HIV/AIDS

Question 1

AIDS Defining Conditions

Name 10

Answer 1

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

Question 2

What is the definition of AIDS

Answer 2

either CD4 count LT 200 or LT 14% or AIDS defining illness

Question 3

What are opportunistic infections to consider at CD4 200-400 (stage 2)

Answer 3

candida (thrush, foot)
herpes zoster
TB

Question 4

What are opportunistic infections to consider at CD4 LT 200 (stage 3/AIDS)

Answer 4

PCP
cryptococcus (meningitis)
toxoplasmosis (CNS mass)
cryptosporidium (chronic diarrhea)
mucocutaneous herpes
coccidiomycosis

Question 5

What are opportunistic infections to consider at CD4 LT 50

Answer 5

MAC

CMV retinitis

Question 6

List 5 primary risk factors associated with increased likelihood of acquiring HIV infection.

Answer 6

• Homosexuality or bisexuality
  - IV drug use
  - Heterosexual exposure to at risk partner
  - Blood transfusion prior to 1985
  - Vertical and horizontal maternal-neonatal transmission

Question 7

What are 3 causes of false negative HIV tests

Answer 7

1. window period after transmission but before seroconversion
2. Seroreversion after HAART
3. atypical HIV strain

Question 8

For what conditions, and at what CD4 level, is prophylaxis indicated?

Answer 8

PCP/CD4 LT 200/ Septra
Toxoplasmosis/CD4 LT 100/Septra
MAC/CD4 LT 50/Azithro
CMV retinitis/CD4 LT 50/valganicyclovir

Question 9

List 6 cardiac complications of HIV / AIDS:

Answer 9

• 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

Question 10

List 5 non-infectious pulmonary complications that HIV patients are at increased rick for:

Answer 10

• Kaposi sarcoma
• Non-Hodgkins lymphoma
• Lung Ca (increased risk for)
• COPD
• Sarcoidosis
• Drug hypersensitivity
• FB granulomatosis
• Lymphocytic interstitial pneumonitis

Question 11

What are indications for steroids in PCP

Answer 11

PaO2 LT 70
Aa gradient GT 35

Prednisone 40mg daily with 21d taper

Question 12

List sites of extrapulmonary TB infection in the HIV patient.

Answer 12

• CNS
• Bone
• Visceral
• Skin
• Pericardial
• Eye
• Pharynx
  Lymph nodes

Question 13

What is the recommended treatment of TB in HIV/AIDS?

Answer 13

• ISOLATION
• 4 drug regimen for 6 months (RIPE)
  o Rifampin
  o Isoniazid
  o Pyrazinamide
  Ethambutol or streptomycin

Question 14

What does the LP look like in HIV patients (without concurrent opportunistic CNS infections)?

Answer 14

• Aseptic meningitis à moderate pleiocytosis, lymphocytic predominance
  - MUST think about HIV in sexually active person with aseptic meningitis!!

Question 15

List 6 things that can cause focal CNS lesions on CT in HIV patients:

Answer 15

Infectious

• Brain abscess
• Tuberculoma
• CMV encephalitis
• Toxoplasma
• Other fungal infections

Non-infectious

• Primary CNS lymphoma
• Kaposi sarcoma
• Hemorrhage
• Progressive multifocal leukoencephalopathy (PML)
• HIV encephalopathy

Question 16

What is the DDx for oral candida in the HIV patient?

Answer 16

• EBV hairy leukoplakia (can’t scrape off)

- Kaposi sarcoma (usually on palate)

Question 17

Provide a good working differential for dysphagia and odynophagia in an HIV-infected patient?

Answer 17

• Candida esophagitis
• HSV esophagitis
• CMV esophagitis
• KS
• MAC esophagitis
• Idiopathic esophagitis
  GERD (more common in HIV patients)

Question 18

List etiologic agents causing diarrhea in HIV-infected patients.

Answer 18

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

Question 19

What 2 organisms must be considered in infections of bone, joint, and bursa?

Answer 19

• Bartonella
  - TB
  Gonococcal infection

Question 20

What is Kaposi sarcoma?

Answer 20

• A vascular neoplasm
  - Most common AIDS related malignancy
  - Skin most commonly involved organ
  - Lesions are violaceous papules, plaques, or nodules

Question 21

What 5 classes of drugs are use to treat HIV.

Answer 21

1. Nucleoside reverse transcriptase inhibitors
   2. Nonnucleoside reverse transciptase inhibitors
   3. Protease inhibitors
   4. Entry inhibitors
   Integrase inhibitors

Question 22

What’s a HCP chance of seroconversion post exposure to blood of HIV+ pt?

Answer 22

• Percutaneous: 0.3% (95% CI 0.2-0.5%)

- Mucocutaneous: 0.09% (95% CI 0.006-0.5%)

Question 23

List 5 high-risk features in relation to a potential HIV exposure.

Answer 23

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