HIV/AIDS (last POM lecture!!)

Question 1

Common modes of HIV infection:

Answer 1

1. Sexual transmission at the genital or colonic mucosa
2. Exposure to other infected fluids like blood or blood products
3. Transmission from mother to infant
4. Occasionally, accidental occupational exposure

Question 2

What pathogen is important for HIV?

Answer 2

p24

Question 3

Viral variation:

Answer 3

1. altered cell tropism
2. immune escape
3. resistance to RT and PI’s;
4. mutation
5. high rates of virus turnover
6. selection of viral variants

Question 4

Most likely to get HIV from

Answer 4

MSM; females with heterosexual contact

Question 5

Why could we be seeing more cases of HIV among adults?

Answer 5

People who don’t know they are positive spread the disease

Question 6

Stages of illness:

Answer 6

Stage 0: negative test within 180 days of positive test;
Stage 1: CD4 cells greater than 500
Stage 2: CD4 cells 200-499
Stage 3: CD4 cells less than 200

Question 7

Some AIDS defining infections and cancers:

Answer 7

1. bacterial infections (mycobacterium disseminated or extrapulmonary; salmonella septicemia)
2. Fungal (candidiasis, cryptococcosis, pneumocystis jirovecii pneumonia
3. Viral :CMV retinitis, PML, herpes simplex
4. Parasitic: toxoplasmosis;

cervical cancer, Kaposi, lymphomas (Burkitt, etc.)

Question 8

Some symptoms with HIV for suspicion:

Answer 8

mono-like syndrome; high-risk behavior; rash, mucocutaneous ulcers, diarrhea, LAD; febrile illness

Question 9

Diagnostic testing includes:

Answer 9

IgM and IgG antibody with p24 antigen; HIV RNA detection; HIV antigen detection; western blot

Question 10

Cough and fever in HIV positive patient:

Answer 10

Think recurrent bacterial pneumonia, TB, PJP; maybe viral and parasites;
maybe cryptococcosis and histo, along with Kaposi sarcoma;
large lymph nodes for TB or lymphoma

Question 11

What shows up at an CD4 count; low CD4 count?

Answer 11

Sinusitis, bronchitis, bacterial pneumonia, TB;

PCP, disseminated fungal disease, CMV

Question 12

Diagnostic testing for HIV and cough/fever:

Answer 12

Sputum analysis and Ag testing;

invasive (bronchoscopy better than sputum analysis; also lung biopsy)

Question 13

What are some random tests the lecturer liked?

Answer 13

Acid fast smear for cryptosporidium, Isospora, and cyclospora;
trichrome for Microsporidium!!!