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HIV Flashcards

1
Q

Prophylaxis for PCP

A

CD4<200 or prior PCP infection

TMP-SMX (single-strength)

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2
Q

Prophylaxis MAC

A

CD4<50

Weekly azithromycin

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3
Q

Prophylaxis toxoplasma Gondii

A

CD4<100 AND +IgG serology

Double-strength TMP-SMX

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4
Q

Prophylaxis for candida

A

Only if multiple recurrences (secondary prophylaxis)

Esophagitis —> fluconazole
Oral —> fluconazole or nystatin wash/swallow

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5
Q

Fever, Ring-enhancing lesions on MRI

A

Toxo

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6
Q

Treatment of active toxoplasmosis

A 
High-dose PO pyrimethamine and sulfadiazine
And leukovorin (folic acid analog to prevent hematologic toxicity)
X4-8 weeks
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7
Q

Treatment of crytococcal meningitis

A

Amphotericin B and flucytosine

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8
Q 
S/p Solid organ transplant
Systemic illness (pneumonitis, hepatitis, gastroenteritis)
A

Consider CMV viremia

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9
Q

How to diagnose CMV

A

CMV PCR in blood

Tissue bx rarely needed

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10
Q

Treatment of CMV

A

Oral valganciclovir if mild

If severe —> IV ganciclovir (SE: neutropenia)

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11
Q

HIV patient (known or unknown)
Nonproductive cough, dyspnea, hypoxic!
Increased LDH
CXR diffuse, bilateral interstitial infiltrates w ground glass appearance
Cytology of induced sputum might reveal no organisms

A

Pneumocystis jirovecii

If induced sputum show nothing —> proceed to get specimen by bronchoscopy

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12
Q

Treatment of Pneumocystis jiroveci

A

High-dose TMP-SMX x 21 days

+Prednisone taper if PaO2<70 or Aa gradient >35

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13
Q

Lung tissue with silver stain reveals folded cysts containing comma-shaped spores

A

PJP

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14
Q

Multiple red-violaceous macules, papule, or nodules that can progress to plaques

A

Kaposi sarcoma (vascular proliferative disease attributed to HHV-8)

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15
Q

Looks like KS (vascular cutaneous lesions: small reddish/purple papule -> friable pedunculated or nodular lesions)
+ Constitutional sx (fever, malaise night sweats)

A

Bacillary angiomatosis (Bartonella henselae or Quintana)

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16
Q

Treatment for bacillary angiomatosis

A

Doxycycline or erythromycin

ART if HIV+

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17
Q

Risk factors for bacillary angiomatosis

A 
Cat exposure, homelessness (lice)
Advanced HIV (CD4<100)
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18
Q

White plaques on buccal mucosa and palate that are easily removable

A

Oral thrush (candida)

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19
Q

Treatment for candida esophagitis

A

Oral fluconazole 3-5 days

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20
Q

Deep, linear ulcers in distal esophagus

A

CMV

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21
Q

Vesicles and round/ovoid ulcers in mouth

A

HSV

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22
Q

Esophagitis with severe odynophagia but without dysphagia or thrush

A

Viral esophagitis (CMV or HSV)

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23
Q

Fever, cough, WATERY diarrhea, splenomegaly, weight loss
Elevated ALK-P
CD4<50

A

Think about disseminated MAC

Can’t really get this if CD4>50
(Diarrhea usually not bloody)

24
Q

HIV+, severe WATERY diarrhea
Low grade fever, weight loss
Contact with animals (eg horses)
CD4<180

A

Cryptosporidium

25
Q

How to diagnose cryptosporidiosis?

A

Stool exam with modified acid-fast stain -> cryptosporidial oocytes

26
Q

HIV+, frequent, small volume BLOODY diarrhea, abd pain

CD4<50

A

CMV

27
Q

Slowly progressive confusion, paresis, ataxia, seizure

CT Brian: white matter lesions w/ no enhancement/edema

A

Progressive multi focal leukoencephalopathy (JC virus reactivation)
Often fatal. Tx with ART.

28
Q

Acute fever, headache, seizures, focal neuro deficits, AMS

Unilateral temporal lobe-enhancing lesions w/ mass effect

A

Herpes encephalitis

29
Q

Single well-defined, enhancing focal lesion

A

Primary CNS lymphoma

30
Q

HIV+, lives in Midwest
Fever, weight loss, hepatosplenomegaly, lymphadenopathy, nonproductive cough, palatal ulcers, pancytopenia(!!!)
CXR: diffuse nodular densities, hilar lymphadenopathy

A

Disseminated histoplasmosis

31
Q

Diagnosis of disseminated histoplasmosis

A

Urine or serum antigen test

32
Q

Risk factors for histoplasmosis

A

HIV
Spelunking
Exposure to bird or bat excretions
Ohio and Mississippi River valleys

33
Q

Treatment of disseminated histoplasmosis

A

Amphotericin B (after improvement, transition to oral itraconazole for >1 year). Initiate ART.

34
Q

HIV+
Fever, lethargy, headache, AMS, INCREASED ICP!!
Absent meningeal signs!!
LP: elevated opening pressure, low WBC, low glucose, elevated protein

A

Crytococcal meningoencephalitis

35
Q

How to treat crytococcal meningoencephalitis?

A

IV amphotericin B + flucytosine x 2 weeks
Then maintenance with fluconazole

Increased opening pressure may require serial LPs or shunt

36
Q

How to diagnose crytococcal meningitis?

A

CSF antigen test is best

Or CSF India ink stain
Shows encapsulated yeast

37
Q

Pseudohyphae and budding yeasts

A

Candida

“I am candid with my buddies, so I’m only pseudo-hyping this plaque that I won””

38
Q

45 degree angle branching septate hyphae

A

Aspergillus

39
Q

Yeasts w/ wide capsular halo

Narrow-based unequal budding

A

Crytococcus

40
Q

Irregular broad (empty-looking), nonseptate hyphae. Wide-angle branching

A

Mucor

41
Q

HIV+ with CD4<50

Frequent low-volume stools that can be BLOODY

A

CMV

Note that cryptosporidium, microsporidium/isosporidium, and MAC tends to give watery diarrhea!

42
Q

What is diff between cryptococcus vs cryptosporidium?

A

Both in primarily immunocompromised

Cryptococcus (yeast): CNS, lungs
Cryptosporidium (parasite): Diarrhea (transient in healthy ppl, chronic in immunocompromised)

43
Q

Can HIV+ patients get vaccines for MMR, varicella?

A

Live vaccines

Contraindicated ONLY if CD4<200

44
Q

Chronic decline in multiple cognitive domains, +/- mood and behavior disturbances
MRI: DIFFUSE increase in intensity in white matter
Increased risk in age >50 and CD4<200

A

HIV-associated neurocognitive disorder (HAND)

Note that in PML: MRI shows focal, asymmetric (instead of diffuse) lesions

45
Q

If pregnant HIV+ patient not on ART at time of delivery… what to do?

A

Tx with AZT intrapartum.

Infant should receive AZT for 6 weeks after birth.

46
Q

Side effect of protease inhibitors?

A

metabolic syndrome

47
Q

side effect of NRTIs? (zidovudine)

A

bone marrow suppression, neuropathy

48
Q

side effect of Indinavir

A

crystal-induced nephropathy

49
Q

side effect of didanosine?

A

pancreatitis

50
Q

side effect of abacavir?

A

hypersensitivity rxn

51
Q

side effect of nevirapine?

A

liver failure

52
Q

side effect of efavirenz (NNRTI)

A

vivid dreams, hallucinations

53
Q

Live vaccines in HIV

A

Can give varicella and MMR if CD4>200

NEVER give oral polio to patients or contacts (because contacts shed the polio in their stool)

54
Q

Treatment for MAC

A

Clarithromycin. Consider HAART if HIV+.

Ethambutol +/- rifabutin is second line.

55
Q

Treatment of toxo

A

Pyrimethamine + sulfadiazine and leuvovorin (folate analog to prevent hematologic toxicity) for 4-8 weeks.

ID (12 decks)

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