HIV Flashcards
Antiplatelet antibodies
ITP
Bamboo spine on x-ray
Ankylosing spondylitis
Webbing of neck, short stature
Turner syndrome
Painful, raised lesions on finger pads
Fever
Osler’s nodes (infective endocarditis
Dry eyes, dry mouth, arthritis
Sjogren Syndrome
Posterior cervical adenopathy
EBV
Cat scratch disease
Otitis media
Low serum ceruloplasmin
Wilson disease
Coreceptors of HIV
CCR5
CXCR4
tropism - some viruses like to attach to certain coreceptors
Cells with CCR5
Macrophages
Dendritic cells
cells with CXCR4
CD4+ T cells
structure genes
gag
env
pol
gag
p24 capsid protein
p17 matrix protein
env
gp120
gp41
pol
Reverse transcriptase
Integrase
diagnosis of AIDS
- CD4 < 200
- % of CD4 cells <14%
- Opportunistic infection (PCP)
- Interstitial infiltrates on CXR
- CD4 count <200
PCP
Pneumocystis jirovecii pneumonia
CD4 count <50
MAC / MAI
Mycobacterium avium complex
- Systemic disease with hepatosplenomegaly, fever, cough in AIDS patient
- CD4 count <150
- Bird / Bat droppings
- Ohio and Mississippi river valleys
Histoplasma capsulatum
AIDS patient with meningitis
Crytococcal meningitis
AIDS patient with mutliple ring-enhancing lesions on brain MRI
Toxoplasmosis
AIDS patient with solitary ring-enhancing lesions
Primary CNS lymphoma
CD4 <50
Cotton-wool spots on retina
“Owl’s eye” nuclear inclusions
Tx?
CMV retinitis
Tx: ganciclovir
Reactivation of latent JC virus
PML
Progressive Multifocal Leukoencephalopathy
Chronic watery diarrhea
Significant wasting
Crytosporidiosis
Oral Thrush vs. Oral hairy leukoplakia (EBV)
Oral thrush – can scrape off
Kaposi sarcoma
What number herpes?
HHV-8
Malignancies associated with HIV
Usually viral
- HHV-8 (Kaposi)
- EBV (Lymphoma / NHL)
- HPV (cervical, /vaginal carcinoma)
abx ppx when CD4 <200
PCP
- TMP-SMX
- Dapsone (monitor G6PD)
- Pentamidine (aerosolized)
abx ppx when CD4 <100
Toxoplasmosis (if positive IgG)
- TMP-SMX
- Dapsone + Pentamidine + Leucovorin
abx ppx when CD4 <50
MAC
- Azithromycin
abx ppx when CD4 <150
Histoplasmosis
- Itraconazole
Most common causes of DIC
"STOP Making Thrombi" S: sepsis T: trauma O: obstetric complications P: pancreatitis M: malignancy T: transfusion
Most common cause of death in Lupus patients
Renal failure from lupus nephropathy
- skin hyperpigementation
- hypotension
- weakness
- malaise
- anorexia
- wt loss
Addison Disease
autoimmune disease that attack adrenals, adrenal atrophy, decreased aldosterone and cortisol
HAART treatment
Everyone w/ HIV regardless of CD4
Definitely in anyone w/ CD4 <350 or AIDS
Ritonavir
Protease inhibitor (pol gene)
MC side effect: GI intolerance
“boost” other drugs by inhibit P450
Hyperglycemia
Lipodystrophy (Cushing-like)
Pancreatitis (not common)
Atazanavir, Indinavir
Protease inhibitor (pol gene)
GI Intolerance
Nephrolithiasis (Indinavir, Atazanavir)
Increased bilirubin (Atazanavir)
Zidovudine Didanosine Lamivudine Abacavir Emtricitabine
Mechanism
Major side effect
NRTI - nucleoside
- Inhibit HIV reverse transcriptase
- Nucleoside analogs
- Competitive inhibitors
- Must be phosphorylated or activated by thymidine kinase
Lactic Acidosis (all NRTIs)
Tenofovir
NtRTI - nucleoTide
Zidovudine (AZT)
indications and side effects
Newborns born to HIV (+) mothers
Bone Marrow suppression (anemia, leukopenia)
Occupational exposure
3 drug regimen, 4 weeks
Didanosine
indications and side effects
Pancreatits
Peripheral neuropathy
Hepatic steatosis
Abacavir
indications and side effects
Hypersensitivity reaction
Nevirapine
Delavirdine
Efavirenz
Rilpivirine
mechanism
NNRTIs
non-competitively inhibit reverse transcriptase
Do NOT require phosphorylation to be active
Fusion inhibitor
Name, indications and side effects
Enfuvirtide - last effort after failure of other therapy
- given by injection
- expensive
- injection site reactions
- increased risk of bacterial pneumonia
Integrase inhibitor
Raltegravir
Elvitegravir
Dolutegravir
Raltegravir
side effects
Nausea
Rash
Myopathy
CCR5 antagonist
Maraviroc
Maraviroc
Binds CCR5, inhibits gp120 conformational change so virus cannot bind host cell
NNRTIs
Nevirapine
Delavirdine
Efavirenz
Rilpivirine
Given to pregnant women with HIV
Zidovudine given to pregnant women who are not on antiretroviral therapy during their pregnancy .
Pregnant women already on control with ART stay with HAART.
