HIV/AIDS and opportunistic infections Flashcards
US populations most at risk for HIV contraction
african american and hispanic gay and bisexual men
Area of the world that bears heaviest burden of HIV/AIDS
subsaharan Africa
Clinical signs of HIV
asymptomatic, often for years
Mean time between infection of HIV and AIDS development
10 years
Clinical PE findings specific for HIV
hairy leukoplakia, disseminated Kaposi sarcoma, cuteaneous bacillary angiomatosis
HIV initial lab diagnostic test
immunoassay for HIV antibody and HIV p24 ag
Test that follows HIV-1/2 Ag/Ab combo assay
HIV-1/2 Ab differentiation immunoassay
HIV samples negative on Ab differentiation are tested next with what assay?
HIV-1 nucleic acid amplification test
If NAAT is pos with a neg. Ab test, dx is
acute HIV
If specimen is positive on combo assay, then negative on Ab differentiation and NAAT, dx is…
false-positive
Nonspecific lab findings in patients with HIV
anemia, leukopenia, thrombocytopenia, ESR increased, polyclonal hypergammaglobulinemia, hypercholestrolemia, cutaneous anergy
Marker used to guide HIV therapy decisions and prognostics
CD4 count
Common side effects/OI of CD4 ct >300
Pneumococcal pneumonia, TB, herpes zoster, oral candidiasis, vaginal candidiasis, fatigue
Common side effects/OI of CD4<300
Oral Hairy leukoplakia, thrush, fever, weight loss, diarrhea
Opportunistic infections and diseases of CD4<200
P. jirovecii, disseminated histoplasmosis, kaposi sarcoma, extrapulmonary TB, NHL, CNS lymphoma
Opportunistic infections of CD4<100
Crypto, esophageal candidiasis, toxoplasmosis
Opportunistic infections of CD4<50
Mycobaterium-avium complex, CMV, primary CNS lymphoma
How often should CD4 counts be checked?
Every 3-6 months
Differential considerations for HIV sxs
Cancer, chronic infections, endocrine diseases; pulmonary, neuro, GI presentations
AIDS-defining illnesses
P. jirovecii, Kaposi sarcoma, CMV infection, histoplasmosis, crypto, coccidioidomycosis, TB
P. jirovecii pneumonia
most common OI associated with AIDS; fever, cough, SOB, atypical apical infiltrates
Dx of P. jirovecii
Wright-Giemsa stain, direct fluorescence ab, bronchoalveolar lavage
Lab findings that make P. jirovecii unlikely
normal diffusing cap of CO, CT scan that demonstrates no interstitial lung disease, CD4>250 within 2 mo prior to resp symptoms
Most common cause of pulmonary disease in HIV-infected persons
CA-pneumonia
Toxoplasmosis clinical findings
HA, fever, focal neuro deficit, AMS, seizures
Toxo CT findings
multiple subcortical lesions with predilection for basal ganglia
Second most common cause of space-occupying brain lesion in HIV patients
primary CNS lymphoma
Primary CNS lymphoma
DLCBcell, often associated with EBV
Presentation of primary CNS lymphoma
mass lesion, HA, neuropsych sxs, focal deficits, altered gait, seizures, onset days-weeks
Major complications associated with CMV
retinitis, colitis, esophageal ulceration, encephalitis, pneumonitis
Kaposi Sarcoma
vascular tumor associated with HHV-8 that often appear on lower extremities, face, oral mucosa, and genitalia
Kaposi sarcoma lesion description
papular, mm to cm in diameter
Prophylactic treatment P. jirovecii
TMP-SMX, 1 DS tablet daily PO
TB prophylaxis
Isoniazid + pyridoxine x 9months
T. gondii prophylaxis
TMP-SMX 1 DS tablet PO qd
Varicella prophylaxis
acyclovir 800 mg PO 5x day for 5-7 days
Immunizations recommended for HIV patients
Hep B, Hep A, influenza, S. pneumoniae, HPV
Vaccines for HIV patients to avoid
live vaccines
