HIV / AIDS Flashcards
HIV/AIDS: ddx respiratory opportunistic infxn
- PJP, atypical mycobacterium, cryptococcosis, disseminated histoplasmosis
- Typicals: S. pneumo, mycobacterium, influenza
HIV/AIDS: findings suggestive of PCP
nonproductive cough with elevated LDH
Oral thrush indicated CD4 count less than ____.
250 cells/mm3
ABG findings with poor prognosis
PO2 <70 mmHg
A-a (alveolar-arteriolar) gradient >35 mmHg
consider corticosteroids
How to diagnose AIDS
CD4 count <200/mm3, or AIDS-defining illness in someone HIV (+)
Normal CD4 count in immunocompetent patients
CD4 600-1500
CD4 count where immune function is compromosed
500 or less
HIV syndrome
mono-like illness with fever, HAs, lymphadenopathy, pharyngitis +/- macular rash
HIV latency period
8-10 years after initial infection
CD4 <500 opportunistic infections
recurrent PNAs, TB, vaginal candidiasis, herpes zoster
CD4 <200 opportunistic infections
PJP, toxoplasmosis, cryptococcosis, histoplasmosis, cryptosporidiosis
CD4 <50 opportunisitic infections
disseminated histoplasmosis, MAC, CMV retinitis/colitis/esophagitis, primary CNS lymphoma
CXR in PJP diagnosis
normal or diffuse bilateral interstitial lung opacities +/- lung cysts
PJP complications
severe alveolar lung opacitis, ARDS, lung cyst rupture and spontaneous PTXs
Gold standard PJP diagnosis
- 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)
Empiric tx for PJP
TMP-SMX
Alternative tx for PJP
If sulfa allergy:
inhaled pentamidine, clindamycin w/primaquine, dapson, or atovaquone
Risk factors for TB
incarceration, recent immigration from endemic area, homeless
T/F: negative PPD or IGRA is sufficient work up to exclude TB in an HIV patient
FALSE. Also, hematogenous spread more likely and presents with extrapulmonary manifestations
CNS mass lesion in AIDS patient is most likely ____.
Cerebral toxoplasmosis, opportunistic infection
Presentation: HA, seizure, focal neuro deficits
CNS mass lesion in AIDS patients not responsive to sulfadiazine/pyrimethamine:
CNS lymphoma – single mass lesion instead of multiple
Diagnosis of CNS lymphoma
1) LP –> CSF analysis to for EBV DNA
2) Stereotactic brain biopsy
Signs / sxs cryptococcal meningitis
chronic, indolent, mood/personality changes, HA, visual distubances. Get serum cryptococcal antiGEN
Dx of cryptococcal meningitis
India ink stain, fungal culture, CSF cryptococcal angtigen
Tx cryptococcal meningitis
- Amphotericin B + flucytosine, then chronic PO fluconazole
2. Larve volume LP for increased intracranial pressures
Signs / sxs CMV infection
CD4<50
fever, constitutional sxs, retinitis, esophagitis, colitis, adrenalitis
Tx CMV infection
IV ganciclovir, valganciclovir, foscarnet, cidofovir
MAC (Mycobacterium avium-intracellulare Complex)
CD4<50
persistent fever, weight loss, constitutional sxs, abd pain, watery diarrhea
Dx / Tx of MAC
Dx: mycobacterial blood culture
Tx: azithromycin or clarithromycin, + ethambutol and rifabutin
PCP prophylaxis
PPX if CD4 <200
TMP-SMX DS one tab daily
Toxoplasmosis prophylaxis
PPX if CD4 <100 and positive serology
tx with daily TMP-SMX
MAC prophylaxis
PPX if CD4<50
clarithromycin 500mg BID or azithromycin 1200mg weekly
When to discontinue PPX
once patient is on HAART and CD4 counts >100-200 depending for 3 months
HAART consists of _____
1) Two nucleoside reverse transcriptase inhibitors (NRTIs)
2) Non-NRTI or a protease inhibitor
When to initiate HAART
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)
IRIS
Immune Reconstitution Inflammatory Syndrome: initial worsening of sxs after starting HAART, typically 1-2 months
