HIV Flashcards

1
Q

Stained for CD20 shows:

Stained for CD3 shows:

these signal:

A

B cells

T cells

signals antigen being presented with some high prevelance

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2
Q
A

p24 is positive:

Pneumocystis PNU

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3
Q
A

Pneumocystis Jirovecii fungal organism

eosinic frothy material filling the alveolar space

PCP

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4
Q
A

pneumocystic jirovecii cysts

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5
Q

What is the mechanism of action of Trimethoprim/sulfamethoxazole (TMP/SMX)?

A

Inhibit enzyme systems involved in synthesis of tetrahydrofolic acid (THF).

folic acid synthesis inhibitor

drug of choice for PCP

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6
Q

phases of HIV infection:

A

Three phases of HIV infection:

1.Acute phase = characterized by a high level of virus production and viremia; the symptoms are nonspecific – viral syndrome.

2.Chronic phase = a smoldering, low-level HIV replication, predominantly in lymphoid tissues, which may last several years.

3.Crisis phase = breakdown of host defenses, viral replication, and the symptoms of persistent fever, fatigue, weight loss, and diarrhea..

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7
Q

What is the significance of the CD4+ cell counts in this patient?

A

HIV infection is stratified into three clinical categories based on CD4+ count:

1.³ 500/µL = low probability of progression

2.200 - 499/µL

3.< 200/µL or rapidly falling = high probability of progression

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8
Q

How is the clinical pathology laboratory evaluation used to help diagnose HIV infection?

A

ELISA p24/HIV-1/2 antibody test

First-line test to assess whether the patient has an HIV infection

Excellent sensitivity and specificity (>99%); however, due to the gravity of the diagnosis, a confirmatory test is done.

Western blot

Confirms the presence of the HIV

Classic pattern of HIV positivity shows 9 bands

PCR amplification for HIV-1

1.HIV viral load

  • Earliest marker
  • 1 - 6 weeks after exposure
  • High viral load is related to seroconversion symptoms

2.p24 antigen

  • First HIV antigen
  • 1 - 8 weeks after exposure

3.HIV antibody

  • May be detected as early as 2 weeks
  • At 4 weeks will detect 95% of infections
  • >99.9% of people by 12 weeks
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9
Q

What percent of patients with AIDS have clinical evidence of neurologic dysfunction?

A

30 - 50% of patients with AIDS have neurologic impairment during the course of their illness

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10
Q

What is the cause of the patient’s progressive confusion during the terminal phase of his illness?

A

Many processes need to be considered in the differential diagnosis of altered mental status in this patient:

1.Opportunistic diseases INFECTION!!!!!

Viral: CMV, PML

Bacterial: tuberculosis, pyogenic bacterial infections

Fungal: cryptococcus, histoplasmosis, coccidioidomycosis

Parasitic: toxoplasmosis

  1. Neoplastic diseases: lymphoma
  2. Primary HIV-associated syndromes: HIV encephalitis
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11
Q
A

Kaposi’s Sarcoma spots

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12
Q

What are the common pathogens producing diarrhea in patients with AIDS?

A

Common diarrhea producing pathogens in AIDS include:

Mycobacterium avium-intracellulare

Cryptosporidium or Isosporidium

Cytomegalovirus (CMV)

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13
Q
A

Intestines with macrophages that are full of acid fast bacilli

Mycobacterium avium-intracellulare

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14
Q
A

Colon CMV infection, ulcerations

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15
Q
A

CMV reactivation in colon

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16
Q

How do CMV infections differ in immunocompetent versus immunosuppressed patients?

A

•Immunocompetent patients = viral syndrome resembling acute infectious mononucleosis

•Immunosuppressed patient, whether acquired primarily or as a result of reactivation = disseminated, fulminant, and lethal disease with multiorgan involvement.

17
Q
A

top shows pneumocystis in lung

bottom shows cytomegalovirus in his lung

18
Q
A

CMV Retinitas (included with retinal hemorrage slide)

19
Q
A

JC virus in brain cells (late stage aids)

20
Q
A

Toxoplasmosis in microglial brain cells

21
Q
A

perivascular lymphomatous infiltrate.

They are characteristically B-cell neoplasms associated with Epstein-Barr virus (EBV) reactivation

22
Q

reactivated EBV slide:

A
23
Q
A

Kaposi sarcoma

associated with the human herpes virus 8

24
Q

HIV: three most common secondary neoplasms found in HIV patients, look for ______ and they will also have _____

A

kaposis sarcoma

or lymphoma

possible HPV reactivation

neurological deficiency

25
Q

HIV surface adhesion proteins, gp120 binds to:

major capsid protein is _____

A

CD4 receptor

p24 (able to test early in infection)

26
Q

HIV cell requires _____

A

CD4 T cell to be activated to begin replication of hiv genome

27
Q

clinical phases of hiv?

A

1.Acute viral syndrome

–Infection of memory CD4+ T cells in mucosal lymphoid tissues

–Death of many infected cells

–Viremia dissemination and development of host immune responses

  1. Chronic phase (clinical latency)

–Usually asymptomatic

–Lymph nodes and the spleen are sites of continuous HIV replication and cell destruction

–Over a period of years, the continuous cycle of virus infection, T-cell death, and new infection leads to a steady decline in the number of CD4+ T cells in the lymphoid tissues and the circulation

3.Clinical AIDS

–Breakdown of host defense

–Serious opportunistic infections, secondary neoplasms, or clinical neurologic disease

28
Q

2 most common opportunistic infections that AIDS patients present with:

A
29
Q

most common fungal infection AIDS patients present with:

Also:

A

pneumocystis jirovecci

Candidiasis (Candida albicans)

Most common fungal infection AIDS

Heralds the transition to AIDS

Oropharyngitis, pneumonia, tracheo-esophagitis

Cryptococcosis (Cryptococcus neoformans)

Inhalation of infected soil

Seen in10% AIDS

CNS meningitis, pneumonia

Coccidioidomycosis (Coccidioides immitis)

“Valley Fever” Southwest US

Pneumonia or disseminated to skin

Histoplasmosis (Histoplasma capsulatum)

Pneumonia or disseminated

30
Q

Most common Bacterial infection for AIDS

A

MAI

Mycobacterium Avium-cellulare

31
Q

Neoplams found in AIDS patients

A

Kaposi’s HHV 8

32
Q
A

Anal carcinoma

HPV reactivation

matastisizing through basement membrane

Malignant carcinoma

33
Q

most common neurologic dysfunctions:

A

JC polyomavirus

34
Q
A