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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
How to diagnose cryptosporidiosis?
Stool exam with modified acid-fast stain -> cryptosporidial oocytes
26
HIV+, frequent, small volume BLOODY diarrhea, abd pain | CD4<50
CMV
27
Slowly progressive confusion, paresis, ataxia, seizure | CT Brian: white matter lesions w/ no enhancement/edema
Progressive multi focal leukoencephalopathy (JC virus reactivation) Often fatal. Tx with ART.
28
Acute fever, headache, seizures, focal neuro deficits, AMS | Unilateral temporal lobe-enhancing lesions w/ mass effect
Herpes encephalitis
29
Single well-defined, enhancing focal lesion
Primary CNS lymphoma
30
HIV+, lives in Midwest Fever, weight loss, hepatosplenomegaly, lymphadenopathy, nonproductive cough, palatal ulcers, pancytopenia(!!!) CXR: diffuse nodular densities, hilar lymphadenopathy
Disseminated histoplasmosis
31
Diagnosis of disseminated histoplasmosis
Urine or serum antigen test
32
Risk factors for histoplasmosis
HIV Spelunking Exposure to bird or bat excretions Ohio and Mississippi River valleys
33
Treatment of disseminated histoplasmosis
Amphotericin B (after improvement, transition to oral itraconazole for >1 year). Initiate ART.
34
HIV+ Fever, lethargy, headache, AMS, INCREASED ICP!! Absent meningeal signs!! LP: elevated opening pressure, low WBC, low glucose, elevated protein
Crytococcal meningoencephalitis
35
How to treat crytococcal meningoencephalitis?
IV amphotericin B + flucytosine x 2 weeks Then maintenance with fluconazole Increased opening pressure may require serial LPs or shunt
36
How to diagnose crytococcal meningitis?
CSF antigen test is best Or CSF India ink stain Shows encapsulated yeast
37
Pseudohyphae and budding yeasts
Candida "I am candid with my buddies, so I'm only pseudo-hyping this plaque that I won""
38
45 degree angle branching septate hyphae
Aspergillus
39
Yeasts w/ wide capsular halo | Narrow-based unequal budding
Crytococcus
40
Irregular broad (empty-looking), nonseptate hyphae. Wide-angle branching
Mucor
41
HIV+ with CD4<50 | Frequent low-volume stools that can be BLOODY
CMV | Note that cryptosporidium, microsporidium/isosporidium, and MAC tends to give watery diarrhea!
42
What is diff between cryptococcus vs cryptosporidium?
Both in primarily immunocompromised Cryptococcus (yeast): CNS, lungs Cryptosporidium (parasite): Diarrhea (transient in healthy ppl, chronic in immunocompromised)
43
Can HIV+ patients get vaccines for MMR, varicella?
Live vaccines | Contraindicated ONLY if CD4<200
44
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
HIV-associated neurocognitive disorder (HAND) Note that in PML: MRI shows focal, asymmetric (instead of diffuse) lesions
45
If pregnant HIV+ patient not on ART at time of delivery... what to do?
Tx with AZT intrapartum. Infant should receive AZT for 6 weeks after birth.
46
Side effect of protease inhibitors?
metabolic syndrome
47
side effect of NRTIs? (zidovudine)
bone marrow suppression, neuropathy
48
side effect of Indinavir
crystal-induced nephropathy
49
side effect of didanosine?
pancreatitis
50
side effect of abacavir?
hypersensitivity rxn
51
side effect of nevirapine?
liver failure
52
side effect of efavirenz (NNRTI)
vivid dreams, hallucinations
53
Live vaccines in HIV
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
Treatment for MAC
Clarithromycin. Consider HAART if HIV+. | Ethambutol +/- rifabutin is second line.
55
Treatment of toxo
Pyrimethamine + sulfadiazine and leuvovorin (folate analog to prevent hematologic toxicity) for 4-8 weeks.

ID (12 decks)

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