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clin med III, exam 2 > HIV > Flashcards

HIV Flashcards

1
Q

What is the HIV virus? what unique machinery does it use

A
  • retrovirus
    • uses reverse transcriptase to turn RNA -> DNA -> integrate its genetic material into host DNA and produce new viruses
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2
Q

HIV targets what type of host cells

A
  • T cells particularly CD4 T cells (helper cells)
  • also infects B lymphocytes and macrophages
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3
Q

role of CD4 T cells

A
  • enhance immune response
  • tell B cells to make antibodies
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4
Q

how is HIV transmitted

A
  • sexual transmission
    • exchange of infected body fluids
  • IVDU
  • needlestick
  • HIV infected mom -> infant
  • ***requires infectious body fluid and port of entry
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5
Q

risk of transmission of HIV with insertive vaginal intercourse

A

1/10,000

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6
Q

risk of transmission of HIV with receptive vaginal intercourse

A

1/1000

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7
Q

risk of transmission of HIV with receptive anal intercourse

A

1/50

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8
Q

risk of transmission of HIV with shared drug needle

A

1/150

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9
Q

risk of transmission of HIV with occupational needlestick

A

1/300

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10
Q

when does the primary HIV infection (acute HIV) occur after exposure?? Most common symptoms

A
  • 2-6 wks after exposure
  • mono-like or flu-like illness
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11
Q

which test would you use in primary HIV infection (acute HIV): HIV RNA and/or HIV Ab test

A
  • routine HIV Ab test is often negative
  • HIV RNA tests for viral load
    • usually extremely high in acute phase
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12
Q

why is it important to diagnose pt in acute HIV phase

A
  • pt is highly infectious during this period
  • diagnosis will likely limit transmission to others
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13
Q

clinical presentation

  • fever
  • adenopathy
  • sore throat
  • rash: upper trunk, neck, face
  • mucocutaneous ulcers
A

acute HIV infection

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14
Q

what laboratory abnormalities would you expect in acute HIV infection

A
  • elevated LFTs
  • leukopenia
  • anemia
  • thrombocytopenia
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15
Q

When does patient seroconvert in HIV time period

A
  • seroconvert -> become antibody positive
    • begins as immune system responds to infection
  • clinical latency
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16
Q

Describe what is going on during clinical latency in HIV

A
  1. immune system responds to infection -> seroconverts
  2. viral load decreases to “set point” then slowly rises over time
  3. CD4 T cell count slowly declines
  4. pt asymptomatic
  • stage lasts average 10 yrs
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17
Q

symptomatic HIV is characterized by what two pathonmeunonic symptoms

A
  • oral hairy leukoplakia : (EBV) seen in mouth
  • Kaposi’s sarcoma
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18
Q

List common HIV related infections (CD4 T cell count around 500)

A
  • Tuberculosis
  • herpes simplex
  • herpes zoster
  • vaginal candidiasis
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19
Q

Definition of progression to AIDS

A
  • CD4 T cell count < 200 cells/cml OR
  • HIV (regardless of T cell count) AND 1/27 AIDS defining conditions
20
Q

clinical presentation in patient with h/o HIV

  • nonspecific: fever, cough, SOB
  • may result in severe hypoxemia
  • CXR shows diffuse or perihilar infiltrates
A
  • Pneumocystis Jiroveci PNA
    • opportunistic infection
    • fungus
21
Q

how is Pneumocystis Jiroveci PNA diagnosed? what lab is most reliably elevated with this

A
  • sputum sample
  • lab: elevated LDH (serum lactate dehydrogenase) in 95%
22
Q

first line tx of Pneumocystis Jiroveci PNA

A

Bactrim

23
Q

What is the cause of the most common intracranial lesion in HIV patients

A
  • Toxoplasmosis
    • causes encephalitis
24
Q

causative agent of Toxoplasmosis

A
  • Toxoplasma gondii
    • single celled parasite
25
Q

how is Toxoplasmosis acquired

A
  • ingestion of cat feces
  • contaminated raw food or utensils
26
Q

clinical presentation in pt with HIV

  • HA, focal neurological deficits, sz, AMS
  • can cause retinitis and pneumonititis
  • multiple contrast enhancing lesions on brain CT or MRI
A

Toxoplasmosis

27
Q

Mycobacterium avium complex causes what in immunocompetent patients

A

pulmonary infection

28
Q

Mycobacterium avium complex causes what in HIV patients

A
  • systemic disease
    • ​night sweats
    • weight loss
    • abd pain
    • anemia
29
Q

transmission of mycobacterium avium complex

A
  • bacteria found in soil and dust
  • inhaled or ingested
30
Q

how is mycobacterium avium complex diagnosed

A
  • sputum acid fast bacillus (AFB) stain positive
  • positive sputum cultures
  • positive blood cultures
31
Q

what is the most common retinal infection in AIDS patients

A

cytomegalovirus retinitis

32
Q

causative agent of cytomegalovirus? how is it transmitted

A
  • CMV, a herpes virus common in general population
  • routes of transmission
    • blood
    • sexually transmitted
    • perinatally
33
Q

if cytomegalovirus retinitis left untreated, it can lead to

A

blindness

34
Q

how is cytomegalovirus retinitis diagnosed

A
  • cotton wool spots
  • infiltrates
  • hemorrhages
  • seropositive for CMV
35
Q

what is the relationship between how invasive a candida infection is and the CD4 T cell count

A

the more invasive a candida infection is, the lower the CD4 T cell count

36
Q

what locations of candida infections are most associated with AIDS

A
  • esophageal candidiasis
  • recurrent vaginal candidiasis

*thrush will brush compared to leukoplakia

37
Q

Kaposi’s sarcoma occurs at what CD4 T cell count

A

may occur at any CD4 T cell count

38
Q

what is Kaposi’s sarcoma

A
  • vascular neoplasm
  • lesions multifocal and widespread
  • associated lymphadenopathy
39
Q

HIV antibody test will detect HIV infection at what point in infection

A
  • detect 4-12 weeks after infection
  • once pt seroconverts
40
Q

Rapid HIV tests tests what

A
  • antibody test in saliva or blood
  • a positive test requires confirmation
41
Q

combination HIV antibody and antigen testing is best for catching what stage of HIV infection

A

acute HIV

42
Q

List the CDC recommendations for screening

A
  1. “opt out testing”
  2. screen all pts aged 13-64
  3. pts associated with associated infections
    • TB
    • each presentation of an STI
  4. screen pregnant women
  5. screen at risk pts at least annually
43
Q

initial work up of patient who tests positive for HIV

A
  1. coonsult with HIV specialist
    • confirmatory HIV Ab testing if indicated
    • CD4 T cell count
    • HIV RNA viral load
    • genetic resistance testing
44
Q

AIDS Patient with CD4 T cell < 100 may be prophylactically on bactrim for

A
  • pneumocystis jiroveci
  • toxoplasmosis
45
Q

AIDS Patient with CD4 T cell < 50 may be prophylactically on azithromycin for

A

MAC

46
Q

mother to infant transmission can occur during pregnancy, labor and delivery, and breastfeeding. Risk of transmission without tx? with tx?

A
  • without tx: 15-40%
  • with tx: 2%
    • combination ART
    • avoid breast feeding

clin med III, exam 2 (6 decks)

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