HIV / AIDS

Question 1

HIV/AIDS: ddx respiratory opportunistic infxn

Answer 1

• PJP, atypical mycobacterium, cryptococcosis, disseminated histoplasmosis
• Typicals: S. pneumo, mycobacterium, influenza

Question 2

HIV/AIDS: findings suggestive of PCP

Answer 2

nonproductive cough with elevated LDH

Question 3

Oral thrush indicated CD4 count less than ____.

Answer 3

250 cells/mm3

Question 4

ABG findings with poor prognosis

Answer 4

PO2 <70 mmHg
A-a (alveolar-arteriolar) gradient >35 mmHg
consider corticosteroids

Question 5

How to diagnose AIDS

Answer 5

CD4 count <200/mm3, or AIDS-defining illness in someone HIV (+)

Question 6

Normal CD4 count in immunocompetent patients

Answer 6

CD4 600-1500

Question 7

CD4 count where immune function is compromosed

Answer 7

500 or less

Question 8

HIV syndrome

Answer 8

mono-like illness with fever, HAs, lymphadenopathy, pharyngitis +/- macular rash

Question 9

HIV latency period

Answer 9

8-10 years after initial infection

Question 10

CD4 <500 opportunistic infections

Answer 10

recurrent PNAs, TB, vaginal candidiasis, herpes zoster

Question 11

CD4 <200 opportunistic infections

Answer 11

PJP, toxoplasmosis, cryptococcosis, histoplasmosis, cryptosporidiosis

Question 12

CD4 <50 opportunisitic infections

Answer 12

disseminated histoplasmosis, MAC, CMV retinitis/colitis/esophagitis, primary CNS lymphoma

Question 13

CXR in PJP diagnosis

Answer 13

normal or diffuse bilateral interstitial lung opacities +/- lung cysts

Question 14

PJP complications

Answer 14

severe alveolar lung opacitis, ARDS, lung cyst rupture and spontaneous PTXs

Question 15

Gold standard PJP diagnosis

Answer 15

• PCR or staining (giemsa vs silver) of induced sputum (aerosolized hypertonic saline or BAL) revealing P. jirovecii, unicellular fungus
• Elevated LDH (not specific, rules out PJP if normal)

Question 16

Empiric tx for PJP

Answer 16

TMP-SMX

Question 17

Alternative tx for PJP

Answer 17

If sulfa allergy:

inhaled pentamidine, clindamycin w/primaquine, dapson, or atovaquone

Question 18

Risk factors for TB

Answer 18

incarceration, recent immigration from endemic area, homeless

Question 19

T/F: negative PPD or IGRA is sufficient work up to exclude TB in an HIV patient

Answer 19

FALSE. Also, hematogenous spread more likely and presents with extrapulmonary manifestations

Question 20

CNS mass lesion in AIDS patient is most likely ____.

Answer 20

Cerebral toxoplasmosis, opportunistic infection

Presentation: HA, seizure, focal neuro deficits

Question 21

CNS mass lesion in AIDS patients not responsive to sulfadiazine/pyrimethamine:

Answer 21

CNS lymphoma – single mass lesion instead of multiple

Question 22

Diagnosis of CNS lymphoma

Answer 22

1) LP –> CSF analysis to for EBV DNA

2) Stereotactic brain biopsy

Question 23

Signs / sxs cryptococcal meningitis

Answer 23

chronic, indolent, mood/personality changes, HA, visual distubances. Get serum cryptococcal antiGEN

Question 24

Dx of cryptococcal meningitis

Answer 24

India ink stain, fungal culture, CSF cryptococcal angtigen

Question 25

Tx cryptococcal meningitis

Answer 25

1. Amphotericin B + flucytosine, then chronic PO fluconazole | 2. Larve volume LP for increased intracranial pressures

Question 26

Signs / sxs CMV infection

Answer 26

CD4<50 | fever, constitutional sxs, retinitis, esophagitis, colitis, adrenalitis

Question 27

Tx CMV infection

Answer 27

IV ganciclovir, valganciclovir, foscarnet, cidofovir

Question 28

MAC (Mycobacterium avium-intracellulare Complex)

Answer 28

CD4<50 | persistent fever, weight loss, constitutional sxs, abd pain, watery diarrhea

Question 29

Dx / Tx of MAC

Answer 29

Dx: mycobacterial blood culture Tx: azithromycin or clarithromycin, + ethambutol and rifabutin

Question 30

PCP prophylaxis

Answer 30

PPX if CD4 <200 | TMP-SMX DS one tab daily

Question 31

Toxoplasmosis prophylaxis

Answer 31

PPX if CD4 <100 and positive serology | tx with daily TMP-SMX

Question 32

MAC prophylaxis

Answer 32

PPX if CD4<50 | clarithromycin 500mg BID or azithromycin 1200mg weekly

Question 33

When to discontinue PPX

Answer 33

once patient is on HAART and CD4 counts >100-200 depending for 3 months

Question 34

HAART consists of _____

Answer 34

1) Two nucleoside reverse transcriptase inhibitors (NRTIs) | 2) Non-NRTI or a protease inhibitor

Question 35

When to initiate HAART

Answer 35

1) acute HIV infection 2) HIV positive and CD4<500 3) symptomatic regardless of CD4 count 4) Pregnancy 5) Hx of AIDS defining condition 6) HIV with HBV or HCV coinfection 7) HIV associated nephropathy (HIVAN)

Question 36

IRIS

Answer 36

Immune Reconstitution Inflammatory Syndrome: initial worsening of sxs after starting HAART, typically 1-2 months