HIV Complications III Flashcards
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
How do you manage MAI [3]
Rifabutin, ethambutol and clarithromycin
What are the typical clinical features of MAI [5]
In a HIV patient
fever
sweats
abdominal pain from lymphadenopathy
diarrhoea - from infection of the small bowel
There may be hepatomegaly and deranged LFTs
Dx of MAI in HIV ptx? [3]
Diagnosis is made by blood cultures and bone marrow examination
Describe the length of time for TB treatment in an HIV infected individual [2]
Treatment is for a minimum of 6 months and is extended to 12 months if CNS disease.
Describe the presentation of mycobacterium avium intracellulare (MAI) with HIV infection
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
Describe the dx of HIV x MAI
- 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
Treatment of HIV x MAI? [4]
TREATMENT:
Clarithromycin or Azithromycin + Ethambutol +/- Rifabutin
Ciprofloxacin sometimes used
HIV x CMV causes which common complication? [1]
Which other complications does it cause? [5]
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)
Describe the clinical features and fundoscopy results for CMV retinitis [2]
Visual impairment:
- painless visual loss
- floaters
- flashing lights
Fundoscopy:
- retinal haemorrhages and necrosis
- ‘pizza’ retina
- retinal detachment and uveitis in some cases
Describe the GI manifestiations of CMV x HIV infection [4]
GI MANIFESTATIONS:
* Oral ulceration
* Oesophageal Ulcers-lower half oesophagus
* Duodenitis and Gastritis
* Colitis-bloody diarrhoea- owl’s eye inclusion bodies seen on histology
Which endocrine organ can be impacted by CMV infection with PLWHIV? [1]
ADRENALITIS
May be associated with CMV disease in other organs or in isolation.
Symptoms and signs as with adrenal insufficiency.
Whats the tx for CMV retinitis? [1]
TREATMENT: URGENT as may be sight threatening: Valganciclovir PO or Ganciclovir IV
Foscarnet, Cidofovir if resistant CMV
Oral hairy leukoplakia is caused by infection by which pathogen? [1]
Describe the pattern of seen [1]
Oral hairy leukoplakia - EBV
White adherent patches on lateral border of tongue with characteristic ribbed appearance
How do you differentiate oral hairy leucoplakia to oral candidiasis? [4]
HIV and diarrhoea
What causes AIDS dementia complex? [1]
How does this appear on a CT? [1]
AIDS dementia complex:
- caused by HIV virus itself
CT:
- cortical and subcortical atrophy
Describe what is meant by progressive multifocal leukoencephalopathy (PML) in PLWHIV [2]
Describe how this looks on a CT or MRI [1]
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
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]
herpes zoster ophthalmicus
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
Dx? [1]
Tx? [2]
Typical cerebral Toxoplasmosis – multiple ring-enhancing lesions
- Sulphadiazine + Pyramethamine
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
NB: all are symptoms
Tx? [1]
NB: PMH includes HIV Dx
Valganciclovir
CMV Retinitis
Describe the clinical presentation of Progressive Multifocal Leucoencephalopathy [4]
Insidious onset of:
* Motor deficit
* Personality change
* Visual field
* Brainstem and cerebellar involvement
Tx? [1]
PMH HIV
Typical Intracerebral Lymphoma - Single, non-enhancing lesion
Tx: Radiotherapy
Which non-AIDS defining cancer has the biggest cancer risk in HIV? [1]
Anal
