HIV Complications I

Question 1

A CD4 count 200 - 500 cells/mm³ predisposes patients to which disorders due to infections from other pathogens [4]

Answer 1

Oral thrush
Shingles
Hairy Leukoplakia
Kaposi sarcoma

Answer 3

< [40] copies/ml = “undetectable”

Question 4

Infections by which pathogens causes:

Hairy Leukoplakia
Kaposi sarcoma

Answer 4

Hairy Leukoplakia - EBV
Kaposi sarcoma - HHV-8

Question 5

A CD4 count 100-200 cells/mm³ predisposes patients to which disorders due to infections from other pathogens [4]

Answer 5

Cryptosporidiosis (usually self-limiting)

Cerebral toxoplasmosis

Progressive multifocal leukoencephalopathy - JC virus

Pneumocystis jirovecii pneumonia

HIV dementia

Question 6

Progressive multifocal leukoencephalopathy occurs secondary due to an infection by which virus? [1]

Answer 6

JC virus

Question 7

A CD4 count 50-100cells/mm³ predisposes patients to which disorders due to infections from other pathogens [4]

Answer 7

Aspergillosis (secondary to Aspergillus fumigatus)
Oesophageal candidiasis (secondary to Candida albicans)
Cryptococcal meningitis
Primary CNS lymphoma (secondary to EBV)

Question 8

A CD4 count < 50cells/mm³ predisposes patients to which disorders due to infections from other pathogens [2]

Answer 8

Cytomegalovirus retinitis
Mycobacterium avium-intracellulare infection

Question 9

[] is the most common opportunistic infection in AIDS.

Why is this clinically significant? [1]

Answer 9

PCP is the most common opportunistic infection in AIDS
- all patients with a CD4 count < 200/mm³ should receive PCP prophylaxis

Question 10

Which drugs are used as PCP prophylaxis in HIV patients? [1]

Answer 10

co-trimoxazole

Question 11

Yearly cervical smears are recommended in HIV as it increases the risk of [] infection and cervical cancer.

Answer 11

Yearly cervical smears are recommended in HIV as it increases the risk of human papillomavirus (HPV) infection and cervical cancer.

Question 12

Name four maliganancies associated with HIV infection [4]

Answer 12

KS
NHL
Primary intracerebral lymphoma
Cervial and anal carcinoma

NB: Malignancies now most common cause of death in HIV patients
Shift from AIDS-defining cancers to non-AIDS-defining cancers:
Not associated with CD4 counts
Incidence not reduced by HAART

Question 13

[] is a common complication of PCP

State 3 extrapulmonary manifestations of PCP [3]

Answer 13

Pneumothorax is a common complication of PCP:
* hepatosplenomegaly
* lymphadenopathy
* choroid lesions

Question 14

Name this complication of HIV [1]

Which infective organism causes it? [1]

Answer 14

HHV-8

Question 15

Describe the clinical manifestations of Kaposi’s sarcoma [4]

Answer 15

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

skin lesions may later ulcerate

respiratory involvement may cause massive haemoptysis and pleural effusion

Facial KS may present at the tip of the nose

Cutaneous KS is commonest, but can occur at any site, particularly gastro-intestinal tract (including the

Question 16

Describe how you would treat KS [1]

Answer 16

Not all KS needs treatment – depends on site and severity of lesion

The most effective intervention is ART, which may be sufficient in up to 2/3 of cases

OTHER LOCAL TREATMENTS INCLUDE:
* Radiotherapy
* Cryotherapy
* Surgical excision (usually only for diagnosis)
* Intra-lesional injection of chemotherapy
* Cosmetic camouflage using make-up

Question 17

Extensive or visceral KS may require systemic chemotherapy.

Describe which drugs might be used to treat this [4]

Answer 17

Bleomycin, etoposide and liposomal anthracyclines and paclitaxel may be used.

Question 18

Which types of NHL are associated with HIV [2]

Answer 18

Large cell Lymphomas (2/3) - usually EBV associated

Burkitt’s Lymphomas (1/3), 40% are EBV positive

Question 19

What is the treatment for HIV associated NHL? [4]

Answer 19

TREATMENT:
Chemotherapy - regimes vary but cyclophosphamide, doxorubicin, vincristine and prednisolone are used
commonly

CHOP

Question 20

A patient is starting chemotherapy for their NHL associated with their HIV dx.

Which three drugs should be initiated [3] to protect agaisnt which infections [3]

Answer 20

Cotrimoxazole - PCP
Azithromycin - Mycobacterium Avium Intercellulare (MAI)
Fluconazole - Candida

Question 21

Describe the type of lymphoma that is assocaited with primary intracerebral lymphoma [1]

Describe the symptoms of primary intracerebral lymphoma that is associated with HIV + [5]

Answer 21

Most lesions are high grade diffuse, large-cell immunoblastic B cell lymphomas that are
monoclonal and almost invariably associated with EBV

Symptoms:
* Headache,
* Confusion
* memory loss
* lethargy
* focal neurology and seizures

Question 22

Which investigational findings would suggest a patient is suffering from primary intracerebral lymphoma

Answer 22

CT / MRI
- suggestive features: single or multiple lesions, crosses midline, peri-ventricular location.

LP
- EBV DNA in CSF

Investigations necessary to exclude extranodal lymphoma
- CT thorax / abdomen and pelvis, bone
marrow aspiration and trephine

Clinical non-response to 2-weeks of Toxoplasma

Brain biopsy provides definitive identification
- but is not always possible due to the location of
the lesion/s

Question 23

Describe the treatment for primary intracerebral lymphoma associated with HIV [3]

Answer 23

TREATMENT:
* Radiotherapy (whole brain) is the mainstay of treatment
* Dexamethasone 4mg qds will reduce the oedema associated with the tumour and will provide an initial benefit
* Chemotherapy may be offered

Question 24

HIV x HPV causes which cancers? [2]

Which HPV types are most commonly implicated? [2]

Answer 24

Anal and cervical
HPV 16 & 18

HPV also associated with penile, vulval, vaginal and oropharyngeal carcinoma

Question 25

What screening do WIHIV have every year? [1]

Answer 25

HIV-infected women have yearly cervical cytology / colposcopy

Question 27

Lymphoma vs Toxoplasmosios