HIV/AIDS and Opportunistic Infections Flashcards
Which route of transmission has the highest risk of transmission?
receptive anal intercourse 1:100 - 1:30
insertive vaginal intercourse is 1:10,000
A healthcare provider is working at a mission trip in Uganda. During the course of checking blood samples, they get stuck by a used needle. Which of the following best describes their transmission risk.
A. 1:100
B. 1:10,000
C. 1:2
D. 1:300
D. 1:300
things that change risk factors include depth of penetration, hollow bore needles, blood on needles, advanced stage of disease in source.
*remember to divide incidence in 2 with needle sharing in illicit drug use to 1:150
Without prophylactic prevention, what percentage of children born to HIV+ mothers will contract the disease
13-40%
Which two groups represent the most likely to be HIV positive?
African americans
Gay/Bixesual men
What is the mean time between infection with HIV and development of AIDS
10 years
Which diagnostic test, looks for the presence of HIV ab and the HIV p24 antigen?
combines immunoassay
improves ability to detect because p24 is present before Ab
99.6% specificity
If a person was negative for the HIV-1/2 Ab differentiation immunoassay, what test would you do to confirm the negative finding.
HIV-1 nucleic acid amplification test (NAAT)
if positive with negative ab test -> acute HIV
if initial positive on ab test, negative NAAT -> false positive.
What is the most widely used marker for HIV prognostic information?
absolute CD4 count
trend is more important than single determination
What are the limitations to consider when using CD4 count?
Diurnal variation
depression with intercurrent illness
intra-laboratory and interlaboratory variability
Which diseases are common with a CD4 count of >300
Pink Penises Hop On Very Fast (300 mph)
Pneumococcal pneumonia Pulmonary Tb Herpes Zoster Oral Candidiasis Vaginal Candidiasis Fatigue
Which diseases are common with a CD4 count of <300
Over The Worst Fucking Day
Oral Hairy Leukoplakia Thrush Weight Loss Fever Diarrhea
Which diseases are common with a CD4 count of <200
Please Dont Kap Every Non Catholic
Pneumocystis Jirovecii (PCP) Disseminated histoplasmosis Kaposi Sarcoma Extrapulmonary/miliary TB Non-Hodgkin's Lymphoma CNS Lymphoma
Which diseases are common with a CD4 count of <100
Cryptococcosis (cryptococcal meningitis)
Esophageal candidiasis
Toxoplasmosis
Which diseases are common with a CD4 count of <50
Mycobacterium-avium complex (MAC)
Cytomegalovirus
Primary CNS lymphoma
marked as important
How often should CD4 counts be monitored in patients taking antiretroviral treatment consistently
3-6 Months
True or false: CD4 count measures how actively HIV is replicating in the body
False:
this is measured by viral load. provides important prognostic info
What are the AIDS defining illnesses?
Pneumocystis jirovecii
CMV infection
Coccidioidomycosis (disseminated or extrapulmonary)
Mycobacterium TB
These were the ones they emphasized but I would also know kaposi sarcoma.
What is the most common opportunistic infection associated with AIDS
pneumocystis jirovecii
Fever, cough, shortness of breath
Hypoxemia.
What techniques are used to obtain a definitive diagnosis of PJP
Wright-Giemsa stain or Direct Fluorescence antibody
Bronchoalveolar lavage (BAL)
Describe the findings in Pneumocystis Pneumonia
elevated serum Lactate Dehydrogenase
serum beta glucan more sensitive and specific than LDH
if normal diffusion capacity of CO make pCP unlikely
What is the most common cause of pulmonary disease in HIV+ pts
Community-acquired pneumonia
What is the most common space occupying lesion in HIV+ pts
Toxoplasmosis
What is the typical CD4 count and and symptoms associated with someone with a toxoplasmosis infection
CD4 <100
headache
fever
focal neuro deficits
altered mental status and seizures
how does toxoplasmosis appear on unenhanced CT scan
multiple subcortical lesions with predilection in basal ganglia
on MRI you see the typical ring enhancing lesions associated with toxoplasmosis but you confirm 100% it isn’t toxo. what other diseases should remain on your differential
CNS Lymphoma
fungal infection
cerebral TB
what is the second most common cause of space-occupying lesion in HIV
Primary CNS lymphoma
70-90% of patients with cryptococcal meningitis have a positive result of what?
serum CRAG (cryptococcal antigen)
Describe Primary CNS lymphoma
diffuse, large-cell B-cell malignancy
high association with EBV
usually occurs CD4 <50
Describe the problems associated with CMV in HIV pts
Retinitis* Colitis Esophageal ulceration Encephalitis Pneumonitis
Describe Kaposi Sarcoma
caused by HHV-8
skin lesions appear on LE, face, oral mucosa, and genitalia
Pulmonary involvement can occur in HIV pts
Describe the situation that would warrant prophylaxis for PCP and what would that be
CD4+ <200 or Oropharyngeal candidiasis or prior PCP
Trimethoprim-sulfamethoxazole (TMP-SMX) (Bactrim)
- -1 DS tablet PO
- 1 SS tablet PO
What drugs are indicated in mycobacterium TB prophylaxis
Isoniazid 300 mg + Pyridoxine 25 mg PO
or
Isoniazid 900 mg PO 2X/week + Pyridoxine 25 mg PO QD
What type of vaccines should you avoid in patients with HIV
LIVE vaccines
