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Rezi FC > HIV > Flashcards

HIV Flashcards

1
Q

Factori care determina scaderea ratei de noi infectari in tarile dezvoltate

A

Intensificarea si repetarea testarii
Initierea rapida a terapiei ARV eficiente
Utilizarea mai frecventa a PrEP - pentru cei neinfectati dar cu risc mare de dobandire

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2
Q

Indicatii de testare HIV - universal

A

Clinici de gineco/BTS
Servicii de consultatii prenatale
Sectii unde se practica avort
Centre pentru persoane dependente de droguri
Servicii de ingrijire pentru persoane cu TB, HVC, HVB, limfom
Centre de ingrijire primara in zonele cu prevalenta mare (=minim 2 cazuri/1000 locuitori)
Persoanele aflate in detentie

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3
Q

Indicatii de testare HIV - persoane la care se recomanda

A

Toti pacientii diagnosticati cu ITS
Partenerii sexuali ai partenerilor cu HIV
MSM
Femei care fac sex cu MSM
Istoric de consum de droguri i.v
Cei care vin din tari cu prevalenta HIV crescuta (>1%)
Persoane care raporteaza contacte sexuale in strainatate/UK cu indivizi din tari cu prevalenta crescuta
Cei care vin la spital si HIV-ul intra in DDx

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4
Q

Boli definitorii SIDA

A

Toxoplasmoza cerebrala
Meningita cu Cryptococcus
LEMP
Limfom primar cerebral
Sarcom Kaposi
Criptosporidioza persistenta
Limfom non-Hodking (LNH)
Cancere cervicale

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5
Q

Boli respiratorii asociate HIV

A

TB
Aspergiloza
Pneumocistoza (Pneumocystis jirovecii)
Pneumonie bacteriana

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6
Q

Boli neurologice asociate HIV

A

Toxoplasmoza cerebrala
Meningita cu Cryptococcus
Encefalita/meningita aseptica
LEMP
Abces cerebral
Limfom primar cerebral
Leziune inlocuitoare de spatiu de cauza necunoscuta
Mielita transversa
Guillain-Barre
Neuropatie periferica
Dementa

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7
Q

Boli dermatologice asociate HIV

A

Sarcom Kaposi
Herpes zoster recurent/pe dermatomere multiple
Psoriazis sever/refractar
Dermatita seboreica severa/refractara

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8
Q

Boli GI asociate HIV

A

Criptosporidioza persistenta
Candidoza orala
Leucoplazie paroasa orala
Diaree cronica de cauza necunoscuta
Scadere ponderala de cauza necunoscuta
Infectii cu
* Salmonella
* Shigella
* Campylobacter
* VHB
* VHC

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9
Q

Boli oncologice asociate HIV

A

LNH
LH
Cancer pulmonar
Cancer de cap si gat
Seminom
Cancer anal
Displazie intraepiteliala anala
Boala Castleman

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10
Q

Boli ginecologice asociate HIV

A

Cancer cervical
Neoplazie intraepiteliala vaginala/cervicala minim grad 2

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11
Q

Boli hematologice asociate HIV

A

Orice discrazie sangvina inexplicabila
* Trombocitopenie
* Neutropenie
* Limfopenie

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12
Q

Boli oftalmologice asociate HIV

A

Retinita CMV
Boli retiniene infectioase - inclusiv HSV, toxoplasma
Orice retinopatie inexplicabila

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13
Q

Boli ORL asociate HIV

A

Parotidita cronica
Chisturi parotidiene limfoepiteliale
Limfadenopatii de cauza necunoscuta

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14
Q

Alte conditii asociate HIV

A

Sindrom mononucleosis-like (=infectia HIV primara)
Orice limfadenopatie de cauza necunoscuta
Febra de cauza necunoscuta
Orice ITS

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15
Q

O rata crescuta de transmitere a HIV pe cale verticala se asociaza cu

A

Stadiu avansat al infectiei la mama
Incarcatura virala materna crescuta
Ruptura prelungita si/sau prematura de membrane
Corioamniotita

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16
Q

Interventii pentru reducerea transmiterii verticale a HIV in tarile dezvoltate

A

Screening pentru depistarea infectiei in sarcina
Terapia ARV
Evitarea alaptarii

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17
Q

Risc de infectie HIV pe cale verticala in UK

A

1:1000

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18
Q

Zone in care acele contaminate reprezinta o cale principala de transmitere HIV

A

America Latina
Europa de Est
Asia de Sud-Est

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19
Q

Localizari HIV-2

A

Africa de Vest
Franta
Portugalia

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20
Q

Localizare HIV-1 M-B

A

Europa
Australia
America de Nord

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21
Q

Spectrul tulburarilor HIV este rezultatul:

A

Efectelor directe ale HIV
Disfunctiei imune asociate HIV
Medicamentelor ARV
Coinfectiilor si/sau comorbiditatilor existente

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22
Q

Boli asociate HIV din categoria B a clasificarii CDC

A

Angiomatoza bacilara (Bartonella henselae/quintana)
Candidoza orofaringiana
Leucoplazie paroasa orala
Herpes zoster pe mai multe dermatomere
Listerioza
PTI
BIP - in special cu abcese tubo-ovariene
Neuropatie periferica

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23
Q

Aspect CT coccidioides, paracoccidioides, blastomyces

A

Infiltrate difuze reticulo-nodulare
Condensari
Noduli unici/multipli
Cavitati
Limfadenopatie mediastinala

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24
Q

Aspect CT histoplasmoza

A

Infiltrate difuze reticulare/reticulo-nodulare
Infiltrate miliare
Limfadenopatie mediastinala (uneori)

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25
Q

Clinica criptococoza

A

Debut insidios cu febra nespecifica, greata, cefalee
Simptome respiratorii nespecifice - febra, tuse, scurtarea respiratiei
De obicei da si afectare neurologica = meningita (dar poate da si afectare pulmonara izolata)
Forma diseminata la ID
Ulterior alterarea constientei + tulburari de comportament
RAR convulsii, semne de focar
Redoare de ceafa, fotofobie - POT FI ABSENTE

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26
Q

Populatii afectate de criptococcus neoformans

A

CD4 < 200/mm3
Corticoterapie long-term
Post-transplant de organe solide/celule stem

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27
Q

Aspect CT criptococoza

A

Infiltrate
Noduli
Cavitati

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28
Q

Populatie afectata de pneumocistoza

A

CD4 < 200/mm3
Corticoterapie long-term
Imunosupresoare

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29
Q

Aspect CT pneumocistoza

A

Opacitati perihilare in “geam mat”

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30
Q

Simptome infectie HIV acuta

A

Febra
Letargie
Mialgii
Artralgii
Limfadenopatie
Odinofagie
Ulceratii de mucoasa
Eruptie maculopapulara rozata tranzitorie - ocazional
Simptome neurologice - FRECVENTE
* Cefalee
* Fotofobie
* Neuropatie
* Mielopatie
RAR encefalopatie

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31
Q

Caractere limfadenopatie in HIV

A

Dimensiune >1 cm
Minim 2 localizari extrainghinale
Durata >3 luni
Simetrici
Fermi
Mobili
Nedurerosi

32
Q

Evaluarea initiala a pacientului cu HIV ar trebui sa includa informatii despre

A

Statusul socioeconomic
Suportul social
Relatiile si familia pacientului
Consumul de droguri
Date de contact ale partenerilor

33
Q

Scopurile evaluarii initiale a pacientilor HIV

A

Stadiul infectiei
Prezenta de comorbiditati/coinfectii
Starea de sanatate fizica, mentala si sexuala a pacientului

34
Q

Factori independenti de HIV care afecteaza numarul de CD4

A

Fumat
Exercitii fizice
Infectii intercurente
Variatii diurne

35
Q

Evaluarea regulata la pacientii HIV este necesara pentru a monitoriza

A

Boli intercurente
Schemele terapeutice
Vaccinarile
Folosirea de droguri recreationale
Istoricul activitatii sexuale
Decizii cu privire la reproducere
Citologia cervicala
Situatia sociala
Servicii de suport
Locul de munca
Locuinta

36
Q

La pacientii HIV se monitorizeaza regulat obligatoriu

A

Greutatea
IMC
Markerii metabolici
Markerii ososi
TA
Riscul CV

37
Q

Probleme potentiale la initierea terapiei ARV

A

RA
Interactiuni
Cancere/complicatii ale lor
Reconstitutie imuna
Infectii la gazda ID
Infectii oportuniste acute
Afectiuni cerebrale organice/functionale
Afectiuni fara legatura directa cu HIV

38
Q

Istoricul medical complet la initierea terapiei ARV

A

Alte ARV
Droguri recreationale
Profilaxii
Calatorii
APP de boala asociata HIV
Surse potentiale de agenti infectiosi
* Igiena alimentara
* Contact cu animale
* Contact cu infectii acute
* Contact cu TB
* ITS

39
Q

Examen fizic complet la initierea terapiei ARV

A

Semne de RA: eruptii, ulceratii orale
Semne de sepsis diseminat
Semne de imunosupresie - candidoza orala, leucoplazie paroasa orala
Semne neurologice de focar/meningism
Semne de alterare a statusului mental (organic/functional)
Sistem ganglionar
Examinare
* Regiunea genitala - HSV, sifilis, gonoree
* Fund de ochi - retinita CMV
* Cavitate bucala

40
Q

Investigatii imediate la initierea terapiei ARV

A

Hemograma, FL
Glicemie
Functie hepatica, renala
Gazometrie (cu EAB)
Hemoculturi (inclusiv mycobacterii)
Examen microscopic si culturi din
* Scaun
* Urina
* Sputa
* LCR

Screening malarie (daca vine din zone endemice)
Serologie - Ag capsular Cryptococcus, Toxoplasma
RxP
CT/RM cerebral - daca exista semne de focar + MEREU inainte de PL

41
Q

Limitele eficacitatii terapiei ARV

A

Inabilitatea de a elimina virusul din spatiile intracelulare
RA
Aderenta la tratament
Interactiunile medicamentoase complexe
Selectia de tulpini rezistente

42
Q

La baza deciziilor terapeutice stau

A

Incarcatura virala = viremia
Genotipul
Numarul de CD4
Comorbiditatile
Medicatia curenta
Circumstantele individuale

43
Q

Situatii speciale cand se initiaza terapia ARV

A

Coinfectia cu hep B, C
Sarcina
Seroconversie
Profilaxie post-expunere

44
Q

Toxicitate ARV - tabel 37.16

A

Tenofovir - disfunctie renala
Abacavir - reactii de HS (la HLA B5701)
Efavirenz - toxicitate SNC = NEUROTOXIC (limitat in timp)
Nevirapina - hepatotoxicitate severa la cei cu CD4 mare
Inhibitori de proteaza (majoritatea) - hiperlipidemie, anomalii metabolice (rezistenta la insulina)
Inhibitori de proteaza (pe termen lung) - risc cardiovascular

45
Q

ARV administrate de 2 ori pe zi

A

Etravirina
Raltegravir
Enfuvirtide (s.c)

46
Q

Toxicitate ARV - text

A

INRT - toxicitate mitocondriala, boli renale, boli osoase
INNRT - eruptii cutanate, cresterea enzimelor hepatice
Efavirenz - neurotoxic
Etravirina - eruptii cutanate
Nevirapina - hepatotoxicitate, reactii alergice cutanate (eruptii) mai ales la cei cu CD4 mare
Dolutegravir - blocheaza secretia tubulara a Cr => crestere usoara a Cr serice
Inhibitori proteaza - tulburari de metabolism lipidic (hiperTG), glucidic (rezistenta la insulina), afecteaza functia de coagulare a celor cu hemofilie
Atazanavir, darunavir - tulburari GI, tulburari de metabolism lipidic
Atazanavir - hiperbilirubinemie (Bi = neconjugata) => icter
Enfuvirtida - reactii locale la locul injectarii (s.c)

47
Q

RA Efavirenz

A

Neurotoxic
* Disforie
* Insomnie
* Risc suicidar crescut

48
Q

Denumiri comerciale ARV

A

Truvada = tenofovir + emtricitabina
Kivexa = abacavir + lamivudina
Triumeq = kivexa + dolutegravir
Stribild = truvada + elvitegravir + cobicistat
Symtuza = truvada (TAF) + darunavir + cobicistat

49
Q

Prescrierea de inhibitori de proteaza poate fi influentata de diferente de

A

Toxicitate
Farmacocinetica
Tip de rezistenta
Costuri

50
Q

Evaluarea CLINICA periodica (6-12 luni) ar trebui sa inlcuda

A

Aderenta
Tolerabilitatea
Masurarea greutatii, TA
Teste urinare

51
Q

Pacientii se monitorizeaza pentru toxicitate si comorbiditati prin

A

Analize complete de sange
Profil hepatic
Profil renal
Profil osos
Functie metabolica - profil lipidic, HbA1c

52
Q

Inductori enzimatici care pot reduce nivelul de ARV

A

Rifampicina
Rifabutina
Warfarina
Nevirapina

53
Q

Toxicitati aditionale la combinarea ARV cu alte medicatii

A

Cresterea nivelului de corticosteroizi (inh/p.o)
Statinele -> toxicitate musculara
AntiTB -> hepatotoxicitate crescuta
Chimio/doze mari de cotrimoxazol -> mielosupresie importanta

54
Q

Afectiuni ce determina manifestari retiniene

A

Pneumocistoza
Toxoplasmoza
Sifilis
Limfom

55
Q

Localizare foliculita eozinofilica

A

Fata
Brate
Membre inferioare

56
Q

Manifestari tegumentare in HIV

A

Tegumente uscate
Acnee
Eruptie papulara pruriginoasa
Herpes zoster - pe mai multe dermatomere
Foliculita
Dermatita seboreica
Condiloame
Onicomicoza
Molluscum contagiosum
Pitiriazis - versicolor, rosea
Tinea - cruris, pedis
Scabie
Ihtioza
Sarcom Kaposi

57
Q

Manifestari mucoase in HIV

A

Ulceratii aftoase
Boala parodontala
Leucoplazie paroasa orala
Candidoza - orala, vaginala
Herpes simplex - oral, genital
Condiloame - orale, genitale

58
Q

Complicatii hematologice in HIV

A

Limfopenie
Neutropenie
Anemie
Trombocitopenie izolata
Pancitopenie

59
Q

Complicatii ale medicamentelor medulotoxice

A

Anemie, neutropenie - lamivudina
Neutropenie - ganciclovir
Pancitopenie - chimioterapice
Agranulocitoza - cotrimoxazol

60
Q

Afectiunile renale determinate de HIV

A

HIVAN
Nefropatie IgA
Microangiopatie trombotica (TMA)

61
Q

Medicamente nefrotoxice utilizate la pacientii cu HIV (NU ARV)

A

Foscarnet
Pentamidina
Sulfadiazina
Amfotericina B

62
Q

Mecanisme care cresc susceptibilitatea la infectii oportuniste

A

Disfunctia LT - protozoare, fungi, virusuri
Disfunctia macrofagelor - bacterii intracelulare (Mycobacterium, Salmonella)
Imunitate deficitara mediata de LB (umorala) - bacterii incapsulate (S. pneumoniae, H. influenzae)

63
Q

Protozoare asociate infectiei HIV

A

Toxoplasma gondii
Leishmania donovani
Cryptosporidium parvum
Isospora belli
Microsporidia

64
Q

Fungi asociati infectiei HIV

A

Candida
Histoplasma capsulatum
Cryptococcus neoformans
Coccidioides immitis
Aspergillus fumigatus
Pneumocystis jirovecii
Dermatofiti (Trichophyton)

65
Q

Virusuri asociate infectiei HIV

A

Poliomavirus JC
HSV
VZV
CMV
HHV-8
HPV

66
Q

Bacterii asociate infectiei HIV

A

M. tuberculosis (BK)
MAI
S. aureus
S. pneumoniae
H. influenzae
M. catarrhalis
Salmonella
Nocardia
Bartonella quintana
Rhodococcus equii

67
Q

Consecintele clinice ale afectarii sistemului imun prin HIV depind de cel putin 3 factori

A

Expunerea la microorganisme de-a lungul vietii
Efectul patogen al microorganismelor cu care a venit in contact
Gradul de imunosupresie a gazdei

68
Q

Agenti patogeni cu virulenta mai mare care pot sa apara in stadii incipiente de HIV

A

M. tuberculosis
Candida
Virusuri herpetice

69
Q

Infectii evitabile prin igiena alimentara

A

Salmonella
Toxoplasma
Cryptosporidium

70
Q

Contactele sexuale protejate limiteaza expunerea la

A

VHB
VHC
HSV
HPV

71
Q

Chimioprofilaxia primara este eficienta pentru

A

Pneumocystis jirovecii
Toxoplasma gondii
MAI

72
Q

Chimioprofilaxia primara nu se recomanda in general pentru

A

CMV
Herpesvirusuri
Fungi

73
Q

Manifestari toxoplasmoza

A

Febra
Cefalee
Leziuni neurologice focale
Convulsii
+/- confuzie

74
Q

DDx toxoplasmoza cerebrala

A

Limfom cerebral
Tuberculom
Cryptococoza focala

75
Q

Manifestari cryptosporidiaza

A

Diaree apoasa severa si persistenta
+
Greata
Varsaturi
Anorexie
Dureri abdominale

76
Q

Manifestari leishmanioza

A

Frecvent nespecifice
* Febra
* Stare generala alterata
* Diaree
* Scadere ponderala
+
Manifestari importante
* Splenomegalie
* Anemie
* Trombocitopenie

77
Q
A

Rezi FC (29 decks)

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