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ASL - Infectious Disease > HIV / AIDS > Flashcards

HIV / AIDS Flashcards

1
Q

HIV/AIDS: ddx respiratory opportunistic infxn

A
  • PJP, atypical mycobacterium, cryptococcosis, disseminated histoplasmosis
  • Typicals: S. pneumo, mycobacterium, influenza
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2
Q

HIV/AIDS: findings suggestive of PCP

A

nonproductive cough with elevated LDH

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3
Q

Oral thrush indicated CD4 count less than ____.

A

250 cells/mm3

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4
Q

ABG findings with poor prognosis

A

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

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5
Q

How to diagnose AIDS

A

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

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6
Q

Normal CD4 count in immunocompetent patients

A

CD4 600-1500

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7
Q

CD4 count where immune function is compromosed

A

500 or less

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8
Q

HIV syndrome

A

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

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9
Q

HIV latency period

A

8-10 years after initial infection

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10
Q

CD4 <500 opportunistic infections

A

recurrent PNAs, TB, vaginal candidiasis, herpes zoster

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11
Q

CD4 <200 opportunistic infections

A

PJP, toxoplasmosis, cryptococcosis, histoplasmosis, cryptosporidiosis

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12
Q

CD4 <50 opportunisitic infections

A

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

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13
Q

CXR in PJP diagnosis

A

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

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14
Q

PJP complications

A

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

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15
Q

Gold standard PJP diagnosis

A
  • 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)
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16
Q

Empiric tx for PJP

A

TMP-SMX

17
Q

Alternative tx for PJP

A

If sulfa allergy:

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

18
Q

Risk factors for TB

A

incarceration, recent immigration from endemic area, homeless

19
Q

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

A

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

20
Q

CNS mass lesion in AIDS patient is most likely ____.

A

Cerebral toxoplasmosis, opportunistic infection

Presentation: HA, seizure, focal neuro deficits

21
Q

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

A

CNS lymphoma – single mass lesion instead of multiple

22
Q

Diagnosis of CNS lymphoma

A

1) LP –> CSF analysis to for EBV DNA

2) Stereotactic brain biopsy

23
Q

Signs / sxs cryptococcal meningitis

A

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

24
Q

Dx of cryptococcal meningitis

A

India ink stain, fungal culture, CSF cryptococcal angtigen

25
Q

Tx cryptococcal meningitis

A
  1. Amphotericin B + flucytosine, then chronic PO fluconazole

2. Larve volume LP for increased intracranial pressures

26
Q

Signs / sxs CMV infection

A

CD4<50

fever, constitutional sxs, retinitis, esophagitis, colitis, adrenalitis

27
Q

Tx CMV infection

A

IV ganciclovir, valganciclovir, foscarnet, cidofovir

28
Q

MAC (Mycobacterium avium-intracellulare Complex)

A

CD4<50

persistent fever, weight loss, constitutional sxs, abd pain, watery diarrhea

29
Q

Dx / Tx of MAC

A

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

30
Q

PCP prophylaxis

A

PPX if CD4 <200

TMP-SMX DS one tab daily

31
Q

Toxoplasmosis prophylaxis

A

PPX if CD4 <100 and positive serology

tx with daily TMP-SMX

32
Q

MAC prophylaxis

A

PPX if CD4<50

clarithromycin 500mg BID or azithromycin 1200mg weekly

33
Q

When to discontinue PPX

A

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

34
Q

HAART consists of _____

A

1) Two nucleoside reverse transcriptase inhibitors (NRTIs)

2) Non-NRTI or a protease inhibitor

35
Q

When to initiate HAART

A

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)

36
Q

IRIS

A

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

ASL - Infectious Disease (1 decks)

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