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Heme/Oncology > HIV/AIDS Dr. Naqvi > Flashcards

HIV/AIDS Dr. Naqvi Flashcards

1
Q

set of symptoms infections and malignancy resulting from the damage to the human immune system caused by the human immunodeficiency virus

A

acquired immune deficiency syndrome (AIDS)

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2
Q

what does HIV attack

A

CD4 T helper lymphocytes

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3
Q

another indicator of AIDS

A

CD4 count very low

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4
Q

HIV/AIDS transmission

A
  • sexual contact
  • infected blood, like transfusions
  • shared needles
  • occupational exposures
  • perinatal transmission
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5
Q

HIV infections transmitted largely by

A

MSM

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6
Q

HIV integrates into the host cell genome, and long lived cells can serve as a…

A

reservoir of virus

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7
Q

most persons who develop HIV infection experience an acute symptomatic illness, referred to as ___________, within a few weeks of acquiring the infection.

A

acute retroviral syndrome

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8
Q

patients with acute infection may not yet be producing antibodies against HIV antigen which results in negative results on traditional HIV serologic testing

A

window period

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9
Q

what should you check during window period

A

P24 CA

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10
Q

how is AIDS diagnosed

A
  • when indicator opportunistic infections or malignancies develop
  • when CD4 cell count falls below 200
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11
Q

chronic HIV/AIDS symptoms

A
  • lymphadenopathy
  • fever, night sweats
  • fatigue
  • weight loss
  • chronic diarrhea
  • seb derm, psoriasis, tinea, onychomycosis
  • oral apthous ulcers
  • peripheral neuropathy
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12
Q

some indications for HIV testing

A
  • age 13-75
  • history of at risk behavior
  • symptoms of acute or chronic HIV infection
  • known or suspected exposure
  • blood/semen/organ donor
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13
Q

what diagnostic tests are done for HIV

A
  • combination HIV antibody-HIV p24 antigen testing
    –> diagnoses infection within 12-16 days of infection
  • older enzyme-linked immunosorbent assay (ELISA) antibody tests (followed by confirmatory western blot)
    –> becomes positive 3 to 4 weeks after acute infection and remain the test of choice in screening for chronic infection
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14
Q
  • positive as early as 3-5 days after acute infection
  • test of choice in diagnosis of acute HIV infection
  • correlates with rate of disease progression
  • used to follow response to antiretroviral therapy (ART)
A

HIV RNA polymerase chain reaction (PCR)

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15
Q

measurement of immunodeficiency

A

diagnostic testing: CD4 count

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16
Q
  • detects mutations that confer resistance to ART
  • should be obtained as part of initial panel of tests for an individual with HIV
  • in the US, 10% to 20% of patients with new HIV infection have transmitted resistance to at least one class of antiretroviral medications
A

diagnostic testing: HIV genotype

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17
Q

when should repeat testing (HIV viral load, CD4 cell count, complete blood count, and tests of kidney function and liver chemistries) be done

A
  • before any modification in current therapy
  • 2-8 weeks after starting or changing therapy
  • every 3 to 6 months in patients who remain stable with their current therapy
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18
Q

although patients with HIV infection generally should not receive live vaccines what is the exception

A

measles-mumps-rubella and varicella vaccines are considered safe for those with CD4 cell counts greater than 200

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19
Q

prophylaxis against opportunistic infection pneumocystis jirovecii in HIV/AIDS

A

TMP-SMX, double strength tablet

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20
Q

prophylaxis against opportunistic infection toxoplasmosis in HIV/AIDS

A

TMP-SMX, double strength tablet

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21
Q

prophylaxis against opportunistic infection mycobacterium avium complex in HIV/AIDS

A

azithromycin

22
Q

prophylaxis against opportunistic infection tuberculosis in HIV/AIDS

A

INH

23
Q

what is recommended for all persons with HIV who are ready to start treatment

A

antiretroviral treatment

24
Q

what is the most important principle in treating HIV infections

A

the antiretroviral regimen must fully suppress viral replication to prevent the development of viral drug resistance

25
Q

recommendations for initial HIV treatment include

A

3 drugs from 2 different classes
- usually two nucleoside reverse transcriptase inhibitors as a “backbone” plus a third agent, most commonly a protease inhibitor or an integrase inhibitor.

26
Q

what can you see with effective antiretroviral therapy

A
  • viral load levels decrease quickly and progressively within the first few weeks of treatment
  • they reach undetectable levels within a few months
  • remain undetectable while therapy continues
27
Q

antiretroviral agents used to treat HIV infection

A
  • abacavir (nucleoside RTIs)
  • efavirenz (non nucleoside RTIs)
  • atazanivir (protease inhibitors)
  • maraviroc (CCR5 antagonist)
  • dolutegravir (integrase inhibitors)
  • cobicistat/ritonavir (pharmokinetic boosters)
28
Q

what to do for pregnant patients with HIV infection

A
  • all pregnant women should be tested for HIV infection
  • all those with HIV should be treated with anti retrovirals
29
Q

post exposure prophylaxis

A
  • must be started asap
  • prophylaxis should always include 3 drugs taken for 4 weeks
30
Q

pre exposure prophylaxis

A

combination tenofovir emtricitabine taken once daily

31
Q

when do opportunistic infections develop

A

when the CD4 cell count is less than 200 and become even more likely when the count is lower

32
Q

when can opportunistic infections: mucocutaneous candida infection occur

A

can develop with CD4 counts greater than 200

33
Q

how to treat opportunistic infections: mucocutaneous candida infection (thrush)

A

topical agents like clotrimazole troches or nystatin suspension

if severe: oral fluconazole

34
Q

how to diagnose opportunistic infection: cryptococcal meningitis

A

CSF culture or antigen testing of CSF or serum

35
Q

how to treat opportunistic infection: cryptococcal meningitis

A

anti fungal agents and control of increased intracranial pressure by serial lumbar punctures or shunting

36
Q

patient presents with subacute onset of fever, dyspnea, and dry cough, and chest radiographs most commonly show diffuse interstitial or alveolar infiltrates

A

pneumocystis jirovecii pneumonia

37
Q

pneumocystis jirovecii pneumonia treatment

A

high dose trimethoprim sulfamethoxazole

adjunct glucocorticoids are beneficial and should be used in patients with an arterial partial pressure of oxygen of less than 70 mm Hg or an arterial gradient of greater than 35 mm Hg

38
Q
  • can cause encephalitis in patients with CD4 cell counts less than 100
  • patients presents with HA, fever, focal neurologic deficits, and possibly seizures
  • multiple ring enhancing lesions are seen on imaging studies
A

toxoplasma gondii

39
Q

toxoplasma gondii treatment

A

pyrimethamine plus either sulfadiazine or clindamycin

40
Q

may present at any CD4 cell count, is more likely to be extra pulmonary at presentation, and may not have the classic chest radiograph findings

A

tuberculosis

41
Q

usually disseminated at presentation and develops at CD4 cell counts less than 50

A

MAC infection

42
Q

clinical features of tuberculosis and MAC infections

A

fever, sweats, weight loss, lymphadenopathy, hepatosplenomegaly, and cytopenias

43
Q

tuberculosis and MAC infections treatment

A

multidrug regimen with clarithromycin or azithromycin

44
Q

most common manifestations are retinitis, esophagitis or colitis, and polyradiculitis or encephalitis

A

cytomegalovirus infection

45
Q

how to make diagnosis of cytomegalovirus infection

A

clinically or by demonstrating CMV by histopathologic studies or NAAT

46
Q

cytomegalovirus infection treatment

A

oral valganciclovir or IV ganciclovir

47
Q
  • poxvirus infection that most commonly causes multiple small papules on the face and trunk
  • usually responds to immune reconstitution after treatment of the HIV treatment
A

molluscum contagiosum

48
Q
  • caused by a herpes family virus (HHV 8) and presents with lesions that may vary in color from red to purple to brown and may be macule, papules, plaques, or nodules
  • most found on the skin but may also occur on mucous membranes of the respiratory and GI tracts
  • if they have this, they have AIDS
A

kaposi sarcoma

49
Q

CD4 count generally < 500

A
  • salmonella
  • C diff
  • kaposi sarcoma
  • TB
  • HSV
50
Q

CD4 count < 200

A

candida
AIDS dementia syndrome
pneumocystis jiroveci pneumonia

51
Q

CD4 count < 100

A

B cell lymphoma (non Hodgkins)
toxoplasmosis
histoplasmosis
cryptococcosis
coccidioidomycosis
cryptosporidia

52
Q

CD4 count < 50

A

CMV
CNS lymphoma
MAC

Heme/Oncology (2 decks)

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