HIV Flashcards
Acute HIV syndrome affect what portion of first-time infected? Characterized by?
30% of patients. Mononucleosis like illness with fever, headaches (aseptic meningitis), shotty lymphadenopathy, pharyngitis, and macular rash
Patient with HIV presents with dry cough. Diagnosis? Helpful lab test?
PCP; Elevated LDH
At CD4 levels less than 500 patients are susceptible to which infections?
Pneumonia, TB, vaginal candidiasis, HZV and HSV
At CD4 levels less than 200, patients can develop?
PCP, toxoplasmosis, histoplasmosis, Cryptococcus, Cryptosporidium
At CD4 levels less than 50, patients susceptible to?
MAI, CMV, CNS lymphoma, esophagitis
Most common opportunistic infection affecting AIDS patients? Presents with? can lead to?
PCP. Dry cough. Can lead to respiratory compromise or spontaneous pneumothorax (from rupture of blebs)
Definitive diagnosis of PCP with what stain?
Giemsa or Silver stain
Serum marker used as an indirect marker for PCP? Level? May also be elevated in?
Elevated LDH. Patients with LDH less than 220 are very unlikely to have PCP. Also seen in Histoplasmosis or lymphoma.
PCP unlikely to be cause of infection if?
- LDL level less than 220
2. CD4 count more than 250
PCP positive patients with arterial PO2 less than 70 or Aa gradient more than 35 should be treated with?
Prednisone in conjunction with TMP-SMX
Patchy infiltrates and pleural based infiltrates can be seen with?
TB and Cryptococcus
Patients allergic to sulfa can be treated for PCP with?
If G6PD deficiency?
Pentamidine + clindamycin with primaquine
Pentamidine
Cavitary lesions can be seen with?
TB, PCP, Coccidioides
Most common causes of pneumonia in AIDS patients are?
Same organisms that cause pneumonia immunocompetent patients
Think community-acquired pneumonia if?
Acute onset of fever and productive cough, with the pulmonary infiltrate
Patient with an indolent or chronic history of cough and weight-loss - think?
TB
Most common CNS mass lesion in AIDS patients? Tx? If lesions do not regress after two weeks of treatment, likely diagnosis? Test?
Toxoplasmosis. Sulfadiazine with pyrimethamine. CNS lymphoma. Stereotactic brain biopsy.
This is present in more than 90% of cases of patients with CNS lymphoma?
Epstein-Barr virus
Screen for Cryptococcus? If Cryptococcus, CNS findings?
Serum cryptococcal antigen or LP. Normal white blood cells but elevated intracranial pressure.
Treatment cryptococcal meningitis?
Amphotericin B plus flucytosine followed by chronic suppression with oral fluconazole
Signs of CMV infection?
- Persistent fever and constitutional symptoms
- Retinitis that can lead to blindness
- Esophagitis that can cause odynophagia
- Necrotizing adrenalitis that can cause adrenal insufficiency
Treatment for CMV?
Ganciclovur, foscarnet, cidofovir
Patient with low CD4+T count presents with persistent fevers, weight-loss, abdominal pain, or diarrhea. Cause? Tx?
MAI. Clarithromycin and ethambutol and rifabutin.
Appropriate prophylaxis when CD4 count less than 200? Less than 100? Less than 50?
Double strength tablets of TMP SMX 3x week. Increase TMP SMX. Clarithromycin daily or azithromycin weekly
HAART therapy?
Backbone - two nucleoside analog reverse transcriptase inhibitors
Base - Non-nucleoside analogue reverse transcript inhibitor or a protease inhibitor
Immune reconstitution syndrome?
Improvement in the immune system can cause worsening of symptoms 1 to 2 weeks after starting HAART.
PNA ppx in HIV pts?
Bactrim if CD4<50 (for atypicals)
