitis
is the most frequently occurring neoplasm, characterized by high-grade, rapidly growing mass lesions.
Non-Hodgkin’s lymphoma
Transmission of HIV occurs through
semen, vaginal secretions,
blood or blood products, and
breast milk, and
in utero by transplacental transmission
__________________occurs 2 to 4 weeks after infection with HIV. Also called___________, this is the initial response to infection, causing symptoms in the majority of those infected. The clini- cal presentation is nonspecific, resembling a flulike or mononucleosis- like syndrome; the diagnosis is missed in about 75% of cases.
Stage 1 or acute HIV infection
acute retroviral syndrome
Symptoms of acute HIV infection typically occur within 1 month of becoming infected, may last for___________, and include ________
2 to 10 weeks
fever (>90%), fatigue (70% to 90%), pharyngitis (>70%), rash (40% to 80%), headache (30% to 70%), and lymphadenopathy (40% to 70%); other reported symptoms are weight loss, headache, and diarrhea.
Seroconversion and detectable antibody response to HIV usually occur ___________ after infection, although delays can be up to ____________
3 to 8 weeks
11 months
_______________of HIV infection is the period of clinical latency or HIV inactivity during which time patients generally have no complaints or find- ings on physical examination except for possible persistent generalized lymphadenopathy (enlarged lymph nodes in at least two noncontiguous sites other than inguinal nodes)
Stage 2
median incubation time from exposure to the development of AIDS is estimated at__________ for adults; shorter incubation periods occur in untreated infants and older adults ‘
10 years
of HIV infection has either laboratory markers of severe immu- nosuppression (CD cell counts <200 cells/mm3) or occurrence of one of any opportunistic infections or AIDS-defining illnesses
Stage 3
Mean times from transmission to detection are shortest for viral load (_______days), followed by p24 antigen (________days), enzyme-linked immunosorbent assay positivity (25 days), and Western blot positivity (31 days)
17 days
22 days
most commonly used testing method for HIV is
detection of antibodies to the virus
Enzyme-linked immunosorbent assay detects
specific serum antibodies to HIV antigens
Western blot assay detects
HIV antibodies to viral antigens
CD4+ T-cell counts of_________cells/mm3 and a viral load of________ copies/ mm3 are associated with increased risk of AIDS-defining illnesses.
<200
> 50,000
When stage of disease is unknown, use the___________ to approximate the CD4+ T-cell count.
total lymphocyte count
total lymphocyte count________ cells/mm3 had a sensitivity of 95% for a CD4 count of <200 cells/mm3
<1700
is the most serious ocular opportunistic infection and is the leading cause of blindness in AIDS patients
Cytomegalovirus retinitis
In cytomegalovirus retinitis, indirect ophthalmoscopy findings are
 fluffy white perivascular lesions with areas of hemorrhage
The most common cause of pneumonia in HIV-infected patients in the United States and Western Europe is_______________, followed by______ and ____________
Streptococcus pneumoniae
PCP
Tuberculosis
_____________ or ______________appearance is demonstrated by hemorrhages and the dirty white granular-appearing retinal necrosis adjacent to major vessels
Pizza pie” or “cheese and ketchup”
whitish retinal lesions without hemorrhage
Toxoplasma retinochoroiditis
multiple discrete yellowish spots on choroid and retina
Cryptococcus chorioretinitis
multiple pale yellow-white choroidal spots
pneumocystis choroiditis
is the most common opportunistic infection among AIDS patients
PCP PNEUMOCYSTIS PNEUMONIA
The causal agent of PCP is known as___________, previously classified as a protozoan but now reclassified as a fungus.
P. jirovecii (previously known as P. carinii)
is often the initial opportunistic infection that establishes the diagnosis of AIDS
PCP
most frequent serious complication of HIV infection in the United States
PCP
most common identifiable cause of death in patients with AIDS
PCP
The preferred therapy is______________
trimethoprim-sulfamethoxazole
Typical presentations of tuberculosis occur in patients with CD4+ T-cell counts of__________ cells/mm3
> 200 to 500
Those with tuberculosis and advanced HIV infection, with CD4 cell counts_______ cells/mm3, often have extrapulmonary or dissemi- nated disease.
<100
Frequent sites of dissemination are___________________________
peripheral lymph nodes, bone marrow, CNS, GI system, and urogenital system
All HIV-infected patients with positive purified protein derivative skin tests should receive isoniazid plus pyridoxine for____________; alternatives include rifampin or rifabutin for 4 months
9 to 12 months
the most common pulmonary infection in HIV- infected patients
Bacterial pneumonia
__________, 100 mg once daily for 7 to 14 days, is first-line treatment For oral candidiasis or thrush
Oral fluconazole
appears as a nontender, well-circumscribed, slightly raised violaceous lesion
Oral Kaposi’s sarcoma
Diarrhea with CD4 <200 cells/mm3, consider
Cryptosporidium and microsporidia
Diarrhea with CD4 is <50 cells/mm3, patients are at risk for.
cytomegalovirus and MAC
Kaposi sarcoma are firm, painless, raised, brown-black or purple patches, plaques, or nodules
Common sites are the face, chest, genitals, and oral cavity
HIV-infected persons should not receive live-virus or live-bacteria vaccines.
The exception to this rule is the ___________vaccine.
measles-mumps-rubella
