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SBL Exam 2 > HIV/AIDS & Opportunistic Infection (Tyler) > Flashcards

HIV/AIDS & Opportunistic Infection (Tyler) Flashcards

1
Q

What is the highest risk of transmission for HIV?

A

Receptive anal intercourse (1:100 to 1:30)

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2
Q

What is the next highest risk of transmission after receptive anal intercourse?

A

Needlestick with infected blood (1:300)
Sharing needles with drug usage (1:150)

***Why you need to be careful if collecting blood from HIV+ patient!

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3
Q

What population are the most likely to be diagnosed with HIV?

A

African American Gay/Bisexual Males followed by Latino Gay/Bisexual Males

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4
Q

Globally, what part of the population has the majority of new HIV infections been a part of (as of 2015)?

A

General Population (56%)

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5
Q

This part of the world bears the heaviest burden of HIV and AIDS worldwide, accounting for 66% of all new HIV infections.

A

Sub-Saharan Africa

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6
Q

Many individuals with HIV infection remain asymptomatic for years even without antiretroviral treatment. There is a mean time of approximately ________ between infection and development of AIDS.

A

10 years

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7
Q

T/F. HIV has one specific symptom that makes it stand out right away.

A

False. A combination of complaints is more suggestive of HIV infection than any one symptom.

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8
Q

Abnormal findings on PE range from completely nonspecific to highly specific for HIV infection. Those that are specific include…

A
    • Hairy leukoplakia of the tongue
    • Disseminated Kaposi sarcoma
    • Cutaneous bacillary angiomatosis
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9
Q

For testing, the HIV test combines immunoassay for HIV antibody with a test for HIV ______ antigen. This improves the ability of the test to detect early HIV infection because ______ antigen becomes detectable a week before Ab in acute infection.

A

p24

p24

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10
Q

A positive result on HIV-1/2 Ag/Ab combination assay is followed by testing of the sample with…

A

HIV-1/2 Ab differentiation immunoassay

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11
Q

In the HIV-1/2 Ab differentiation immunoassay, if there is detection of HIV-1/2 Ab then the diagnosis is confirmed. If the samples are negative on Ab differentiation then they are tested with…

A

HIV-1 Nucleic Acid Amplification Test (NAAT)

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12
Q

If NAAT result is positive with a negative Ab differentiation test, then what is the diagnosis?

A

Acute HIV

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13
Q

If specimens are positive on initial combination assay and then are negative on Ab differentiation immunoassay and NAAT, the test is…

A

False-Positive

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14
Q

Study the HIV testing paths on slides 18-19!

A

Know them, cuz Dr. Daddy Bob said so ;)

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15
Q

This particular count is the most widely used marker to provide prognostic information and to guide therapy decisions.

A

CD4 Lymphocyte Count

***The trend is more important than a single determination!

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16
Q

If the CD4 Lymphocyte count is >300, what should we consider?

A
    • Pneumococcal pneumonia
    • Pulmonary tuberculosis
    • Herpes Zoster
    • Oral candidiasis
    • Vaginal candidiasis
    • Fatigue
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17
Q

If the CD4 Lymphocyte count is <300, what should we consider?

A
    • Oral Hairy Leukoplakia
    • Thrush
    • Fever
    • Weight Loss
    • Diarrhea
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18
Q

If the CD4 Lymphocyte count is <200, what should we consider?

A
    • Pneumocystis jirovecii pneumonia
    • Disseminated histoplasmosis
    • Kaposi Sarcoma
    • Extrapulmonary/miliary TB
    • Non-Hodgkin’s Lymphoma
    • CNS Lymphoma
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19
Q

If the CD4 Lymphocyte count is <100, what should we consider?

A
    • Cryptococcosis (Cryptococcal meningitis)
    • Esophageal candidiasis
    • Toxoplasmosis
20
Q

If the CD4 Lymphocyte count is <50, what should we consider?

A
    • Mycobacterium-avium complex (MAC)
    • Cytomegalovirus (CMV)
    • Primary CNS lymphoma

***Know these for sure!!!

21
Q

Why should CD4 counts be monitored every 3-6 months in patients taking antiretroviral treatments consistently?

A

It measures the immune dysfunction

22
Q

CD4 counts do NOT provide a measure of how actively HIV is replicating in the body. Instead, what test is used to assess the level of viral replication and provide useful prognostic information that is independent of the information provided by CD4 counts?

A

HIV Viral Load test

23
Q

What is the AIDS-defining illness?

A

Opportunistic infections

  • **Includes:
    • Multiple, or recurrent, bacterial infections
    • Pneumocystis jirovecii pneumonia
    • Kaposi Sarcoma
    • Lymphoma
    • CMV infection
    • Histoplasmosis
    • Coccidioidomycosis, disseminated or extrapulmonary
    • Cryptococcosis, extrapulmonary
    • Mycobacterium tuberculosis of any site
24
Q

This is the most common opportunistic infection associated with AIDS.

A

Pneumocystis jirovecii

25
Q

What is the cornerstone of diagnosis for Pneumocystis jirovecii pneumonia, which most characteristically shows diffuse or perihilar infiltrates (66%)?

A

Chest Radiograph

26
Q

A definitive diagnosis for Pneumocystis can be obtained in 50-80% of cases by what tests?

A

Wright-Giemsa Stain OR Direct Fluorescence Antibody (DFA) test of induced sputum

27
Q

When a sputum examination comes back negative, but the patient is still suspected of having Pneumocystis pneumonia, then what technique is used (95% accuracy in diagnosis)?

A

Bronchoalveolar lavage (BAL)

28
Q

Elevation of _______ _______ ________ occurs in 95% of cases of Pneumocystis pneumonia, but the specificity of this finding is at best 75%. A _______ _______ _______ test is more sensitive and specific for Pneumocystis pneumonia but it’s still not used very much (usually can diagnose without it).

A

Serum Lactate Dehydrogenase (LDH)

Serum Beta-Glucan

29
Q

A normal diffusing capacity of carbon monoxide or a high-resolution CT scan of the chest that demonstrates no interstitial lung disease makes the diagnosis of ________ _______ VERY unlikely.

A

Pneumocystis pneumonia

30
Q

CD4 counts greater than ________ within 2 months prior to evaluation of respiratory symptoms makes a diagnosis of Pneumocystis pneumonia unlikely. Only 1-5% of cases occur above this CD4 count.

A

250 cells/mcL

31
Q

__________ can be seen in HIV-infected patients with a history of Pneumocystis pneumonia. This can be due to _________, which are cystic-appearing areas (on x-ray).

A

Pneumothoraces

Pneumatoceles

32
Q

What is the most common cause of pulmonary disease in HIV-infected persons?

A

Community-acquired pneumonia

  • **Can be from:
    • Bacterial, mycobacterial, and viral pneumonias
    • Recurrent: AIDS defining (as is the case with any recurrent bacterial process)
33
Q

This is the most common space-occupying lesion in HIV, causing multiple subcortical lesions with a predilection for the basal ganglia.

A

Toxoplasmosis

34
Q

Toxoplasmosis is a common cause of ________ ________ in patients with AIDS.

A

Focal Encephalitis

35
Q

Serologic tests are not useful for Toxoplasmosis, because Abs are prevalent in the general population. The presence of Abs in the ________ is helpful, although there is a high rate of false-negative results.

A

CSF

36
Q

_______ is more sensitive than contrast-enhanced CT scan in detecting toxoplasmosis. Imaging typically shows multiple ring-enhancing lesions with surrounding areas of _______.

A

MRI

Edema

37
Q

This is the 2nd most common cause of space-occupying lesions in HIV. It is typically a single ring-enhancing lesion, but can be multiple.

A

Primary CNS Lymphoma

38
Q

Primary CNS Lymphoma can develop into what? And what is it highly associated with?

A

Diffuse, Large-Cell, B-Cell Malignancy

EBV (CSF PCR)

39
Q

What does Primary CNS Lymphoma present with?

A
    • Mass lesion
    • Headaches
    • Confusion, disorientation
    • Altered gait and balance, falls
    • Focal deficits
    • Seizures
    • Onset days-weeks
40
Q

This can be a cause of considerable morbidity in severely immunocompromised HIV-infected individuals.

A

Cytomegalovirus (CMV)

41
Q

What is the most major problem encountered with CMV?

A

Retinitis – looks like “cottage cheese and ketchup” infiltrates

42
Q

Kaposi Sarcoma is a low-grade vascular tumor associated with _______. Incidence of Kaposi Sarcoma in HIV-infected persons has significantly declined thanks to ________.

A

HHV-8 (Human Herpesvirus 8)

HAART (Highly Active Antiretroviral Therapy)

43
Q

Extracutaneous spread of Kaposi Sarcoma is common, particularly to the oral cavity, GI tract, and respiratory tract. Skin lesions appear most often on the…

A
    • LE
    • Face (especially the nose)
    • Oral mucosa
    • Genitalia
44
Q

In what situations do we need to be prophylactic for Pneumocystis jirovecii and give medications?

A
    • CD4+ T cell count <200
    • Oropharyngeal candidiasis
    • Prior bout of PCP (Pneumocystis Pneumonia)

***Needs to be one of above, not all 3!

45
Q

What medication is given for Pneumocystis jirovecii prophylaxis?

A

Trimethoprim-sulfamethoxazole (TMP-SMX) – aka Bactrim

*1 DS tablet daily PO

SBL Exam 2 (7 decks)

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