HIV/AIDS and opportunistic infections

Question 1

Laboratory findings of HIV diagnosis

Answer 1

4th gen HIV test: Combines immunoassay for HIV AB woth a test for HIV p24 ag which shows a week prior to AB in acute infection

followed cofirmation by a HIV-1/2 AB differentiation immunoassay
-if negative then perform HIV-1 Nucleic acid amplification test (NAAt)

Question 2

CD4 lymphocytes greater than 300`

Answer 2

Pneumococcal pneumonia

Pulmonary tuberculosis

Herpes Zoster

Oral candidiasis

Vaginal candidiasis

Fatigue

Question 3

CD4 Lymphocytes less than 300

Answer 3

Oral Hairy Leukoplakia

Thrush

Fever

Weight Loss

Diarrhea

Question 4

CD4 Lympocytes less than 200

Answer 4

Pneumocytsitis Jirovecii pneumonia PJP

Disseminated Histoplasmoisis

Kaposi sarcoma

Extrapulmonary miliary TB

Non-Hodgkins’s Lymphoma

CNS Lymphoma

Question 5

CD$ lymphocytes less than 100

Answer 5

Cryptococcosis meningitis

Esophageal candidiasis

Toxoplasmoisis

Question 6

CD4 less than 50

Answer 6

Myobacterium avium complex

Cytomegalovirus

Primary CNS lymphoma

Question 7

What are the Aids Defining Illnesses?

Answer 7

Oppurtunistic Infectiions:

Multiple or recurrent bacterial unfections

Pneumocytosis jirovecii pneumonia

Kaposi Sarcoma

Lymphoma

CMV infection

Histoplasmosis

Coccicdioomycosis, disseminated or extrapulmonary

Cryptoccosis extrapulmonary

Myobacterium tuberculosis of any site, pulmonar, disseminated or extrapulmonary

Question 8

how to determine Pneumocystisdiagnosis

Answer 8

chast radiograph is cornerstone of diagnosis

• diffuse or perihilar infiltrates are most characteristic
• atypical infiltrates
• apica; infiltrates

Wright-Giemsa Stain or direct fluorescence antibody DFA test of induced sputum

Bronchoalveolar lavage (BAL)

Question 9

will Pneumocystis Pneumonia be present if the CD4 count is greater than 250?

Answer 9

No

Question 10

what does a normal diffusing capacity of carbon monoxide or a high resolution CT scan of the cehest that demonstrates no interstitial lung disease tell you?

Answer 10

Pneumocystis pneumonia is very unlikely

Question 11

what is the most common cause of pulmonary disease in HIV infected person?

Answer 11

Community acquired pneumonia

Question 12

What is the most common space occupying lesion in HIV and what does it show on images?

Answer 12

Multiple subcortical lesions with a predilection for the basal ganglia

it occurs in paitents with CD4 cell ccount below 100

Multiple ring enhancing lesions with surrounding areas of edema

Question 13

what is the second most common space occupying lesion in HIV and its characteristics

Answer 13

Primary CNS lympphoma:

• Diffuse Large B cell melignancy
• High association with EBV
• Usually occuras with CD4 less than 50 but can occur with levels greater than 300

Question 14

What are the major problems encountered with cytomegalovirus?

Answer 14

Retinitis
Colitis
Esophageal ulceration 
Encephalitis
Pneumonitis

Question 15

what to give to a patient with possiblePneumocystits Jirovecii

Answer 15

CD4 count below 200 or oropharyngeal candidiasis or prior bout of PCP

Give Trimethoprium sulfamethoxazole (TMP-SMX)