HIV Flashcards
What does the acute retroviral syndrome of HIV look like?
fever, fatigue, LAD, HA, pharyngitis, n/v/d, +/- aseptic meningitis.
How long after exposure does the acute retroviral syndrome present?
2-3 weeks s/p exposure.
Other HIV clues?
- young pt new b/l Bell’s palsy
- young pt w unexplained thrombocytopenia + fatigue
- young pt unexplained weight loss >10%
- young pt w Thrush, zoster, kaposi
If known exposure to HIV?
AZT, lamivudine, and nelfinavir for 4 weeks
When to start HAART?
CD4 55,00
Preggos if viral load > 1000
What HIV med causes GI issues, leukepenia, macrocytic anemia?
Zidovudine
What HIV med causes HS rash, fever, n/v, muscle aches, SOB in 1st 6 weeks? What should you do?
Abacavir. D/C and never use again!
What HIV med causes nephrolithiasis and hyperbilirubinemia?
indinavir (protease inhibitor)
What HIV med causes sleepiness, confusion, psycho sx?
Efavirenz
HIV+ patient w/ DOE, dry cough, fever, chest pain
Think p. jirovecci pneumonia.
What CD4 count to be concerned w/ p. jirovecci ?
CXR for p. jirovecci shows?
bilat diffuse symmetric interstitial infiltrates.
Best test for p. jirovecci ? possible lab value finding?
After CXR, do bronchoscopy w/ BAL to visualize bug. May see elevated LDH.
1st line treatment for p. jirovecci pneumonia?:
trim-sulfa
2nd line treatment for p. jirovecci pneumonia?:
trim-dapsone, or primaquine-clinda, or pentamidine.
When to add steroids to p. jirovecci pneumonia treatment?
PaO2 35
When to add prophylaxis against p. jirovecci?
When CD4
Three causes of HIV diarrhea?
CMV, MAC, Cryptosporidium. CD4 count
Sx of CMV diarrhea?
Can be bloody
Dx of CMV diarrhea?
Colonoscopy/biopsy.
Treatment of CMV diarrhea?
gangiclovier (se: neutropenia), or foscarnet (se: renal tox).
Sx of MAC diarrhea?
Diarrhea, wasting, fevers, night sweats.
Tx of MAC diarrhea?
clarithromycin, ethambutol +/- rifampin. Prophylax w/ azithromycin weekly.
Sx of cryptosporidum diarrhea?
transmitted via dog poo, swimming pools. Water diarrhea w/ mucus, oocysts are acid fast.
HIV pt w/ neurologic sx and multiple ring enhancing lesions?
Toxoplasmosis.
Treatment of HIV toxo?
pyramethamine + sulfadiazine + folic acid for 6 weeks. If no imporvement after 1 week, consider biopsy.
HIV pt w/ neurologic sx and 1 ring enhancing lesions?
CNS lymphoma.
What virus is CNS lymphoma associated with?
EBV infection of b-cells.
Treatment of CNS lymphoma?
HAART.
If HIV+ patient has seizure w/ de ja vu aura and 500 RBCs in CSF? Treat?
HSV encephalitis (temporal lobe). acyclovir ASAP.
If HIV+ patient w/ s/s of meningitis? DX & TX?
think crypto, + india ink. Tx w/ ampho IV for 2 weeks then fluconazole maintenance.
If HIV+ patient has hemisensory loss, visual impairment, + babinski?
PML. JC polyomavirus demyelinates at grey-white jxn.
Dx of PML?
Brain bx.
If memory problems or gait disturbance in HIV patient?
AIDS-Dementia complex. Check serum, CSF and MRI to r/o treatable causes.
HIV+ patients with exophytic purple lesions that look vascular?
Bartonella sp. Bacillary angiomatosis.
Other sx of bacillary angiomatosis?
visceral lesions to. Prone to hemorraghe. Also non specific symptoms like malaise, fever, weight loss, abd pain, etc.
What HIV med causes pancreatitis?
didanosine
What HIV med causes liver failure?
nevirapine
What class of HIV meds cause SJS?
NNRTI
What class of HIV meds cause lactic acidosis
NRTI
