HIV

Question 1

The laboratory test generally accepted as the best indicator of the immediate state of immunologic competence of the patient with HIV infection.

Answer 1

CD4 count

Question 2

Patients with CD4+ T-cell counts ______ are at high risk of disease from P. jirovecii

Answer 2

<200/μL

Question 3

Patients with CD4+ T-cell counts _____ are also at high risk of disease from CMV, mycobacteria of the M. avium complex (MAC), and/or T. gondii

Answer 3

<50/ μL

Question 4

Patients with HIV infection should have CD4+ T-cell measurements performed at ______ and ______ thereafter

Answer 4

the time of diagnosis, every 3–6 months

Question 5

CDC HIV Infection Stage 3 in patients more than 5 years old is defined as CD4 count of?

Answer 5

<200

*Stage 1 - >500
Stage 2 - 200-499
Stage 3 - <200

Question 6

The most common cause of HIV disease throughout the world

Answer 6

HIV 1

Question 7

When should the plasma HIV RNA level be measured?

Answer 7

at the time of HIV diagnosis and every 3–6 months thereafter in the untreated patient.

Question 8

The average length of time from HIV initial infection to the development of clinical disease

Answer 8

10 years

Question 9

TRUE OR FALSE: A diagnosis of AIDS is made in any individual age 6 years and older with HIV infection and a CD4+ T-cell count <200/μL and in anyone with HIV infection who develops one of the HIV-associated diseases considered to be indicative of a severe defect in cell-mediated immunity

Answer 9

TRUE

Question 10

It is the single most common cause of pneumonia in patients with HIV infection in the United States and can be identified as a likely etiologic agent in 25% of cases of pneumonia in patients with HIV infection

Answer 10

P. jirovecii

*Pneumocystis pneumonia (PCP) is caused by the fungus P. jirovecii and was once the hallmark of AIDS

Question 11

The risk of PCP is greatest among those who have experienced a previous bout of PCP and those who have CD4+ T-cell counts of ______

Answer 11

<200/μL

Question 12

The standard treatment for PCP or disseminated pneumocystosis

Answer 12

trimethoprim-sulfamethoxazole (TMP-SMX).

Question 13

The treatment of choice for severe disease in the patient unable to tolerate TMP-SMX.

Answer 13

IV Pentamidine

Question 14

What additional medication can be given for patients with a Pao2 <70 mmHg or with an a–a gradient >35 mmHg

Answer 14

Glucocorticoid

Question 15

The preferred regimen for PCP prophylaxis.

Answer 15

TMP-SMX, one double-strength tablet daily

• This regimen also provides protection against toxoplasmosis and some bacterial respiratory pathogens

Question 16

When is prophylaxis for PCP indicated for any HIV-infected individual?

Answer 16

1) HIV-infected individual who has experienced a prior bout of PCP
2) any patient with a CD4+ T-cell count of <200/μL or a CD4 percentage <15
3) any patient with unexplained fever for >2 weeks
4) any patient with a recent history of oropharyngeal candidiasis

Question 17

Indications to discontinue PCP prophylaxis

Answer 17

patients treated with ART who maintain good suppression of HIV (<50 copies/mL) and CD4+ T-cell counts >200/μL for at least 3 months.

Question 18

AIDS pandemic is primarily caused by the ____

Answer 18

HIV-1 M group viruses.

Question 19

Two major envelope proteins if the HIV virion

Answer 19

• the external gp120
  
  • the transmembrane gp41

Question 20

Two major co-receptors for HIV-1

Answer 20

CCR5 and CXCR4

Question 21

Among the parenteral type of exposure in HIV, which carries the highest risk of exposure?

Answer 21

Blood transfusion

Question 22

TRUE OR FALSE: Receptive anal intercourse carries the highest risk of HIV transmission

Answer 22

TRUE

Question 23

When should HIV testing be repeated if the patient’s HIV 1 western blot showed indeterminate result?

Answer 23

4-6 weeks

Question 24

the leading infectious cause of meningitis in patients with AIDS

Answer 24

Fungal meningitis

• vast majority of these are due to C. neoformans

Question 25

TRUE OR FALSE: The diagnosis of cryptococcal meningitis is made by identification of organisms in spinal fluid with india ink examination or by the detection of cryptococcal antigen.

Answer 25

TRUE

Question 26

The diagnosis of this disease is usually suspected on the basis of MRI findings of multiple lesions in multiple locations

Answer 26

Cerebral Toxoplasmosis

Question 27

Initial treatment regimen for cryptococcal meningitis

Answer 27

Initial treatment is with IV amphotericin B 0.7 mg/kg daily, or liposomal amphotericin 4–6 mg/kg daily, with flucytosine 25 mg/kg 4x a day for at least 2 weeks if possible

Question 28

Standard regimen for toxoplasmosis

Answer 28

Standard treatment is sulfadiazine and pyrimethamine with leucovorin as needed for a minimum of 4–6 weeks

Question 29

It is one of the most devastating consequences of HIV infection that usually presents as a painless, progressive loss of vision

Answer 29

CMV retinitis

Question 30

What is the standard therapy for CMV retinitis ?

Answer 30

oral valganciclovir, IV ganciclovir, or IV foscarnet,

• A 3-week induction course is followed by maintenance therapy with oral valganciclovir.
• Maintenance therapy is continued until the CD4+ T-cell count remains >100 μL for >6 months