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SBL > HIV/AIDS & Opportunistic Infections > Flashcards

HIV/AIDS & Opportunistic Infections Flashcards

1
Q

Which has the highest risk of HIV transmission: receptive anal intercourse, insertive anal intercourse, receptive vaginal intercourse, insertive vaginal intercourse, IV drug use by shared needles with an HIV-infected source, or needlestick with infected blood?

A

**Receptive Anal Intercourse: 1 in 65

  • IV drug use with shared needle: 1 in 150
  • needlestick w/ infected blood: 1 in 300
  • insertive anal intercourse: 1 in 1,000
  • receptive vaginal intercourse: 1 in 1,000
  • insertive vaginal intercourse: 1 in 10,000
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2
Q

Which population is least likely to know they’re infected with HIV?

A

-young people ages 13-24

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3
Q

Which population counts for the majority of new HIV diagnoses?

A

gay and bisexual men

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4
Q

Which ethnicity has the highest rate of HIV infection?

A

Black/African American

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5
Q

Which world region bears the heaviest burden of HIV/AIDS worldwide?

A

Sub-Saharan Africa (accounting for 66% of all new HIV infections)

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6
Q

True or False: Globally, the majority of new HIV infections are found in the general population.

A

True; 56% of new HIV infections globally are found in the general population

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7
Q

What is the average time between HIV infection and development of AIDS?

A

10 yrs

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8
Q

True or False: A combination of complaints is more suggestive of HIV infection than any single symptom.

A

True

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9
Q

What are some conditions that are highly specific for HIV infection?

A
  • hairy leukoplakia of the tongue
  • disseminated Kaposi Sarcoma
  • cutaneous bacillary angiomatosis
  • generalized lymphadenopathy (in early infection)
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10
Q

What two things are tested in the combined immunoassay for HIV?

A
  • HIV antibody
  • HIV p24 antigen

-p24 Ag becomes detectable a week before the Ab

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11
Q

True or False: if the combined immunoassay for HIV returns positive, no further testing is required.

A

False; it is followed by an HIV-1/2 Ab differentiation immunoassay

-THEN, detection of HIV-1, HIV-2, or both… confirms Dx.

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12
Q

What happens if a sample is negative or indeterminate on the Ab differentiation test?

A

the sample is tested with an HIV-1 nucleic acid amplification test (NAAT)

(+) is a confirmation of HIV-1

(-) is a false positive from the initial combined immunoassay and Ab differentiation test

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13
Q

What is the most widely used marker to provide prognostic information and guide HIV therapy?

A

CD4 count

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14
Q

What are some limitations to using the CD4 count?

A
  • -diurnal variation
  • -depression with intercurrent illness
  • -intra-laboratory and interlaboratory variability
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15
Q

True or False: the CD4 count trend is more important than a single determination.

A

True

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16
Q

What are some opportunistic infections that can be found in HIV patients, even when their CD4 count is >300?

A
  • pneumococcal PNA
  • pulmonary TB
  • Herpes zoster
  • oral/vaginal candidiasis
  • fatigue (HIV Fatigue Syndrome)
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17
Q

What are some opportunistic infections that can be found in HIV patients when their CD4 count is < 300?

A
  • oral hairy leukoplakia
  • thrush
  • fever
  • weight loss
  • diarrhea
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18
Q

What are some opportunistic infections that can be found in HIV patients when their CD4 count is <200?

A
  • pneumocystic jirovecii PNA
  • disseminated histoplasmosis
  • Kaposi Sarcoma
  • extrapulmonary/miliary TB
  • NHL
  • CNS lymphoma
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19
Q

What are some opportunistic infections that can be found in HIV patients when their CD4 count is <100?

A
  • cryptococcosis (cryptococcal meningitis)
  • esophageal candidiasis
  • toxoplasmosis
20
Q

What are some opportunistic infections that can be found in HIV patients when their CD4 count is <50?

A
  • -mycobacterium-avian complex (MAC)
  • -CMV
  • -primary CNS lymphoma
21
Q

How often should CD4 counts be monitored in HIV patients on anti-retroviral therapy?

A

3-6 months

22
Q

True or False: CD4 counts provide a measure of how actively HIV is replicating in the body.

A

False: HIV Viral Load tests the level of viral replication

23
Q

Name some AIDS-defining illlnesses.

A
  • multiple or recurrent bacterial infections
  • pneumocystis jirovecii PNA
  • Kaposi Sarcoma
  • lymphoma
  • CMV infection
  • histoplasmosis
  • coccidioidomycosis (disseminated or extrapulmonary)
  • extrapulmonary cryptococcosis
  • TB
24
Q

What is the most common opportunistic infection associated with AIDS?

A
  • Pneumocystis jirovecii (Dx by a chest radiograph)

- -shows diffuse or perihilar infiltrates, apical infiltrates

25
Q

What type of procedure would you do if you suspect Pneumocystic jirovecii in a patient, but the sputum sample returns negative?

A

-bronchoalveolar lavage (BAL)

26
Q

What are two lab tests that can be run for Pneymocystis jirovecii and which of the two is more sensitive and specific?

A
  • -elevated serum lactate dehydrogenage (LDH)

- -serum beta-glucan (<

27
Q

What is the likelihood of an infection with Pneumocystis jirovecii if the diffusing capacity of carbon monoxide is normal?

A

very unlikely

28
Q

What is the likelihood of an infection with Pneymocystis jirovecii if a chest CT shows no signs of interstitial lung disease?

A

very unlikely

29
Q

Does a CD4 count > 250 within 2 months prior lessen the likelihood that a respiratory infection is caused by Pneumocystis jirovecii?

A

Yes, because only about 3% of cases occur above this count

30
Q

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

A

community-acquired PNA

bacterial, mycobacterial, or viral

31
Q

What is the most common space-occupying lesion in HIV patients?

A

Toxoplasmosis

32
Q

What are the symptoms of Toxoplasmosis?

A
  • multiple subcortical lesions with a predilection for the basal ganglia
  • HA, fever, focal neurologic deficits, AMS, and seizures
33
Q

Why are serologic tests not useful in making or excluding Dx of Toxoplasmosis?

A
  • antibodies to T. gondii are prevalent in the general population
  • the presence of T. gondii in the CSF is helpful, but there is a high rate of false-negative results
34
Q

Which is more sensitive in detecting toxoplasmosis: MRI or contrast-enhanced CT?

A

MRI

–it will display multiple ring-enhancing lesions with surrounding areas of edema

35
Q

Besides Toxoplasmosis, what are some other Ddx that can present as ring-enhancing lesions on a contrast-enhanced CT?

A
  • CNS lymphoma
  • fungal infection
  • cerebral TB
36
Q

What is the second most common cause of space-occupying lesions (after Toxoplasmosis) in HIV patients?

A

primary CNS lymphoma

–typically a single ring-enhancing lesion

37
Q

What tests is used to detect cryptococcal meningitis in HIV patients?

A
  • latex agglutination test of serum that shows cryptococcal antigen (CRAG)
  • culture of CSF for Cryptococcus
38
Q

Primary CNS Lymphoma in HIV patients is highly associated with which virus?

A

EBV, detected by a CSF PCR

39
Q

What are the symptoms of Primary CNS Lymphoma?

A
  • mass lesion
  • HA
  • confusion, disorientation
  • altered balance/gait, falls, focal deficits
  • seizures
40
Q

What are common skin infections of HIV patients?

A
  • herpes simplex
  • herpes zoster
  • molluscum contagiosum
  • Staph, Strep
  • bacillary angiomatosis
  • fungal
41
Q

What is a considerable cause of morbidity in severely compromised HIV-infected individuals?

A

-CMV

42
Q

What are major problems encountered in CMV of HIV patients?

A
  • Retinitis (most common)
  • -“cottage cheese and ketchup” appearance

-colitis, esophageal ulceration, encephalitis, pneumonitis

43
Q

What is Kaposi Sarcoma?

A

–low-grade vascular tumor associated with HHV-8

–extracutaneous spread to oral cavity, GI tract, and respiratory tract is common

44
Q

Describe the lesions of Kaposi Sarcoma?

A
  • most often on lower extremities, face (especially nose), oral mucosa, and genitalia
  • papular, several mm to several cm in diameter
45
Q

What are pulmonary symptoms of Kaposi Sarcoma?

A

-SOB, fever, cough, hemoptysis, CP

  • -despite an asymptomatic x-ray finding
  • -Dx confirmed via bronchoscopy
46
Q

When would you start prophylaxis for Pneumocystis jirovecii?

A
  • CD4 count < 200
  • when the pt has oropharyngeal candidiasis
  • prior bout of Pneumocystic jirovecii
47
Q

What drug is used as prophylaxis for Pneumocystis jirovecii?

A

–trimethoprim-sulfamethoxazole (TMP-SMX)
(aka Bactrim)

–1 double-strength table daily PO

SBL (4 decks)

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