HIV/AIDS and Opportunistic Infections

Question 1

The risk for HIV increases with what feature to mucosa?

Answer 1

Inflamed or ulcerative mucosa

Question 2

What geographical location bears the heaviest burden of HIV and AIDS worldwide?

Answer 2

Sub-Saharan Africa

Question 3

What are some specific symptoms pointing towards HIV infection?

Answer 3

1) Hairy leukoplakia of tongue
2) Kaposi sarcoma
3) Cutaneous bacillary angiomatosis
4) LAD

Question 4

Testing for HIV combines immunoassay for HIV Ab with a test for what antigen?

Answer 4

p24 Ag

Question 5

A positive result on HIV-1/2 Ag/Ab combination assay is followed by testing of the sample with?

Answer 5

HIV-1/2 Ab differentiation immunoassay

Question 6

Samples that are negative on Ab differentiation are tested with?

Answer 6

HIV-1 nucleic acid amplification test (NAAT)

Question 7

If the NAAT result is positive with a negative Ab then?

If specimens are positive on initial combination assay and then are negative on Ab differentiation immunoassay and NAAT then?

Answer 7

1) Acute HIV is diagnosed

2) It is a false-positive test

Question 8

What is the most widely used marker to provide prognostic info and to guide therapy decisions?

Answer 8

Absolute CD4 Lymphocyte count

Question 9

In regards to the CD4 lymphocyte count, what is more important than a single determination?

Answer 9

The trend

Question 10

What is a patient more susceptible to when CD4 count is less than 200? (6)

Answer 10

1) Pneumocystis jiroveci pneumonia
2) Histoplasmosis
3) Kaposi Sarcoma
4) Extrapulmonary/miliary TB
5) Non-Hodgkin’s Lymphoma
6) CNS lymphoma

Question 11

What is a patient more susceptible to when CD4 count is less than 100? (3)

Answer 11

1) Cryptococcosis
2) Esophageal candidiasis
3) Toxoplasmosis

Question 12

What is a patient more susceptible to when CD4 count is less than 50? (3)

Answer 12

1) Mycobacterium-avium complex
2) Cytomegalovirus
3) Primary CNS lymphoma

Question 13

What assesses the level of viral replication and provides useful prognostic info that is independent of the info provided by CD4 counts?

Answer 13

HIV viral load

Question 14

What is the most common opportunistic infection associated with AIDS?

What does this infection typically cause?

Answer 14

1) Pneumocystis jiroveci

2) Hypoxemia

Question 15

What is the cornerstone of diagnosis for Pneumocystis jiroveci pneumonia?

What is most commonly seen?

Answer 15

1) Chest radiograph

2) Diffused or perihilar infiltrates

Question 16

What would give a definitive diagnosis for pneumocystis?

Answer 16

1) Wright-Giemsa stain
2) Direct fluorescent antibody (DFA) test
3) Bronchoalveolar lavage

Question 17

What enzyme is elevated in Pneumocystis jiroveci pneumonia?

What is more sensitive and specific test compared to the one above?

Answer 17

1) Lactate dehydrogenase (LDH)

2) Serum beta-glucan test

Question 18

What different diagnostic tools can make the diagnosis of pneumocystis pneumonia very unlikely with regards to carbon monoxide, CT imaging, and CD4 count?

Answer 18

1) Normal diffusing capacity of carbon monoxide (DLco)
2) CT scan of chest that shows no interstitial lung disease
3) CD4 count greater than 250 within 2 months prior to eval of respiratory symptoms

Question 19

What can be seen on CXR in HIV infected patients with a history of Pneumocystis pneumonia?

Answer 19

Pneumothorax

Question 20

What is the most common cause of pulmonary disease in HIV infected persons?

What do we know if they are recurrent?

Answer 20

Community acquired pneumonia

2) AIDS defining

Question 21

What is the most common space-occupying lesion in HIV?

What is the second?

Answer 21

1) Toxoplasmosis

2) Primary CNS lymphoma

Question 22

How would you characterize the lesion seen in toxoplasmosis on an unenhanced CT scan?

Answer 22

Multiple subcortical lesions most commonly at the basal ganglia

Question 23

When does toxoplasmosis commonly occur in HIV patients?

Answer 23

CD4 count less than 100

Question 24

In AIDS patients, toxoplasmosis is a common cause of?

Answer 24

Focal encephalitis

Question 25

What does MRI imaging typically shows when detecting toxoplasmosis?

Answer 25

Multiple ring enhancing lesions with surrounding areas of edema

Question 26

Primary CNS lymphoma is highly associated with?

How is it detected?

Answer 26

1) EBV

2) CSF PCR

Question 27

When does primary CNS Lymphoma commonly occur in HIV patients?

Answer 27

CD4 count less than 50

Question 28

What type of lesion do CNS lymphomas typically present with?

Answer 28

Single ring-enhancing lesion

Question 29

What is a common GI problem in HIV-infected patients?

Answer 29

Enterocolitis

Question 30

What is a major problem that in encountered with CMV?

Answer 30

Retinitis

Question 31

Kaposi Sarcoma is a low grade vascular tumor associated with?

Answer 31

Human herpesvirus-8

Question 32

Where do skin lesions from kaposi sarcoma most often appear?

Answer 32

1) LEs
2) Face (nose)
3) Oral mucosa
4) Genitalia

Question 33

Diagnosis of Kaposi Sarcoma can be confirmed by?

Answer 33

Bronchoscopy

Question 34

When does Pneumocystis jirovecii commonly occur in HIV patients?

What is a common co-infection?

Answer 34

1) CD4 count less than 200

2) Oropharyngeal candidiasis

Question 35

What is the treatment for pneumocystis jiroveci?

What is the dosage?

Answer 35

1) Trimethoprim-sulfamethoxazole (TMP-SMX)

2) 1 double strength (DS) tablet daily PO

Question 36

What immunizations are generally recommended for HIV patients?

Answer 36

1) Hepatitis B and A
2) Influenza virus
3) Streptococcus pneumonia
4) HPV

Question 37

What type of vaccines should be avoided in HIV patients?

Answer 37

Live vaccines