HIV - complications and opportunistic infections

Question 1

4 conditions than can occur when CD4 count 200-500

Answer 1

oral thrush
candidiasis
Hairy Leukoplakia
Kaposi Sarcoma

Question 2

What is hairy leukoplakia caused by?

Answer 2

EBV

Question 3

What is Kaposi’s sarcoma caussed by

Answer 3

HH8

Question 4

5 conditions that can occur when CD4 count 100 - 200 cells/mm³

Answer 4

Cryptosporidiosis
Cerebral toxoplasmosis
Progressive multifocal leukoencephalopathy
Pneumocystis jirovecii pneumonia
HIV dementia

Question 5

What is Progressive multifocal leukoencephalopathy caused by

Answer 5

JC Virus

Question 6

4 conditions that can occur when CD4 count 50-100

Answer 6

aspergillosis
oesophageal candidiasis
Cryptococcal meningitis
Primary CNS lymphoma

Question 7

2 conditions that can occur when CD4 count <50

Answer 7

Cytomegalovirus retinitis
Mycobacterium avium-intracellulare infection

Question 8

What is the most common cause of biliary disease in patients with HIV

Answer 8

sclerosing cholangitis due to infections such as CMV, Cryptosporidium and Microsporidia

Question 9

Which vaccines are contra-indicated in HIV+ve patients?

Answer 9

Cholera CVD103-HgR
Influenza-intranasal
Poliomyelitis-oral (OPV)
Tuberculosis (BCG)

Question 10

Which vaccinations can only be used in HIV patients when CD4 >200

Answer 10

Measles, Mumps, Rubella (MMR)
Varicella
Yellow Fever

Question 11

What are the symptoms of toxoplasmosis in HIV?

Answer 11

constitutional symptoms, headache, confusion, drowsiness

Question 12

CT findings of toxoplasmosis lesions in HIV?

Answer 12

CT: usually single or multiple ring enhancing lesions, mass effect may be seen

Question 13

Management of toxoplasmosis in HIV?

Answer 13

management: sulfadiazine and pyrimethamine

Question 14

CNS lymphoma cause

Answer 14

EBV

Question 15

CNS lymphoma imaging

Answer 15

CT: single or multiple homogenous enhancing lesions

Question 16

Treatment primary CNS lymphoma

Answer 16

treatment generally involves steroids (may significantly reduce tumour size), chemotherapy (e.g. methotrexate) + with or without whole brain irradiation. Surgical may be considered for lower grade tumours

Question 17

Toxoplasmosis Imaging clues

Answer 17

Multiple lesions
Ring or nodular enhancement
Thallium SPECT negative

Question 18

Primary CNS lymphoma clues

Answer 18

Single lesion
Solid (homogenous) enhancement
Thallium SPECT positive

Question 19

CT head finding of tuberculosis in HIV

Answer 19

CT: single enhancing lesion

Question 20

Causes of encephalitis in HIV

Answer 20

may be due to CMV or HIV itself

Question 21

CT head finding of encephalitis in HIV

Answer 21

oedematous brain

Question 22

Symptoms of cryptococcus in HIV?

Answer 22

headache, fever, malaise, nausea/vomiting, seizures, focal neurological deficit

Question 23

CSF examination findings of cryptococcus in HIV?

Answer 23

high opening pressure
elevated protein
reduced glucose
normally a lymphocyte predominance but in HIV white cell count many be normal
India ink test positive

Question 24

CT head finding of cryptococcus in HIV?

Answer 24

CT: meningeal enhancement, cerebral oedema

Question 25

Progressive multifocal leukoencephalopathy (PML) cause

Answer 25

JC virus

Question 26

Progressive multifocal leukoencephalopathy (PML) symptoms

Answer 26

behavioural changes, speech, motor, visual impairment

Question 27

Progressive multifocal leukoencephalopathy (PML) CT head

Answer 27

CT: single or multiple lesions, no mass effect, don't usually enhance. MRI is better - high-signal demyelinating white matter lesions are seen

Question 28

AIDS dementia symptoms

Answer 28

symptoms: behavioural changes, motor impairment

Question 29

AIDS dementia CT head findings

Answer 29

CT: cortical and subcortical atrophy

Question 30

Who should receive prophylaxis against PCP?

Answer 30

all patients with a CD4 count < 200/mm³ should receive PCP prophylaxis

Question 31

What are the features of PCP?

Answer 31

dyspnoea dry cough fever very few chest signs

Question 32

Name a common complication of PCP?

Answer 32

Pneumothorax

Question 33

What are the extrapulmonary manifestations of PCP?

Answer 33

hepatosplenomegaly lymphadenopathy choroid lesions

Question 34

Investigations for PCP?

Answer 34

CXR: typically shows bilateral interstitial pulmonary infiltrates but can present with other x-ray findings Best = bronchoalveolar lavage and silver staining

Question 35

Management of PCP?

Answer 35

co-trimoxazole IV pentamidine in severe cases aerosolized pentamidine is an alternative treatment for Pneumocystis jiroveci pneumonia but is less effective with a risk of pneumothorax Steroids if hypoxic

Question 36

What is Kaposi's sarcoma caused by

Answer 36

Human Herpesvirus 8

Question 37

Presentation of Kaposi's sarcoma

Answer 37

presents as purple papules or plaques on the skin or mucosa (e.g. gastrointestinal and respiratory tract)

Question 38

Treatment of Kaposi's sarcoma

Answer 38

radiotherapy + resection

Question 39

What are the features of HIV associated nephropathy?

Answer 39

massive proteinuria resulting in nephrotic syndrome normal or large kidneys focal segmental glomerulosclerosis with focal or global capillary collapse on renal biopsy elevated urea and creatinine normotension

Question 40

Who does CMV retinitis typically affect?

Answer 40

Patients with CD4 count < 50

Question 41

Features of CMV retinitis

Answer 41

visual impairment - 'blurred vision' etc pizza retina

Question 42

Treatment of CMV retinitis

Answer 42

IV ganciclovir treatment used to be life-long but new evidence suggests that it may be discontinued once CD4 > 150 after HAART

Question 43

Causes of diarrhoea in HIV

Answer 43

Cryptosporidium + other protozoa (most common) Cytomegalovirus Mycobacterium avium intracellulare Giardia

Question 44

Ziehl-Neelsen stain (acid-fast stain) result for cryptosporidium

Answer 44

characteristic red cysts of Cryptosporidium

Question 45

Mycobacterium avium intracellulare features

Answer 45

fever, sweats, abdominal pain and diarrhoea.

Question 46

Mycobacterium avium intracellulare treatment

Answer 46

rifabutin, ethambutol and clarithromycin