HIV/AIDS- Bennett

Question 1

define AIDS

Answer 1

A secondary immunodeficiency syndrome resulting from HIV infection and characterized by opportunistic infections, malignancies, neurologic dysfunction and a variety of other syndromes

Question 2

describe the HIV virus

Answer 2

– HIV is a human retro-virus of the lentivirus group– HIV-1 most common cause of aids in the world (w. hemisphere, europe, central, south, & east africa)– HIV-2 more related to the simian retro viruses (less common & less pathogenic mostly isolated in west africa)

Question 3

what part of the immune system is compromised?

Answer 3

• the immune defect is quantitative and qualitative deficiency in the thymus derived t-lymphocytes (t4 population)-
• Defined phenotypically by the presence of cd4 surface molecules
• CD4 is the cellular receptor for HIV.
  
  • Binds with high specificity and affinity

Question 4

HIV testing options

Answer 4

• Elisa first, follow up with western blot and PCR if positive
• Elisa
  
  • First step of an HIV test.
  • Detects the presence of HIV antibodies in the blood.
    
    • Negative –>not HIV infected testing stops
    • Positive the second step of the test is run to confirm the positive results
• Western Blot
  
  • Used to confirm the positive Elisa test results.
  • Detects specific protein bands in HIV infected person
  • In combination with a positive Elisa, a positive Western Blot is 99.9 percent accurate in detecting that HIV infection has occurred.
• HIV PCR
  
  • Detects DNA and RNA sequences that indicate the presence of HIV in the genetic structure of anyone HIV infected.
  • After HIV infection occurs, RNA and DNA from the HIV virus circulates in the blood.
  • The presence of these DNA and RNA “pieces” indicates the presence of HIV virus.

Question 5

clinical manifestations

Answer 5

1. Group I: Acute infection
   
   1. acute mononucleosis like syndrom
   2. characterized by fever, macular or papular rash, malaise, and lymphadenopathy
2. Group II: Asyptomatic infection
   
   1. chronically infected
   2. serology and virus culture positive
   3. no clinical manifestations (latent state)
3. Group III: Persistent genralized lyphadenopathy =
   
   1. palpable enlarged (lymph nodes >1cm.) at two or more extrainguinal sites persisting for more than 3 months, all test results are positive
4. Group IV other diseases =
   
   1. subgroup a constitutional disease
   2. subgroup b neurological disease
   3. subgroup c secondary infectious disease
   4. subgroup d secondary neoplasm
   5. subgroup e other conditions

Question 6

CD4 count and HIV copies are ______ related

Answer 6

inversely

Question 7

HIV Graph

Answer 7

Question 8

key CD4 count

Answer 8

under 400 starts to look bad

Question 9

opportunistic infections at CD4 350 level ***

Answer 9

herpes simplex virus

TB

oral/vaginal thrush

herpes zoster (shingles)

non-hodgkins lymphoma

KAPOSI SACRCOMA

Question 10

opportunistic infections at CD4 200 level ***

Answer 10

pneumocystis carinii penumonia (PCP pneumonia/ PNEUMOCYSTIC JIROVECI PNEUMONIA)

candida esophagitis

bacillary angiomatosis

Question 11

opportunisitic infections at CD4 100 level ***

Answer 11

cryptococcal meningitis

AIDS DEMENTIA

toxoplasmosis encephalitis

progressive multifocal leukoencephalopathy

WASTING SYNDROME

cryptosporidium diarrhea

Question 12

opportunistic infections at CD4 50 level

Answer 12

mycobacterium avium

cytomegalovirus infection

Question 13

primary neutrophic manifestations

Answer 13

Encephalopathy 90%

Meningitis 10%

Myelopathy 12%

MyopathyNeuropathy 10-50%

Question 14

secondary lymphotrophic manifestations

Answer 14

Metabolic and toxic

Neoplasm’s

Opportunistic

Vascular complications

Question 15

Describe encephalopathy

Answer 15

aka AIDS dementia complex

Loss of concentration, forgetfulness, slow thoughts

Motor symptoms: loss of balance, leg weakness

Parkinson’s like: tremors, muscle rigidity, slowed movements

Exam (hyperreflexia, babinski’s, gait ataxia)

Question 16

treatment neuropathies

Answer 16

Desipiramine (25-250mg.) @bedtime

Amytriptyline (25-150mg.) @bedtime

Mexilitine (600 to 1200mg/day)

Gabapentin (300 to 3600 mg/day)

Question 17

the neuropathy resolves after discontinuation of medications … what is it?

Answer 17

drug related distal symmetric polyneuropathy- complication of vincristine, DDI, DDC, D4T

Question 18

Describe GB syndrome

Answer 18

— acute monophasic form of inflammatory demyelinating polyneuropathy (acute progressive ascending)

– Critical Early findings: limb weakness with areflexia beginning distally

– limb weakness & areflexia are critical early findings***

–Maximal neurological dysfunction reached 1month

Question 19

Describe Chronic inflammatory demyelinating polyneuropathy (CIDP)

Answer 19

• occurs during early stages of HIV infection
• motor symptoms developing slowly over several months
• minor sensory complaints & areflexia are common and may precede the motor weakness

Question 20

assoc. with decrease in cd4

Answer 20

progressive lumbosacral polyradiculomyelopathy lower extremity & sacral paresthesias followed by rapidly progressive flaccid parapesis

Question 21

Musculoskeltal manifestations of AIDS

Answer 21

Psoriatic arthritis

Reiter’s

Myopathy

Tenosynovitis

Non-specific arthritis

Question 22

necrotizing mitochondrial myopathy

Answer 22

zidovudine myopathy

Question 23

proximal muscle weakness

Answer 23

HIV related inflammatory myopathy moderately severe, painless, progressive weakness of proximal muscles

Question 24

most common AIDS myopathy

Answer 24

HIV RELATED INFLAMMATORY MYOPATHY

Question 25

myasthenia gravis vs eaton lambert syndrome \*\*\*

Answer 25

both are characterized by fatigability EL improves as the day progresses MG strength is generally in the am.

Question 26

you see a pt with really severe onychomycosis and tinea pedis unresponsive to standard of care tx

Answer 26

may consider HIV/AIDS

Question 27

low extremity edema in HIV AIDS pt

Answer 27

Secondary to hypo-albuminemia due to poor nutrition, malabsorption, defective hepatic synthesis, increase in protein catabolism, or loss in protein due to intestinal kaposi’s

Question 28

kaposi's of the venous system

Answer 28

PSEUDOTHROMBOPHLEBITIS-- Signs and symptoms of dvt-- Erythema , edema accompanied by exquisitley tender indurated cords