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HIV > HIV and the Lung > Flashcards

HIV and the Lung Flashcards

1
Q

Lung conditions assoc. w. bacterial infection in HIV (3)

A

bronchitis

bronchiectasis-often secondary to bacterial/mycobacterial/PCP infection

pneumonia

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2
Q

Organisms assoc. w. bronchitis in HIV (2)

A

strep pneumoniae-commonest cause of pneumonia in HIV

haemophilus

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3
Q

commonest organisms causing pneuomnia in HIV (4)

A

strep pneumoniae

haemophilus

staph aureus

mycobacterium avium intracellulare (ethambutol+clari+rifabutin)

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4
Q

CXR features of pneumonia in HIV

A

atypical-mimicks PCP in 50% of cases (diffuse bilateral infiltrates)

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5
Q

Presentation of PCP (4)

A

non-productive cough

progressive exertional dyspnoea

+/- fever/night sweats

pneumothorax

(NB normally occurs when CD4 <200)

(if CD4<200, prophylactic Abx are given)

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6
Q

Dx of PCP (4)

A

(auscultation usually normal, can have end-inspiratory crackles)

CXR

CT chest (nodules and cysts) if CXR normal but still clinically suspicious

induced sputum sample or bronchoscopy if still unsure:

  • nebulised saline/BAL
  • Grocott’s stain/silver stain shows Mexican hats

desaturation on exercise

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7
Q

CXR features of PCP (6)

A

initially normal

bilateral perihilar interstitial infiltrates:

  • ground glass shadowing
  • hazy shadow through which lung markings can be seen

diffuse alveolar shadowing

upper zone infiltrates resembling TB

peri-hilar lymphadenopathy

intrapulmonary nodes

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8
Q

Rx of PCP (3)

A

1st line: co-trimoxazole

if PaO2=/<9.3: IV/PO steroids to prevent drop in sats on initiating Rx

2nd line: clindamycin+primaquine (NB primaquine CI in G6PD)

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9
Q

SEs of co-trimoxazole (2)

A

marrow/nephro/hepatotoxicity

20% develop mac-pap rash

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10
Q

PCP prophylaxis and criteria (5)

A

co-trimoxazole

give if:

  • CD4<200
  • other AIDS-defining condition
  • previous episodes of PCP

continue prophylaxis until CD4>200 and undetectable viral load for 3mo

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11
Q

Features of pulmonary cryptococcosis (2)

A

can be primary infection secondary to disseminate disease e.g. cryptococcal meningitis

can cause disseminated disease e.g. skin nodules

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12
Q

Dx of pulmonary cryptococcosis

A

identify organism in respiratory secretions

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13
Q

Rx of pulmonary cryptococcosis

A

fluconazole

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14
Q

Features and presentation of histoplasmosis (4)

A

occurs as part of disseminated disease

presentation:

  • subacute fever and wt. loss
  • dyspnoea
  • dry cough
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15
Q

Dx of histoplasmosis (2)

A

BAL

lung biopsy

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16
Q

Rx of histoplasmosis

A

liposomal amphotericin

17
Q

RFs for aspergillosis (2)

A

neutropenia

corticosteroid use

(rare, even in HIV+ve)

18
Q

Presentation of aspergillosis (3)

A

non-specific

pleuritic chest pain

haemoptysis

19
Q

Rx of aspergillosis (2)

A

voriconazole

liposomal amphotericin

20
Q

Features and Rx of influenza infection in HIV (2)

A

not more common in HIV but is more severe

Rx w. oseltamivir if Sx =/<48hr

21
Q

Features and Dx of CMV infection (3)

A

Pneumonitis

CD4<100

Dx by isolating inclusion bodies in BAL/lung tissue

22
Q

Features of KS (2)

A

always accompanied by lymphadenopathic/cutaneous KS

may regress w. cART

23
Q

Features of bronchial carcinoma in HIV (2)

A

2-4 times more likely in HIV+ve smokers

presentation is often w. disseminated disease

24
Q

Features and Rx of non-specific pneumonitis (2)

A

mostly self-limiting

prednisolone may be beneficial

25
Q

Features of lymphocytic interstitial pneuomonitis (2)

A

mainly affects children

mimics IPF: slowly progressing dyspnoea and cough

26
Q

Other non-infective, non-malignant conditions HIV patients are at increased risk of (3)

A

COPD

Pneumothorax

Pulmonary artery HTN: 6-12 times more common

27
Q

Presentation of TB in HIV (2)

A

often atypical

disseminated disease more common

(if HIV+ve pt. has cough/fever/night sweats>HIV until proven otherwise)

28
Q

CXR features of TB in HIV (3)

A

classical upper zone cavitations replaced with:

  • pulmonary infiltrates
  • mediastinal lymphadenopathy
  • pleural effusions
29
Q

Histology of TB in HIV (3)

A

poorly formed granulomas

less caseation

fewer acid-fast bacili present

30
Q

Rx of TB in HIV (3)

A

(NB drug resistance more common in HIV)

RIPE-4for2, 2for4

beware drugs which are metabolised by P450 as rifampicin>reduced cART efficacy>worse HIV control

rifabutin is an alternative with less of an effect on P450

31
Q

Features of IRIS (3)

A

occurs when cART and TB Rx are commenced soon after each other

improvement in immune response>worsening TB Sx

cART can unmask unknown TB which manifests a few wks after commencing cART

(therefore may be worth delaying cART for 1-2mo after TB Rx started)

32
Q

Major criteria for IRIS (4)

A

new/worsening:

  • LNs/cold abscesses/focal tissue involvement
  • radiological features
  • CNS TB
  • serositis

(NB other reasons for worsening Sx need to be ruled out e.g. non-adherence)

33
Q

Minor criteria for IRIS (3)

A

new/worsening:

  • constitutional Sx
  • resp Sx
  • abdo Sx

HIV (7 decks)

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