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Clinical Medicine 1 > HIV > Flashcards

HIV Flashcards

1
Q
  • About how many current individuals are there with HIV in the US?
  • What % are unaware?
  • HIV has a higher prevalence in which individuals?
A
  • 1.2 million
  • 14%
  • African-americans, hispanic men, MSM
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2
Q
  • HIV belongs to the family of (…)
  • What are the 2 subtypes of HIV?
A
  • retroviruses
  • HIV1, HIV2
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3
Q

Which HIV type is distributed worldwide and likely originated in chimpanzees?

A

HIV 1

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4
Q

Which HIV type more predominant in the West Africa origin and likely originated in soot mangabeys?

A

HIV 2

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5
Q
  • What are the subtypes of HIV 1?
  • Which subtype is the major number of cases?
A
  • M, N, O, P
  • M
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6
Q
  • HIV 2 tends to have (…) transmissibility rates than HIV 1?
  • HIV 2 tends to be less likely to progress to (…), but if it does, it follows the same course as those patients with HIV 1?
  • Patients with HIV-2 are more likely to maintain a “fight against” loss of (…) cells?
  • What is this termed?
  • Patients with HIV-2 tend to also have (…) viral load than persons with HIV-1?
A
  • lower transmissibility rates
  • AIDS
  • immune CD4 cells
  • long-term non-progressors
  • lower viral load
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7
Q

How is HIV transmitted?

A
  • sexual contact
  • contaminated blood products
  • breastfreeding
  • intrapartum and perinatally
  • IV drug abusers
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8
Q
  • 70-80% of HIV infections occur with (…) contact (Africa)
  • The highest sexual transmission risk is (…)
  • Risk with (…) has been shown to be very low, but not impossible
A
  • heterosexual contact
  • receptive anal intercourse with HIV + individual
  • oral sex
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9
Q

What should be started as soon as possible in pregnancy to reduce the risk of transmission of HIV to the baby?

A

ART

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10
Q

What factors increase the risk of HIV transmission?

A
  • higher viral titers (more likely to transmit)
  • presence of any other STIs or ulcerations increases risk (HSV, syphilis): allows HIV port of entry
  • oral contraceptive use: progesterone effect of thinning out vaginal lining
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11
Q

What factors reduce the risk of HIV transmission?

A

circumcision reduces risk of transmission

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12
Q

What is HIV not spread by?

A
  • touching a person with HIV
  • insect bites
  • salive, urine, nasal secretions, sputum, sweat, tears, vomit (unless bloody)
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13
Q
  • If a needle stick/fluid contact occurs and the person is HIV+, what is the risk of transmission if not treated with antiretroviral medication within 24 hours?
  • Which is more concerning for risk of HIV transmission, percutaneous puncture or mucocutaneous exposure?
  • Who should you call to report any contact, even if HIV status of patient is unknown?
  • You should contact your infection control person STAT for (…); the goal is to start medication within (…) hours of exposure
  • HIV testing of HCW is performed periodically over (…)
A
  • 0.3%
  • percutaneous puncture
  • infection control
  • PEP (post-exposure prophylaxis)
  • 1-2 hours
  • 6 months; @ 6 weeks, 12 weeks, 6 months
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14
Q

What are some risk factors for HIV acquisition?

A
  • unprotected sex
  • MSM
  • sex workers
  • IV drug use
  • incarceration
  • gender-diverse or transgender
  • maternal-fetal transmission
  • unsafe medical practices
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15
Q

After a positive test for HIV, what should you assess (what should the work-up consist of)?

A

take a thorough history and perform a full physicial
- sexual contacts (partners)
- social history (support that can help with stigma, support and adherence)
- complications (current drug use/chronic health issues)
- immunizations

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16
Q

What immunizations should patients with HIV receive?

A
  • streptococcus pneumoniae
  • hepatitis B (high risk of hepatocellular carcinoma)
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17
Q

HIV uses (…) to transform RNA into DNA so it can become compatible with human (…) cells

A
  • reverse transcriptase
  • human CD4 cells
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18
Q
  • What helps B-cells generate strong antibody responses to pathogens?
  • What do these secrete?
  • What does this aid in?
  • What aids immune memory when a viral pathogen is encountered a second time?
A
  • CD4 T-lymphocytes (“CD4 helper cells”)
  • cytokines
  • killing pathogen (virus in this case); eliminating virally infected cells
  • memory CD4 cells
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19
Q
  • An infection with HIV disrupts or destroys (…)
  • (…) cells are directly infected and destroyed
  • (…) attempts to clear infected cells
  • (…) dies due to erroneous immune activation
  • (…) becomes exhausted and depleted
  • This results in profound destruction of (…)
A
  • CD4 T-lymphocytes
  • CD4 cells
  • immune system
  • CD4 cells
  • immune system
  • CD4 lymphocyte count
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20
Q

What is the course of HIV?

A
  1. virus transmission and dissemination
  2. acute HIV infection
  3. chronic HIV infection
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21
Q
  • Upon initial HIV infection (in the first few days), the virus cannot be detected in (…)
  • This is called the (…) phase
  • Eventually, what happens to the virus?
  • As this specific process is occurring, some patients will detect (…)
  • The viral increase at this time may cause (…)
  • 90% of patients will have (…)
  • These patients will rarely seek care for these symptoms so it is not diagnosed
A
  • plasma
  • eclipse phase
  • disseminates to lymphatic tissue, infects/destroys more CD4 cells, releases more viral progeny
  • their first symptoms
  • acute HIV infection
  • at least one symptom, usually mild
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22
Q
  • What is the first sign of HIV infection?
  • Onset of symptoms usually is (…) weeks after exposure, and resolves with time
  • The average duration of these symptoms is (…) days
A
  • acute HIV infection
  • 2-4 weeks
  • 18 days
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23
Q
  • Acute HIV infection manifests with (…) symptoms
  • What do these symptoms include?
A

mono-like symptoms
- fever
- sore throat (tonsillitis, mucocutaneous ulcers in mouth)
- HA
- lymphadenopathy
- myalgias, arthralgias
- N/V
- night sweats
- generalized maculopapular rash

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24
Q

What symptoms in an acute HIV infection are unique to HIV?

A
  • mucocutaneous ulcers in mouth
  • generalized maculopapular rash
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25
Q

What is the name of this rash?
What is this associated with?

A
  • maculopapular rash
  • HIV (acute HIV infection)
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26
Q

Mucocutaneous ulcers can occur in which locations?

A
  • oral cavity
  • esophagus
  • anus
  • penis
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27
Q

You should consider acute HIV infections in patients who display what symptoms?

(Consider acute HIV infection especially if symptoms are (…))

A
  • fever, fatigue, rash, pharyngitis in pt who has risk factors
  • mucocutaneous ulcers

(prolonged)

28
Q

What is the normal CD4 count?

A

500-1500 cells/mm^3

29
Q

How long can the transition of chronic HIV infection to advanced HIV take in the total absence of antiretroviral therapy?

A

10 years

30
Q

What are the stages (phases) of HIV transitioning from chronic HIV infection to advanced HIV?

(this is the quieter phase)

A
  • chronic HIV infection
  • asymptomatic
  • early symptomatic
  • presence of AIDS defining conditions or CD4 < 200
  • advanced HIV CD4 < 50
31
Q
  • Over time, HIV establishes a (…)
  • What mitigates the viral load and prevents further declines in the CD4 count?
  • As viremia continues/increases, (…) continues to decline during this latent period of infection
  • Don’t confuse latency as (…) as during HIV latency, the virus is (…) and (…)
  • What is the AIDS definition of CD4 levels?
A
  • chronic infection
  • cytotoxic CD8 cells
  • CD4 count
  • no activity; active and replicating
  • CD4 level < 200
32
Q

As CD4 decreases, (…) and (…) increase

A

symptoms and opportunistic disease

33
Q
  • In the earliest phases of HIV infection, most patients are (…)
  • Many will have generalized (…)
  • These will generally present in two areas that are (…)
  • This usually includes the (…) nodes, persists over (…) months, is not explained by other (…), and is generally (…)
  • This asymptomatic period can start in the (…) period
A
  • asymptomatic
  • lymphadenopathy
  • noncontiguous
  • inguinal nodes, 3 months, other illnesses, symmetric
  • acute HIV period
34
Q

Regarding the symptomatic period of HIV:
- The decline of CD4 cells is (…) as the body achieves a balance between cell death and replacement
- As CD4 levels continue to decline slowly over time, HIV+ patients may develop more (…)
- They can become more symptomatic even with CD4 counts above (…), but are more common as CD4 levels decline
- Symptomatic HIV usually related to infections with (…)

A
  • slow
  • symptoms
  • 200
  • opportunistic pathogens
35
Q

What infections are patients with HIV in the symptomatic period relate to?

A
  • oral/vaginal candidiasis (thrush)
  • oral hairy leukoplakia caused by EBV (white plaque on side of tongue)
  • MRSA
  • hepatitis A, B, C
  • streptococcus pneumoniae
  • syphilis
36
Q

What is this showing?

A

oral hairy leukoplakia caused by EBV

37
Q

What are some consequences of HIV?

A
  • HPV and cervical cancer risk increase
  • HIV-polyneuropathy
  • cardiac disease
  • HIV-related encephalitis or dementia
38
Q

Describe HIV-polyneuropathy and what symptoms are associated with it?

A

developed distal and symmetric polyneuropathy:
- numbness or pain in hands/feet
- paresthesias
- progresses to weakness

39
Q
  • Patients with HIV have a higher risk of (…) and (…)
  • What should patients do to decrease heart complication risks?
  • (…) medications can negatively affect cardiac function, but not as severe as HIV itself
A
  • myocardial infarction and heart failure
  • smoking cessation (crucial), control of BP and lipids
  • ART medications
40
Q

What is HIV-related encephalitis or dementia managed with?

A

ART and dementia specific treatments

41
Q

What is the definition of AIDS?

A
  1. CD4 < 200 cells/microL
  2. presence of an AIDS-defining condition in an HIV + individual

(pt w/ AIDS-defining condition who is already HIV+, CD4 doesn’t matter)

42
Q

What AIDS-defining conditions should we know?

A
  • repeated bacterial infections
  • candida in the bronchi, lungs, esophagus
  • pneumocystic pneumonia (pneumocystic jirovecii pneumonia) - fungal
  • wasting syndrome
  • Kaposi’s sarcoma
43
Q
  • What type of tumor is Kaposi sarcoma?
  • What is the cause of Kaposi sarcoma?
  • How is Kaposi sarcoma transmitted?
A
  • vascular tumor
  • kaposi sarcoma herpes virus
  • sexual, maternal, infant
44
Q
  • What type of patients in kaposi sarcoma rare in?
  • How many times more common is kaposi sarcoma in AIDS pts?
  • What % of AIDS patients are affected by kaposi sarcoma?
A
  • immunocompetent
  • 20,000x
  • 35%
45
Q

Kaposi sarcoma can occur in other immunosuppressed conditions but is highly associated with (…)

A

AIDS

46
Q

If patients are not being treated for HIV, (…) is more likely to be seen

A

kaposi sarcoma

47
Q

What is the appearance of kaposi sarcoma and how it grows over time?

A
  • lesions are red/purple
  • become more nodular over time
  • can start to coalesce; borders grow together
48
Q

What parts of the body can Kaposi sarcoma affect?

A
  • skin
  • mucocutaneous sites
  • organs (respiratory tract, GI tract)
49
Q

How is Kaposi sarcoma confirmed?

A

biopsy

50
Q
  • What may also be present in patients with Kaposi sarcoma?
  • When (…) is initiated, these lesions can stabilize or resolve
  • What are some other treatments that can be used to get rid of lesions from KS?
  • What can be used in severe or widespread cases?
A
  • generalized lymphadenopathy
  • antiretroviral therapy
  • surgical excision (cosmetic relief); liquid nitrogen
  • chemotherapy agents: doxorubicin/paclitaxel
51
Q

What AIDS-defining condition is this describing:
- weight loss of at least 10% in the presence of diarrhea or chronic weakness and documented fever for at least 30 days that is not attributable to a concurrent condition other than HIV itself

A

wasting syndrome

52
Q

What are the causes of wasting syndrome?

A
  • cytokine release
  • hypogonadism (low testosterone) associated with HIV
  • metabolic and malabsorptive mechanisms
53
Q

What is the treatment for wasting syndrome?

A
  • nutritional supplement
  • nutritional consultation
  • appetite stimulators (megestrol acetate/dronabinol)
54
Q
  • What was the survival length with AIDS after the appearance of opportunistic infections initially?
  • However, (…) has changed this
  • Now, a 20 y/o infected with HIV on medication can live another (…) years
A
  • 6 months
  • antiretroviral therapy
  • 30 years
55
Q

Describe what long term non-progressors are and what % of HIV patients they make up?

A
  • 5-15%
  • do not follow typical progression to AIDS
  • may not develop AIDS for > 20 years
  • genetic influences result in better immune response/lower virus levels
56
Q

Describe what elite controllers are and what % of HIV patients they make up?

A
  • 0.003%
  • do not show detectable viral levels and maintain CD4 counts for many years
57
Q

How can you diagnose HIV?

A
  • viral load (10-12 days after infection)
  • HIV p24 antigen
  • 4th gen tests: combo test detect p24 antigen and antibodies IgG and IgM (virologic and serologic)
58
Q

What are some initial tests that should be conducted after a positive HIV result?

A
  • CD4 lymphocyte levels
  • HIV viral load
  • CBC, CMP, UA, lipid panel
  • Hep A, B, C testing
  • STI testing
  • HLAb5701 allele test if abacavir is being prescribed
  • genetic drug resistance testing
59
Q

Monitoring of HIV typically consists of getting what levels/tests?

A
  • CD4 and viral load counts
  • eval of side effects/toxicities of medications
60
Q

Describe the 95/95/95 goal of the WHO?

A
  • 95% of HIV+ pts have diagnosis
  • 95% of those diagnosed are one ART
  • 95% of those on ART are considered suppressed
61
Q

There have been a few people cured of HIV, what has this treatment consisted of?

A
  • stem cell transplant after chemotherapy/radiation
  • donor stem cells has a unique genetic alteration allowing for better immune clearance

(these patients had also been diagnosed with cancer)

62
Q
A

KS

63
Q
A

KS

64
Q
A

KS

65
Q
A

mucocutaneous ulcers

Clinical Medicine 1 (4 decks)

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