HIV associated co-morbidities

Question 1

which cytokine is a strong predictor of mortality in HIV comorbidities

Answer 1

IL-6

Question 2

triglycerides/cholesterol over ______ is considered abnormal lipids

Answer 2

200

Question 3

optimal LDL, HDL, and total cholesterol?

Answer 3

LDL 40

total

Question 4

HIV is a major risk for ____ (regarding CV system)

Answer 4

coronary artery disease (CAD)

Question 5

what ART drug type also increases risk of CAD?

if patient has lipid issues, put them on a ___ instead

Answer 5

protease inhibitors

integrase inhibitor

Question 6

how does HIV cause lipid issues/CAD?

Answer 6

chronic inflammation –> inflamed vessels trap more plaque

decreased lipolysis d/t mitochondrial dysfunction, altered regulation of nuclear receptors controlling lipid metabolism and inflammation

Question 7

if TG are >1000, it is probably due to

Answer 7

pancreatitis

Question 8

_____ syndrome is highly associated with HIV

syndrome consists of….

Answer 8

metabolic

abdominal obesity, high TGs (>150), high BP, low HDL, elevated fasting blood glucose (>110)

Question 9

how does HIV cause renal disease?

Answer 9

after infection you get circulating immune complexes that can cause kidney damage

Question 10

HIVAN

Answer 10

HIV associated nephropathy
HIV infection of glomerular endothelial and mesangial cells

renal biopsy shows collapsing focal glomerulosclerosis with tubulointerstitial injury

presents with nephrotic proteinuria (>3g/day), rapid rise in creatinine, large kidneys, no edema, normotensive, hypoglobulinemia, progresses to ESRD in months

Question 11

HIV associated IgA nephropathy

Answer 11

igA antibodies directed against HIV antigen as part of early immunologic response –> circulating IgA complexes

presents with proteinuria, hematuria, and renal insufficiency

biopsy shows IgA deposits in mesangium and capillary walls (immunofluorescence), dense deposits, thickened foot processes, and expansion of mesangial matrix

Question 12

in HIV, bones show ______

Answer 12

decreased BMD

osteonecrosis (avascular necrosis)

Question 13

which ART drug causes a drop in BMD leading to osteopenia/osteoporosis

Answer 13

tenofovir

Question 14

treat decreased BMD with

Answer 14

bisphosphonates and vitamin D

Question 15

to avoid CVD in HIV patients what bad habit should be stopped?

Answer 15

smoking

Question 16

what is 4x more likely in HIV?

Answer 16

diabetes mellitus

Question 17

why do protease inhibitors lead to diabetes mellitus and CAD

Answer 17

they affect pancreatic cells to cause diabetes and affect cyp/p450

Question 18

diagnosis of diabetes mellitus (3 factors)

Answer 18

HgbA1c >6.5%

FBS >126 repeatedly

random glucose >200 with polydipsia and polyuria

Question 19

try to keep hgbA1c below

Answer 19

7%

Question 20

about 50% of HIV patients suffer from

Answer 20

cognitive impairment

Question 21

how does HIV cause cognitive impairment

Answer 21

• HIV enters the brain early in infection via migrating lymphoid and myeloid cells

establishes ifx in perivascular macrophages and microglia and astrocytes

Question 22

what decreases prevalence of cognitive impairment

Answer 22

EARLY ART

Question 23

symptoms of HIV associated dementia

Answer 23

o Apathy, irritable, mania (new onset psychosis), psychomotor retardation, personality changes, social withdrawal, impaired cognition or memory/attention, visuo-spatial issues, unsteady gait, balance, dropping things, tremors, decline in fine motor skills