HIV/AIDS Flashcards
AIDS Defining Conditions
Name 10
Infectious Bacterial • Mycobacterium (disseminated) • Avium • Kansasii • TB • PJP • Pneumonias (recurrent) • Salmonella septicemia
Infectious viral • CMV • Not liver/spleen/nodes • Retinitis • HSV • Chronic ulcers • Bronchitis • Pneumonitis esophagitis
Infectious fungal • Candidiasis • Bronchi/trachea/lungs • Esophagus • Coccidiomycosis (disseminated) • Cryptococcosis (extrapulm) Histoplasmosis (disseminated)
Infectious parasitic
• Toxoplasmosis (brain)
• Cryptosporidiosis (>1mo)
Malignant • Cervical ca (invasive) • Kaposi's sarcoma • Burkitt's lymphoma • Immunoblastic lymphoma Primary brain lymphoma
Miscellaneous
• Encephalopathy
• Wasting syndrome
What is the definition of AIDS
either CD4 count LT 200 or LT 14% or AIDS defining illness
What are opportunistic infections to consider at CD4 200-400 (stage 2)
candida (thrush, foot)
herpes zoster
TB
What are opportunistic infections to consider at CD4 LT 200 (stage 3/AIDS)
PCP cryptococcus (meningitis) toxoplasmosis (CNS mass) cryptosporidium (chronic diarrhea) mucocutaneous herpes coccidiomycosis
What are opportunistic infections to consider at CD4 LT 50
MAC
CMV retinitis
List 5 primary risk factors associated with increased likelihood of acquiring HIV infection.
- Homosexuality or bisexuality
- IV drug use
- Heterosexual exposure to at risk partner
- Blood transfusion prior to 1985
- Vertical and horizontal maternal-neonatal transmission
What are 3 causes of false negative HIV tests
- window period after transmission but before seroconversion
- Seroreversion after HAART
- atypical HIV strain
For what conditions, and at what CD4 level, is prophylaxis indicated?
PCP/CD4 LT 200/ Septra
Toxoplasmosis/CD4 LT 100/Septra
MAC/CD4 LT 50/Azithro
CMV retinitis/CD4 LT 50/valganicyclovir
List 6 cardiac complications of HIV / AIDS:
- Pericarditis
o Purulent pericarditis from TB mc cause pericarditis in developing world
- Myocarditis
- Cardiomyopathies
- Pulmonary vascular disease
- Pulmonary HTN
- Valvuar disease
- Neoplastic involvement of the heart
- Increased risk of ACS (dyslipidemia, inflammation, lipodystrophy)
o Accelerated atherosclerosis from HAART
List 5 non-infectious pulmonary complications that HIV patients are at increased rick for:
- Kaposi sarcoma
- Non-Hodgkins lymphoma
- Lung Ca (increased risk for)
- COPD
- Sarcoidosis
- Drug hypersensitivity
- FB granulomatosis
- Lymphocytic interstitial pneumonitis
What are indications for steroids in PCP
PaO2 LT 70
Aa gradient GT 35
Prednisone 40mg daily with 21d taper
List sites of extrapulmonary TB infection in the HIV patient.
- CNS
- Bone
- Visceral
- Skin
- Pericardial
- Eye
- Pharynx
Lymph nodes
What is the recommended treatment of TB in HIV/AIDS?
- ISOLATION
- 4 drug regimen for 6 months (RIPE)
o Rifampin
o Isoniazid
o Pyrazinamide
Ethambutol or streptomycin
What does the LP look like in HIV patients (without concurrent opportunistic CNS infections)?
- Aseptic meningitis à moderate pleiocytosis, lymphocytic predominance
- MUST think about HIV in sexually active person with aseptic meningitis!!
List 6 things that can cause focal CNS lesions on CT in HIV patients:
Infectious
- Brain abscess
- Tuberculoma
- CMV encephalitis
- Toxoplasma
- Other fungal infections
Non-infectious
- Primary CNS lymphoma
- Kaposi sarcoma
- Hemorrhage
- Progressive multifocal leukoencephalopathy (PML)
- HIV encephalopathy
What is the DDx for oral candida in the HIV patient?
- EBV hairy leukoplakia (can’t scrape off)
- Kaposi sarcoma (usually on palate)
Provide a good working differential for dysphagia and odynophagia in an HIV-infected patient?
- Candida esophagitis
- HSV esophagitis
- CMV esophagitis
- KS
- MAC esophagitis
- Idiopathic esophagitis
GERD (more common in HIV patients)
List etiologic agents causing diarrhea in HIV-infected patients.
Parasites
- Crytosporidium parvum
- Enterocytozoon bieneusi
- Isospor belli
- Giardia lamblia
- Entamoeba histolytica
- Microsporidia
- Cyclosporidia
Bacteria
- Salmonella
- Shigella
- Camphylobacter
- Helicobacter pylori
- M tuberculosis
- M avium comple
- C diff
Fungi - H capsulatum - C neoformans - Coccidiodes immitis Viral: - CMV
What 2 organisms must be considered in infections of bone, joint, and bursa?
- Bartonella
- TB
Gonococcal infection
What is Kaposi sarcoma?
- A vascular neoplasm
- Most common AIDS related malignancy
- Skin most commonly involved organ
- Lesions are violaceous papules, plaques, or nodules
What 5 classes of drugs are use to treat HIV.
- Nucleoside reverse transcriptase inhibitors
2. Nonnucleoside reverse transciptase inhibitors
3. Protease inhibitors
4. Entry inhibitors
Integrase inhibitors
What’s a HCP chance of seroconversion post exposure to blood of HIV+ pt?
- Percutaneous: 0.3% (95% CI 0.2-0.5%)
- Mucocutaneous: 0.09% (95% CI 0.006-0.5%)
List 5 high-risk features in relation to a potential HIV exposure.
The exposure high risk:
- Deep injuries
- Visible blood on a device
- Injuries sustained while placing devise in artery or vein
- Large hollow bore needle – 18g or bigger
- Emergency procedure
- (Low risk: superficial or solid needle)
Body fluid: semen, vaginal secretions, blood
The source high risk:
- Symptomatic HIV
- AIDS
- Acute seroconversion patient
- High viral load
- (low risk: asymptomatic HIV, viral load
