HIV/ AIDS and Opportunistic Infections Flashcards
What is the main reason for disparities in black populations diagnosed with HIV?
social determinants of health such as poverty, access to care, insurance status, structural racism, and economic inequality
What are the high risk activities for HIV transmission?
receptive anal sex–> insertive anal sex–> receptive vaginal sex–> insertive vaginal sex
What are the 3 broad clinical presentations of HIV?
acute HIV infection, chronic asymptomatic HIV, and AIDS
how can an acute HIV infection be described?
within weeks of infection; 40-90% experience acute flu-like symptoms
how can chronic asymptomatic HIV be described?
can last years, asymptomatic
What is the first test to be positive when diagnosing HIV?
HIV RNA PCR/ HIV NAAT/ viral load
what test is second to become positive and when?
HIV p24 antigen; usually positive during acute HIV
what is the last test to become positive when trying to diagnose HIV?
HIV antibody test; may be negative during acute HIV
what is the window period associated with HIV?
period in early HIV infection before HIV antibody tests become positive
what is the first test you order when testing for HIV?
HIV-1/2 antigen/antibody combination immunoassay
if you get a positive HIV-1/2 antigen/antibody combination immunoassay test, what test do you order next?
the HIV-1/2 antibody differentiation immunoassay
what happens if the HIV-1/2 antibody differentiation immunoassay is negative or indeterminate?
you order the HIV RNA PCR/ HIV NAAT/ viral load
what happens if the HIV RNA PCR/ HIV NAAT/ viral load is positive?
pt has acute HIV infection
what happens if the HIV RNA PCR/ HIV NAAT/ viral load is negative?
it was a false positive; no further testing is needed
there are two things to monitor in HIV patients, what are they?
Absolute CD4 count and HIV-1 NAAT (RNA PCR or viral load)
what is the purpose of monitoring the absolute CD4 count in patients with HIV?
it is the best indicator of immunologic function
what are the limitations with CD4 level testing?
CD4 levels can fluctuate dat-to-day
what is considered an undetectable HIV-1 NAAT/ HIV RNA PCR/ viral load number?
anything less than 200 copies
how often do you monitor the HIV-1 NAAT/ HIV-1 RNA PCR/ viral load?
monitor every 3-6 months
viral suppression with ART leads to what?
immune recovery
there is no cure yet for HIV- why? what’s the challenge?
the viral reservoir
there is chronic immune activation in HIV (even with treatment and at high CD4 counts) meaning that these patients are at increased risks for certain conditions such as what?
cardiovascular disease (MI or stroke) or cervical cancer
Who is PrEP given to?
to HIV-negative people at risk for HIV to help prevent them from acquiring HIV
What is PrEP?
medication taken daily to block HIV infection if patient exposed to HIV through sex or IV drug use; 2 nucleoside reverse transcriptase inhibitors
what are the indications for PrEP?
has sex partner with untreated HIV; history of recent condomless anal sex; history of recent bacterial STI, multiple sex partners of unknown HIV status
AIDS can be defined by either:
CD4 count less than 200 or any AIDS defining condition such as PJP PNA (even if CD4 count is greater than 200)
what is the most common AIDS-associated opportunistic infection?
pneumocystis Jirovescii (PJP) PNA
how does PJP PNA present?
with fever, non-productive cough, pleuritic chest pain, dyspnea, and presentation is often sub-acute
what is a key physical exam finding associated with PJP PNA?
exertional hypoxia
what do the imaging findings (CT) usually show in pts with PJP PNA?
ground glass infiltrates
what is the typical presentation of mycobacterium tuberculosis?
fever, cough, dyspnea, weight loss, night sweats, CD4 counts are usually greater than 200
what is the typical finding on CXRs in patients with mycobacterium tuberculosis?
apical cavitary lesion in the upper lung lobes
in advanced HIV with CD4 counts less than 200, how does mycobacterium tuberculosis present?
with disemminated disease affecting lungs in miliary pattern, can also affect GI tract, bone, brain, and lymph nodes
what is the most common HIV associated pulmonary infection?
community acquired PNA
at what CD4 level do patients with HIV run the risk of getting community acquired PNA?
ANY CD4 COUNT
how does community acquired PNA present?
fever, cough, SOB, and infiltrate on CXR
what are the typical causes of community acquired PNA?
strep pneumonia and H. influenza
what is the pathophysiology of CNS toxoplasmosis?
reactivation of latent tissue cysts in patients with prior toxoplasma infection (typically toxoplasma IgG will be positive)
what is the typical presentation of CNS toxoplasmosis?
fever, headache, and focal neuro deficits (seizure or stroke like symptoms)
How do you make the diagnosis of CNS toxoplasmosis?
if you get an MRI and it shows multiple ring-enhancing lesions, you can begin to treat for CNS toxoplasmosis
what can CNS toxoplasmosis be compared to?
primary CNS lymphoma
what are the key differences between CNS toxoplasmosis and CNS lymphoma?
there is typically only a single ring-enhancing lesion on the MRI
what is the leading cause of meningitis in patients with AIDS?
cryptococcal meningitis
how does cryptococcal meningitis present?
fever, ams, headache, focal neuro deficits are less common
how is the diagnosis of cryptococcal meningitis made?
lumbar puncture with CSF showing elevated opening pressure, cryptococcal antigen positive
at what CD4 count are HIV patients at risk for cryptococcal meningitis?
less than 100
at what CD4 count are HIV patients at risk for CNS lymphoma?
less than 50
at what CD4 count are HIV patients at risk for CNS toxoplasmosis?
less than 100
what is a late complication of AID (CD4 count around 10)?
mycobacterium avium intracellulare (MAI)
how does mycobacterium avium intracellulare (MAI) present?
constitutional symptoms (fever, weight loss, night sweats) abdominal pain, and lymphadenopathy
how do you make the diagnosis of mycobacterium avium intracellulare (MAI)?
mycobacterial blood cultures being positive
how does CMV retinitis present?
with floaters, scotomas (flashing lights), and visual field cut; can be sight threatening if lesions are near optic nerve
how does CMV colitis present?
diarrhea, abdominal pain, and weight loss
what does the biopsy look like in a patient with CMV colitis?
owl’s eye cytoplasmic inclusion bodies
when does CMV disease in HIV present?
when CD4 counts are less than 50
when are HIV patients at risk for candidiasis?
when CD4 counts are less than 200
how does oropharyngeal candidiasis present?
white plaques on an erythematous mucosa; easily scraped off
how does esophageal candidiasis present?
odynophagia and retrosternal pain
esophagitis in HIV can be caused by what?
candida, HSV, or CMV
how does oral hairy leukoplakia present and what is it associated with?
associated with presence of EBV; presents with white frondlike lesions along the lateral tongue that DO NOT SCRAPE OFF
how do you prophylactically treat opportunistic infections in patients with HIV?
when their CD4 count drops below 200 you give them TMP-SMX to prevent PJP; when their CD4 count drops below 100, you continue treating them with TMP-SMX to prevent MAI
