HIV Complications III Flashcards

1
Q

Describe the differences between MTB and MAI infection in HIV-Infected Individuals:

  • Area of body impacted
  • Response to treatment (fast/slow)
  • Late or early HIV involvement
A
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2
Q

How do you manage MAI [3]

A

Rifabutin, ethambutol and clarithromycin

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3
Q

What are the typical clinical features of MAI [5]

In a HIV patient

A

fever
sweats
abdominal pain from lymphadenopathy
diarrhoea - from infection of the small bowel
There may be hepatomegaly and deranged LFTs

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4
Q

Dx of MAI in HIV ptx? [3]

A

Diagnosis is made by blood cultures and bone marrow examination

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5
Q

Describe the length of time for TB treatment in an HIV infected individual [2]

A

Treatment is for a minimum of 6 months and is extended to 12 months if CNS disease.

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6
Q

Describe the presentation of mycobacterium avium intracellulare (MAI) with HIV infection

A

SYMPTOMS:
* Fevers
* Sweats
* Weight loss
* Fatigue
* Anorexia
* Infection in small bowel leads to diarrhoea and malabsorption
* Abdominal lymphadenopathy
causes abdominal pain.
* Disseminated MAI is a common cause of PUO in late-stage patients.

SIGNS:
* May be none
* Widespread lymphadenopathy
* Hepatosplenomegaly

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7
Q

Describe the dx of HIV x MAI

A
  • Bone marrow involvement leads to cytopenia, especially red cell hypoplasia.
  • Anaemia, pancytopaenia
  • Raised ALP
  • Low albumin
  • Radiology shows intra-abdominal lymphadenopathy
  • Blood cultures x 3 at least, using special Bactec bottles, bone marrow.
  • Culture of organism from a sterile site (bone marrow, blood, lymph node) is a surer sign of disease than
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8
Q

Treatment of HIV x MAI? [4]

A

TREATMENT:
Clarithromycin or Azithromycin + Ethambutol +/- Rifabutin

Ciprofloxacin sometimes used

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9
Q
A
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10
Q

HIV x CMV causes which common complication? [1]

Which other complications does it cause? [5]

A

Cytomegalovirus (CMV) retinitis
and
GI manifestations
Adrenalitis
Encephalitis (detect CMV in CSF)
Polyradiculopathy (ascending lower limb weakness with symmetrical sensory loss.
Multifocal neuropathy (painful parasthesia and numbness in asymmetrical multifocal pattern)

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11
Q

Describe the clinical features and fundoscopy results for CMV retinitis [2]

A

Visual impairment:
- painless visual loss
- floaters
- flashing lights

Fundoscopy:
- retinal haemorrhages and necrosis
- ‘pizza’ retina
- retinal detachment and uveitis in some cases

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12
Q

Describe the GI manifestiations of CMV x HIV infection [4]

A

GI MANIFESTATIONS:
* Oral ulceration
* Oesophageal Ulcers-lower half oesophagus
* Duodenitis and Gastritis
* Colitis-bloody diarrhoea- owl’s eye inclusion bodies seen on histology

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13
Q

Which endocrine organ can be impacted by CMV infection with PLWHIV? [1]

A

ADRENALITIS
May be associated with CMV disease in other organs or in isolation.
Symptoms and signs as with adrenal insufficiency.

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14
Q

Whats the tx for CMV retinitis? [1]

A

TREATMENT: URGENT as may be sight threatening: Valganciclovir PO or Ganciclovir IV

Foscarnet, Cidofovir if resistant CMV

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15
Q

Oral hairy leukoplakia is caused by infection by which pathogen? [1]

Describe the pattern of seen [1]

A

Oral hairy leukoplakia - EBV

White adherent patches on lateral border of tongue with characteristic ribbed appearance

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16
Q

How do you differentiate oral hairy leucoplakia to oral candidiasis? [4]

A
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17
Q

HIV and diarrhoea

A
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18
Q

What causes AIDS dementia complex? [1]

How does this appear on a CT? [1]

A

AIDS dementia complex:
- caused by HIV virus itself

CT:
- cortical and subcortical atrophy

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19
Q

Describe what is meant by progressive multifocal leukoencephalopathy (PML) in PLWHIV [2]

Describe how this looks on a CT or MRI [1]

A

widespread demyelination due to infection of oligodendrocytes by JC virus

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

20
Q

Infection from which of the following is the most common cause of diarrhoea in HIV patients?

Cytomegalovirus
Cryptosporidium
Mycobacterium avium intracellulare
Giardia

A

Infection from which of the following is the most common cause of diarrhoea in HIV patients?

Cytomegalovirus
Cryptosporidium
Mycobacterium avium intracellulare
Giardia

21
Q

HIV x HSV tx? [1]

22
Q

What might indicate that secondary / shingles infection is occuring in HIV infected person? [1]
HIV x VZV tx? [1]

A

Multidermatomal VZV may occur in HIV

Tx: Valaciclovir 1g tds p.o.for 7 days

23
Q

HEPATIC AND RENAL DISEASE IN HIV

Describe the treatment of Hepatitis B and C and how this differs in the context of HIV co-infection

Describe the spectrum of renal disease in HIV
 Describe the investigation and management of abnormal renal function in an HIV- infected
individual

24
Q

A man who is on treatment for HIV presents with a painful, vesicular rash on the right side of his face around the eye. Fluorescein staining reveals multiple small defects on the right cornea is a stereotypical history of: [1]

A

herpes zoster ophthalmicus

25
What is the underlying aetiology of Kaposi's sarcoma [1]
HPV 8
26
HIV, neuro symptoms, multiple brain lesions with ring enhancement in a question is most likely to indicate: [1]
**Toxoplasmosis**
27
HIV, neuro symptoms, widespread demyelination in a question is most likely to indicate [1]
Progressive multifocal leukoencephalopathy
28
A patient who is known to have HIV presents gradually worsening speech and behavioural problems associated with coordination difficulties. A MRI shows multifocal non-enhancing lesions is a stereotypical history for infection by:
**JC virus**
29
HIV, purple/red skin lesions in a question is most likely to indicate: [1]
**KS**
30
HIV, neuro symptoms, single brain lesions with homogenous enhancement in a question is most likely to indicate:
CNS lymphoma
31
HIV, neuro symptoms, multiple brain lesions with ring enhancement in a question is most likely to indicate [1]
Toxoplasmosis
32
M Avium Intracellulare occurs when the CD4 count is Any 200 - 500 100 - 200 50 - 100 < 50
M Avium Intracellulare occurs when the CD4 count is **50 - 100** **< 50** (less than 100)
33
TB reactivation occurs when the CD4 count is Any 200 - 500 100 - 200 50 - 100 < 50
TB reactivation occurs when the CD4 count is **Any** 200 - 500 100 - 200 50 - 100 < 50
34
Cytomegalovirus retinitis occurs when CD4 count is Any 200 - 500 100 - 200 50 - 100 < 50
Cytomegalovirus retinitis occurs when CD4 count is Any 200 - 500 100 - 200 50 - 100 **< 50**
35
Dx? [1] Tx? [2]
**Typical cerebral Toxoplasmosis – multiple ring-enhancing lesions** - Sulphadiazine + Pyramethamine
36
Prophylaxis for TG in HIV patients? [2]
Dapsone + Pyramethamine
37
A patient is found to have this with India ink staining. What is the diagnosis? [1] What is the most common symptom? Asymptomatic Headache Fever Mental change
**Cryptococcus Neoformans** - Headache is most common ## Footnote NB: all are symptoms
38
Tx for Cryptococcus Neoformans? [1] Prophylaxis? [1]
Rx - **IV Amphotericin** +/- Flucytoscine if severe Prophylaxis **Fluconazole**
39
Tx? [1] ## Footnote NB: PMH includes HIV Dx
**Valganciclovir** ## Footnote **CMV Retinitis**
40
Describe the clinical presentation of Progressive Multifocal Leucoencephalopathy [4]
Insidious onset of: * Motor deficit * Personality change * Visual field * Brainstem and cerebellar involvement
41
Ptx has PMH of HIV. Tx? [4]
**Candida Albicans** Rx - Topical Nystatin or Amphotericin, Fluconazole, Itraconazole, IV Amphotericin
42
Which malignancies are AIDS defining? [3]
**Kaposi’s Sarcoma** **Invasive Cervical Carcinoma** Non-Hodgkin’s lymphoma: * **Diffuse large B-cell lymphoma** * **Burkitt’s lymphoma** * **Primary central nervous system lymphoma**
43
Tx? [1] PMH HIV
Typical Intracerebral Lymphoma - Single, non-enhancing lesion Tx: **Radiotherapy**
44
Which non-AIDS defining cancer has the biggest cancer risk in HIV? [1]
**Anal**
45