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Internal Medicine > HIV > Flashcards

HIV Flashcards

1
Q

What are the key receptors involved in thee infection of CD4 cells by the HIV virus?

A

Viral gp120 attaches to CD4 receptor then binds to CCR5 or CXCR4 coreceptors. viral gp41 is exposed and facilitates fusion and viral entry.

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2
Q

Mortality in HIV/AIDS is usually secondary to….

A

opportunistic infections,
wasting,
cancer

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3
Q

in a HIV infected pregnant woman, Caesarian delivery is indicated if….

A

viral load >1000

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4
Q

what is the typical course of HIV infection?

A
  1. Primary HIV infection
  2. Asymptomatic HIV infection
  3. Symptomatic HIV infection
  4. Full-blown AIDS
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5
Q

The combination of these two tests in confirming a HIV diagnosis yields an overall sensitivity and specificity of >99%….

A

ELISA and Western Blot

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6
Q

Phase I: Primary HIV infection

A

mononucleosis-like syndrome 2-4 weeks after HIV exposure

Duration is brief: 3days-2 weeks

Nonspecific symptoms
High false negative rate due to pre-seroconversion

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7
Q

Phase 2: Asymptomatic HIV infection

A

Seropositive
No clinical evidence of HIV infection
CD4 counts are normal
Longest Phase: lasts 4-7 years if untreated

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8
Q

Phase 3: Symptomatic HIV infection

A

first evidence of immune system dysfunction
Phase lasts 1-3 years with out treatment

Characterized by generalized lymphadenopathy, fungal infections, oral hairy leukoplakia, seborrheic dermatitis, constitutional symptoms

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9
Q

Phase 4: Full-blown AIDS

A

CD4 count

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10
Q

if CD4 count is >500, immune system is…

A

essentially normal

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11
Q

CD4 level between 200-500

A 
Increased risk of HIV related problems:
herpes zoster
TB
lymphoma
bacterial pneumonia
kaposi sarcoma
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12
Q

CD4 count

A

most opportunistic infections occur at this level

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13
Q

Target goal for HIV viral load

A

want undetectable viral load

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14
Q

How often should viral load and CD4 count be measured?

A

At time of diagnosis and every 3-4 months afterward

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15
Q

Pro and Con to p24 antigen assay for diagnosing HIV infection

A

test is less expensive

but it is less sensitive than viral load testing

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16
Q

Patients with acute (primary) HIV infection have very high…

A

levels of viremia

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17
Q

what is the leading cause of death in AIDS?

A

Pneumocystis Pneumonia (PCP)

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18
Q

Treatment of PCP

A

TMP-SMX (trimethoprim/sulfamethoxazole) for three weeks

*If hypoxic or elevated A-a gradient, give steroids

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19
Q

What is the recommended prophylaxis treatment for PCP?

A

oral TMP-SMX 1 dose daily

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20
Q

TB, CMV, MAC infections are more likely when….

A

CD4 count

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21
Q

Seroconversion

A

When patient is positive for HIV antibody
Occurs 3-7 weeks after infection
Confirms HIV diagnosis

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22
Q

IF HIV ELISA is positive, what is the next step?

A

Confirm with Western Blot Test

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23
Q

HIV Patient with subtle memory impairment and cognitive deficits, followed by changes to mental status, aphasia, and motor abnormalities should be evaluated for….

A

AIDS dementia

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24
Q

HIV patient with CNS symptoms and head imaging findings of contrast-enhanced mass lesions in basal ganglia and subcortical white matter should be suspected of having…

A

reactivation of latent toxoplasmosis

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25
Q

How is cryptococcal meningitis diagnosed?

A

CSF cryptococcal antigen
CSF culture
CSF stain with India Ink

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26
Q

How should cryptococcal meningitis be treated in HIV patients?

A

amphotericin B for 10-14 days followed by 8-10 weeks of oral fluconazole

*Lifelong maintenance treatment with fluconazole is indicated

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27
Q

Non-infectious CNS diseases in HIV patients:

A

CNS lymphoma
Cerebrovascular Accidents
Metabolic encephalopathies

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28
Q

The most common GI complaint in HIV patients is….

A

Diarrhea

29
Q

What is the most common cause of dysphagia in HIV patients?

A

Esophageal Candidiasis

30
Q

Common dermatologic/malignant condition in HIV:

A

kaposi sarcoma: painless, raised brown-black or purple papules

31
Q

CMV and HSV infection is seen with CD4 counts….

A
32
Q

What is the most important manifestation of CMV infection in HIV patients?

A

Retinitis: unilateral visual loss that can become bilateral if left untreated

33
Q

Treatment of CMV infection

A

ganciclovir or foscarnet

34
Q

most common opportunistic bacterial infection in AIDS

A

Mycobacterium avium complex (MAC)

35
Q

MAC occurs in patients with…

A

advanced AIDS, CD4

36
Q

MAC clinical features

A

Wasting Syndrome: weight loss, fever
Lymphadennopathy
Anemia
Diarrhea

37
Q

HIV1 Wasting Syndrome

A 
Profound involuntary loss of >10% of body weight in conjunction with either:
Chronic Diarrhea (2 daily) or Fever/persistent weakness for more than one month
38
Q

HIV/AIDS associated malignancies

A

Kaposi Sarcoma
Non-Hodgkin Lymphoma
Primary CNS Lymphoma

39
Q

What lab is always elevated in PCP?

A

LDL level

40
Q

What is highly activated antiretroviral therapy (HAART)?

A

Triple Drug Regimens
Target and inhibit HIV replication at three different points
Involves 2 nucleoside RT inhibitors and either NNRTI or protease inhibitor

41
Q

Nucleoside Reverse Transcriptase Inhibitors Mechanism

A

competitively inhibit RT by lacking 3’OH group

All are nucleosides and require phosphorylation to be active except tenofovir

42
Q

Which of the NRTIs are actually nucleotides?

A

Tenofovir is the only nucleotide

43
Q

Which NRTI is used in pregnancy?

A

Zidovudine

44
Q

NRTI Toxicity

A

Bone marrow suppression

peripheral neuropathy

45
Q

Toxicity of Zidovudine

A

megaloblastic anemia

46
Q

toxicity of didanosine

A

pancreatitis

47
Q

Nonnucleoside RT inhibitors mechanism

A

noncompetitively inhibits RT

Do not require phosphorylation

48
Q

NNRTIs include

A

Efavirenz
Nevirapine
Delaviridine

49
Q

NNRTI toxicity

A

RASH

Hepatotoxicity

50
Q

Efavirenz Toxicity

A

CNS symptoms

51
Q

These antiretroviral drugs are contraindicated in pregnancy

A

Efavirenz and Delaviridine

52
Q

Protease Inhibitors include:

A

all that end in -navir

53
Q

Protease inhibitors mechanism

A

Inhibit protease so that polypeptide viral products cannot be cleaved and activated

54
Q

Toxicity of protease inhibitors

A

Hyperglycemia
hyperlipidemia
GI intolerance
Lipodystrophy

55
Q

Which antiretrovirals are boosted by inhibiting P450?

A

Ritonavir Saquinavir

56
Q

Integrase inhibitor and mechanism

A

raltegravir

inhibits integration into host cell

57
Q

toxicity of raltegravir

A

hypercholesterolemia

58
Q

Fusion inhibitors includes

A

enfuviritide

maraviroc

59
Q

mechanism of enfuviritide

A

binds gp41 to inhibit entry

60
Q

mechanism of maraviroc

A

binds CCR5 to inhibit its interaction with gp120

61
Q

toxicity of fusion inhibitors

A

eosinophilia causing skin reaction at injection site

62
Q

PCP prophylaxis

A

TMP-SMX when CD4

63
Q

TB prophylaxis

A

PPD yearly screening

If PPD is positive give isoniazid and pyridoxine

64
Q

MAC prophylaxis

A

start when CD4

65
Q

Toxoplasmosis prophylaxis

A

start when CD4

66
Q

Vaccination guidelines for HIV patients

A

No live virus vaccines!!!

Pneumovax every 5-6 years
Influenza vaccine yearly
Hep B vaccine if not already Antibody positive
Hep A vaccine
Also dTAP if not already immunized
67
Q

Vaccines that are contraindicated in HIV patients

A 
Varicella
zoster
intranasal influenza
MMR
**These are all common live vaccines

Other vaccines to be aware of that are also live vaccines:
vaccinia (small pox), oral poliovirus vaccine, yellow fever and typhoid

68
Q

Recommendation for Pap tests in women with HIV

A

Pap test at time of diagnosis, then another one after 6 months. If these two are normal, then proceed to do Paps annually. HIV infected women are at increased risk for infection with high risk strains of HPV, and thus at increased risk of cervical cancer.

Internal Medicine (6 decks)

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