HIV & AIDS

Question 1

HIV

Answer 1

RNA retrovirus

Question 2

HIV targets cells

Answer 2

• dendritic cells
• macrophages
• CD4+ T cells

Question 3

pathophysiology of HIV

Answer 3

• rapid viral replication
• susceptible CD4+ T cells
• no HIV- specific immune response

Question 4

how long does the host’s immune cells take to form a response to HIV?

Answer 4

~6 months

Question 5

clinical syms of early HIV infection

Answer 5

• nonspecific clinical syms

- flu-like syms

Question 6

blood HIV viral load correlates with what?

Answer 6

risk of transmission of the virus

Question 7

T/F: pts with early HIV infection are highly contagious

Answer 7

true

Question 8

progressive depletion of CD4+ lymphocytes leads to what?

Answer 8

• pancytopenia

- immune dysfunction

Question 9

pancytopenia

Answer 9

complete wipe out of all cells that are made from bone marrow including WBC, RBC, and platelets

Question 10

what happens if HIV pt’s CD4+ drops to <200?

Answer 10

disease has progressed to AIDS

Question 11

how are pts confirmed for AIDS?

Answer 11

• laboratory confirmed HIV infection AND
• CD4+ lymphocyte counts <200 cells/uL
  AND/OR
• 1 AIDS-defining condition

*if have both then considered to have AIDS

Question 12

do all HIV pts progress to AIDS?

Answer 12

no

Question 13

management of AIDS pts

Answer 13

• early detection and diagnosis
• antiretroviral therapy (ART)
• prophylaxis for opportunistic infections with low CD4+ counts
• txtment of HIV-related complications (i.e. Karposi sarcoma)

Question 14

what percent of HIV-infected pts survive beyond 10 yrs of diagnosis thanks to ART?

Answer 14

> 70%

Question 15

how long are HIV- infected pts on ART for?

Answer 15

a lifetime, continued indefinitely

Question 16

how often are CD4+ count taken after HIV diagnosis?

Answer 16

every 3-4 months

Question 17

ART (HAART)

Answer 17

• cocktail of multiple drugs

- increases survival, reduces complications, improves quality of life

Question 18

goal of ART

Answer 18

inhibit HIV replication so viral load not detectable so

• CD4+ count increases
• restored immune fxn

Question 19

why is compliance difficult for HIV-infected pts going through ART?

Answer 19

many adverse effects and toxicity

Question 20

when should HIV-infected pts start ART?

Answer 20

not sure, there is no general consensus for start of drugs

Question 21

asymptomatic HIV-infected pts have

Answer 21

• okay CD4+ count
• low viral load
• normal platelets and WBCs
• no signs or syms

Question 22

can you treat a asymptomatic HIV-infected pt?

Answer 22

yes, all dental care indicated but take universal precautions

Question 23

asymptomatic, HIV-infected pt with decreasing CD4+ count

Answer 23

• may be developing immune suppression
• increased risk of infection (decreased WBCs)
• increased bleeding (decreased platelets)

Question 24

is routine and complex restorative dentistry okay for asymptomatic, HIV-infected pt with decreasing CD4+ count?

Answer 24

yes

Question 25

can you perform invasive surgical procedures on asymptomatic, HIV-infected pt with decreasing CD4+ count?

Answer 25

obtain WBC and platelet counts first

Question 26

AIDS pts (CD4+ <200)

Answer 26

• significant immunosuppression

check drug interactions with ART

Question 27

can you provide dental txtment in AIDS pts (CD4+ <200)?

Answer 27

emergency care and preventative dental care only

Question 28

how do you prepare for infections after an invasive procedure in AIDS pts (CD4+ <200)?

Answer 28

antibiotic prophylaxis for pt with WBC <500uL

Question 29

how do you prepare for excessive bleeding after an invasive procedure in AIDS pts (CD4+ <200)?

Answer 29

platelets must be >50,000 for 1 tooth minimum