HIV - complications and opportunistic infections Flashcards
4 conditions than can occur when CD4 count 200-500
oral thrush
candidiasis
Hairy Leukoplakia
Kaposi Sarcoma
What is hairy leukoplakia caused by?
EBV
What is Kaposi’s sarcoma caussed by
HH8
5 conditions that can occur when CD4 count 100 - 200 cells/mm³
Cryptosporidiosis
Cerebral toxoplasmosis
Progressive multifocal leukoencephalopathy
Pneumocystis jirovecii pneumonia
HIV dementia
What is Progressive multifocal leukoencephalopathy caused by
JC Virus
4 conditions that can occur when CD4 count 50-100
aspergillosis
oesophageal candidiasis
Cryptococcal meningitis
Primary CNS lymphoma
2 conditions that can occur when CD4 count <50
Cytomegalovirus retinitis
Mycobacterium avium-intracellulare infection
What is the most common cause of biliary disease in patients with HIV
sclerosing cholangitis due to infections such as CMV, Cryptosporidium and Microsporidia
Which vaccines are contra-indicated in HIV+ve patients?
Cholera CVD103-HgR
Influenza-intranasal
Poliomyelitis-oral (OPV)
Tuberculosis (BCG)
Which vaccinations can only be used in HIV patients when CD4 >200
Measles, Mumps, Rubella (MMR)
Varicella
Yellow Fever
What are the symptoms of toxoplasmosis in HIV?
constitutional symptoms, headache, confusion, drowsiness
CT findings of toxoplasmosis lesions in HIV?
CT: usually single or multiple ring enhancing lesions, mass effect may be seen
Management of toxoplasmosis in HIV?
management: sulfadiazine and pyrimethamine
CNS lymphoma cause
EBV
CNS lymphoma imaging
CT: single or multiple homogenous enhancing lesions
Treatment primary CNS lymphoma
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
Toxoplasmosis Imaging clues
Multiple lesions
Ring or nodular enhancement
Thallium SPECT negative
Primary CNS lymphoma clues
Single lesion
Solid (homogenous) enhancement
Thallium SPECT positive
CT head finding of tuberculosis in HIV
CT: single enhancing lesion
Causes of encephalitis in HIV
may be due to CMV or HIV itself
CT head finding of encephalitis in HIV
oedematous brain
Symptoms of cryptococcus in HIV?
headache, fever, malaise, nausea/vomiting, seizures, focal neurological deficit
CSF examination findings of cryptococcus in HIV?
high opening pressure
elevated protein
reduced glucose
normally a lymphocyte predominance but in HIV white cell count many be normal
India ink test positive
CT head finding of cryptococcus in HIV?
CT: meningeal enhancement, cerebral oedema
Progressive multifocal leukoencephalopathy (PML) cause
JC virus
Progressive multifocal leukoencephalopathy (PML) symptoms
behavioural changes, speech, motor, visual impairment
Progressive multifocal leukoencephalopathy (PML) CT head
CT: single or multiple lesions, no mass effect, don’t usually enhance. MRI is better - high-signal demyelinating white matter lesions are seen
AIDS dementia symptoms
symptoms: behavioural changes, motor impairment
AIDS dementia CT head findings
CT: cortical and subcortical atrophy
Who should receive prophylaxis against PCP?
all patients with a CD4 count < 200/mm³ should receive PCP prophylaxis
What are the features of PCP?
dyspnoea
dry cough
fever
very few chest signs
Name a common complication of PCP?
Pneumothorax
What are the extrapulmonary manifestations of PCP?
hepatosplenomegaly
lymphadenopathy
choroid lesions
Investigations for PCP?
CXR: typically shows bilateral interstitial pulmonary infiltrates but can present with other x-ray findings
Best = bronchoalveolar lavage and silver staining
Management of PCP?
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
What is Kaposi’s sarcoma caused by
Human Herpesvirus 8
Presentation of Kaposi’s sarcoma
presents as purple papules or plaques on the skin or mucosa (e.g. gastrointestinal and respiratory tract)
Treatment of Kaposi’s sarcoma
radiotherapy + resection
What are the features of HIV associated nephropathy?
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
Who does CMV retinitis typically affect?
Patients with CD4 count < 50
Features of CMV retinitis
visual impairment - ‘blurred vision’ etc
pizza retina
Treatment of CMV retinitis
IV ganciclovir
treatment used to be life-long but new evidence suggests that it may be discontinued once CD4 > 150 after HAART
Causes of diarrhoea in HIV
Cryptosporidium + other protozoa (most common)
Cytomegalovirus
Mycobacterium avium intracellulare
Giardia
Ziehl-Neelsen stain (acid-fast stain) result for cryptosporidium
characteristic red cysts of Cryptosporidium
Mycobacterium avium intracellulare features
fever, sweats, abdominal pain and diarrhoea.
Mycobacterium avium intracellulare treatment
rifabutin, ethambutol and clarithromycin
