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Fifth Year Medicine > HIV > Flashcards

HIV Flashcards

1
Q

What is seroconversion in HIV?

What are the common symptoms of Primary HIV infection?

A

Seroconversion occurs when antibodies are produced against the virus.

PC: glandular fever-like illness (sore throat, fever, swollen glands)
fever,
inflammation- arthralgia, headaches, neuralgia, malaise
diarrhoea, maculopapular rash
meningitis, neuropathy, encephalopathy

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2
Q

What are the neurological manifestations possible in seroconversion of HIV?

A
  1. aseptic meningioencephalitis
    self limiting headache, meningism, cranial nerve palsy, seizures
  2. Guillain Barré syndrome- demyelinating polyneuropathy
    unsual high WCC may be found on CSF if HIV +ve
  3. Myelitis- inflammation may occur anywhere
  4. Cauda equina syndrome
  5. Myositis
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3
Q

What CD4 counts are associated with possible opportunistic infections in HIV?

A

CD4 below 200/mm3 = toxoplasmosis and cryptococcal meningitis
impaired inflammatory response- headache, no stiff neck or photophobia

CD4 below 50/mm3 = CMV

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4
Q

How would cryptococcal meningitis be investigated in HIV patient?

What needs to be excluded?

A

India ink stain
Cryptococcal antigens (c. neoformans) in blood + CSF
CSF culture

CSF- VRDL for neurosyphilis
TPPA (haemagluttination assay) for syphilis

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5
Q

HIV +ve patient
PC: started as a headache, now hemiparesis + dysphasia, visual problems etc

CT: multiple rounded abscess + mass effect
further IHx?

A

Toxoplasmosis- reactivated HIV, CD4

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6
Q

What prophylaxis against toxoplasma may be given?

When would it be given?

A

Co-trimoxazole if CD4 goes below 200

NB note it is the same as PCP prophylaxis

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7
Q

HIV +ve
PC: headache, confusion, Kernig’s sign negative
what test is needed to diagnose cryptococcus neoformans?

A

95% have cryptococcal antigen in CSF
Gold standard: CSF culture (85% are positive)
India ink stain

Meningitis without classic neck stiffness and photophobia.

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8
Q

On a CT scan, what makes a diagnosis of toxoplasmosis more likely in a HIV patient compared to progressive multifocal leucoencephalopathy (due to Creutzfeldt Jakob papovirus reactivation).

A

In toxoplasmosis, mass effect may occur and tends to be multiple lesions.

In CJ virus reactivation, there may only be a single lesiona and no mass effect occurring.

Both lesions tend to occur at the white/grey interface.

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9
Q

If progressive multifocal leucoencephalopathy is suspected in a HIV +ve patient what investigations should be done?

PC: hemiparesis, confusion, 7th CN palsy, dysphasia (language), visual problems.

A

IHx: CT/MRI looking for brain lesions (single could be JC virus or CNS lymphoma)

CSF PCR
(+ve in 75%) looking for Cruetzfeldt Jakob virus
If negative result, biopsy may be performed.

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10
Q

MRI: cortical atrophy with patches of white matter with high signal.
HIV +ve patient with increasing memory loss and poor concentration.

A

HIV-associated dementia
Diagnosis of exclusion- exclude depression, substance abuse, neurosyphilis and cerebrovascular disease

Rx: HAART with zidovudine

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11
Q

What is the commonest neurological complication in HIV?

A

Distal sensory peripheral neuropathy- like in diabetes

30% of symptomatic AIDS patients get it.
Can be a side effect of nucleoside analogues as well, which gives a dose dependent, reversible neuropathy lasting 6 weeks after the drug is stopped.

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12
Q

HIV patient found to have multiple lesions on CT is treated with sulfadiazine and pymethamine. This has not helped. What should be done next? What is the most likely diagnosis?

A

Biopsy the mass.
Primary CNS lymphoma.
CSF +ve for Epstein Barr virus- thought to be associated- but often contraindicated due to high pressure in brain.

Even with whole brain radiotherapy, prognosis is very poor, so may not biopsy unless a treatable pathology is considered likely.

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13
Q

What CD4 count makes cryptococcus meningitis more likely?

A

CD4 below 100 cells/uL

Cryptococcus is an encapsulated fungi.

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14
Q

What are the stages/groups of HIV infection?

A

CDC 1992

  1. primary HIV infection (seroconversion)
  2. asymptomatic phase
  3. persistent generalised lymphadenopathy
  4. symptomatic infection

Group 4 subdivides into A-E categories according to AIDs-defining conditions present

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15
Q

What features need to be present to define Group 3 phase in HIV?

A

Generalised lymphadenopathy-
lasts at least 3 months
2 extra-inguinal sites
not due to any other cause (bacterial, malignant or sarcoid-esque)

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16
Q

How is Group IVA- HIV wasting syndrome defined?

A

10% loss of weight
fever lasting 1 month +
Diarrhoea lasting 1 month +

Rx: exclude other causes, antipyretics, antidiarrhoeal agents and finally steroids.

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17
Q

HIV +ve patient with a red scaly rash over face and scalp.

A

Seborrhoeic dermatitis

Rx: 1% hydrocortisone and antifungal cream

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18
Q

Common skin problems with HIV and how to treat:

a. tinea cruris
b. vaginal candida
c. oral candida
d. shingles
e. perianal warts

A

Tinea cruris (crotch) -clotrimazole cream
Candidiasis- clotrimazole cream
Oral candidia - nystatin or fluconazole
Shingles- aciclovir/ famciclovir
Recurrent perianal or genital warts - long term aciclovir

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19
Q

What effects on blood count may be expected in HIV

A

low neutrophils- neutropenia
normochromic normocytic anaemia
thrombocytopenia- low platelets
(if bleeding or below 20 need to give antiretrovirals)

HIV meds may be toxic to the bone marrow

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20
Q

which malignancies are deemed AIDs-defining?

A

Kaposi’s sarcoma
High-grade B-cell non-Hodgkin lymphoma
Invasive cervical carcinoma

21
Q

Which virus is associated with kaposi’s sarcoma and body cavity lymphoma?

A

Human herpes virus 8

22
Q

Which virus is associated with non-hodgkins lymphoma?

A

Epstein Barr virus

23
Q

What virus is associated with hepatocellular carcinoma in HIV?

A

Hepatitis B and C

24
Q

HPV may cause warts and which other problems?

A

Anogenital or oral carcinomas

25
Q

How is Human Herpes Virus 8 spread?

A

Sexual transmission- unlikely to be via semen
Mother to child
Organ transplant

26
Q

HIV patient
extensive lymphadenopathy
what would you be worried about?

A

Castleman’s disease- not technically a cancer but lymph node proliferation.

IHx: biopsy
HHV8 virus

27
Q

What factors suggest a good prognosis for Kaposi’s sarcoma?

A

Localised disease -rather than systemic lymph node enlargement
CD4 above 150 cells/microL
No systemic symptoms

can give HAART alone

28
Q

How can Kaposi’s sarcoma be treated?

A

LOCAL
Repeat cryotherapy- may leave scar

Radiotherapy- if lesions are painful or causing lymphatic obstruction
May cause erythema, hair loss, pigmented scarring.

Intra-lesional chemicals for mucocutaneous lesions:
VINBLASTINE or VINCRISTINE
Causes painful inflammatory response before clearance of lesion.

WIDESPREAD- good prognosis
HAART

29
Q

If patient has poor prognostic factors Kaposi’s sarcoma what treatment should they get?

A

HAART + Liposomal DAUNORUBICIN or DOXORUBICIN

SEs: 50% neutropenia, alopecia, vomiting

Need PCP prophylaxis
(HAART alone if poor prognosis)

30
Q

What type of non-hodgkins lymphomas are associated with HIV?

A

Aggressive B cell types:
diffuse large B-cell lymphomas
Burkitt’s lymphoma
non- Burkitt’s lymphoma

rarely primary CNS lymphomas

31
Q

What might a typical regime for non-hodgkins lymphoma in HIV look like?

A 
HAART + CHOP
cyclophosphamide
hydroxydaunomycin
oncovin (vincristine)
prednisolone
32
Q

single lesion on MRI. Patient is HIV +ve

which investigations help distinguish between differential?

A

CSF:
EBV- human herpes 4 PCR
cytology
JC virus PCR

toxoplasma IgG

SPECT- single photo electron CT, hyperactive lesion suggests lymphoma

failure after 2 weeks to respond to toxoplasmosis treatment

33
Q

Hodgkins disease in HIV is more likely and more aggressive.

How to treat?

A

HAART + ABVD

doxorubicin, bleomycin, vinblastine, dacarbazine

34
Q

How would you treat a patient who was found to have concurrent HIV and TB?

A

Treat the TB first, as per normal and not the HIV- generally (Rifamipicin interacts with HAART)
then after two months when TB drugs change to two medications, add HAART

35
Q

HIV patient and fundoscopy, see cotton wool spots, what might be the cause?

A

Retinopathy (from HIV-vasculopathy)
Cotton wool spots- infarcts in neurones

Differ from CMV lesions as small, superficial and less frequent retinal haemorrhages and microaneurysms.

36
Q

HIV patient is started on HAART, gets macular oedema, inflammation of eye and epi-retinal membrane formation (visible as a film on fundoscopy that causes puckering of the retina). What could be cause and treatment?

A

Immune recovery uveitis

Systemic steroids

37
Q

What opportunistic infections do you get in the eye with HIV?

A

CMV infection- multiple floaters, blurring

Varicella zoster virus- (HHV3) vesicular eruptions of face, conjunctivits, uveitis

Herpes Simplex Keratitis- painful corneal ulcers
Toxoplasma retinochoroiditis- retinal lesions
Candida
Kaposi’s sarcoma

38
Q

What kind of CD4 count puts patients at risk of CMV?

A

Below 100 cells/uL

should offer regular dilated examination of the fundi

39
Q

HIV patient complains of floaters and some flashing lights in their vision. Diagnosis + Rx?

A

CMV -retinitis and vessel occlusion leading to necrosis
IHx vitreous sample CMV PCR or clinical
Repeat retinal photographs to track progression

Rx: HAART + intraocular GANCICLOVIR
SEs bone marrow suppression, GI upset

40
Q

Most common cause of necrotising retinitis in HIV?

Rx?

A

Varicella zoster virus

Valaciclovir PO

41
Q

What lumbar puncture opening pressure prompts therapeutic draining in cryptococcus infection with HIV?

A

Above 20cmH20

42
Q

Which stain is needed to identify cryptococcus fungi on microscopy?

A

India ink stain not gram stain.

43
Q

What secondary prophylaxis should be given for cryptococcal meningitis until CD4 count is above 150?

A

Fluconazole

Give until antigen ve and CD4 >150

44
Q

Rx and prophylaxis of CNS toxoplasmosis in HIV?

A

Rx:
sulfadiazine + pyrimethamine (anti folate)
dexamethasone- if risk of coning from mass effect

Prophylaxis: co-trimoxazole

45
Q

Complication to watch out for with cryptococcal meningitis, and prevention? (in HIV)

A

Intracranial hypertension leading to visual failure or death

Rx: daily lumbar punctures to relieve pressure

46
Q

Cryptococcal meningitis Rx in HIV?

A

Rx: Amphotericin B + 5-flucytosine

47
Q

HIV associated infection that is a notifiable disease?

A

Hepatitis

48
Q

Which herpes virus is associated with CNS lymphoma in HIV?

A

Ebstein Barr virus (HHV4)

Fifth Year Medicine (32 decks)

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