HIV-Cutaneous Manifestations Flashcards
Cutaneous manifestations CD4>500
Oral hairy leukoplakia
Acute retroviral syndrome
Vaginal candidiasis
Seb derm
Cutaneous manifestations CD4 250-500
Thrush
Herpes zoster
Severe psoriasis
Eruptive atypical melanocytic nevi and melanoma
Kaposis
Cutaneous manifestations CD4 50-250
Severe seb derm
eosinophilic folliculitis
Mollusca (extensive)
Disseminated cryptococcus, NTM, histo, cocci, HSV, Mollusca
Non-hodgkins lymphoma
Bacillary angiomatosis
Botryomycosis
Cutaneous manifestation CD4 <50
- Erosive HSV (large, non-healing)
- papular pruritic eruption
- Giant mollusca
- Perianal CMV ulcers
- Major apthae
- MAC
- Acquired icthyosis
Diseases at CD4<200 (non derm) and prophylaxis
PJP
Prophylaxis: Septra (1 DS tab)
Diseases at CD4<100 and prophylaxis
Toxo
Ppx: Septra (2x dose)
Diseases at CD4<50
MAC (Abdominal syndrome!)
Ppx: Azithromycin
Bacterial pneumonias in HIV with CD<200
Legionella and staph <100
Psuedomonas and aspergillosis <50
Pathophys HIV infections and associated drug targets
- Binding to CD4+ cell via a few receptors including CCR5 or CXCR4 (CCR5 inhibitor)
- Fusion with plasma membrane (fusion inhibitor)
- RNA-→ DNA via reverse trasncriptase (Nucleoside RTI)
- DNa incorporated into host DNA via integrase (integrate inhibitor)
- Then can replicate and produce more virus, proteases further process the proteins for virus replication (protease inhibitors)
When does acute retroviral syndrome occur after inoculation?
4-6 weeks after
How long doses it take ofor CD4 counts to drop?
Initial infection results in a reduction in circulating CD4 + T cells, which is followed by a recovery to nearly normal levels and a subsequent slow fall of about 50 to 100 cells/mm 3 per year.
-In contrast, the CD4 + T cells residing within the gastrointestinal tract are rapidly depleted early on.
chronic inflammation in HIV patients due to?
- low grade HIV replication
- recurrent infections and re-activations
- immune response to HIV
- impaired mucosal integrity and bacterial translocation
Clinical features of acute retroviral syndrome
fever, headache, myalgia, arthralgia, pharyngitis, night sweats, x 14 days ash
- morbilliform eruption that is generalized, face and trunk predominantly, 4-5 days
- occasionally can get oral and anal ulcers
Infectious complications HIV (list)
- Viral
- HSV
- VZV
- Molluscum
- Bacterial
- Fungal
How is HSV different in HIV?
- more persistent, frequent, larger/deeper/more extensive, non-healing
- can occur in mobile, unattached oropharynx and esophagus
How to test for HSV
- Scrape ulcer edge for PCR, DFA (direct fluorescent ab) or culture
- Skin bx for Tzank smear
Treatment HSV
higher rates (5%) resistance due to low thymidine kinase activity in HSV.
May need to treat longer, until all lesions healed
Alternatives to acyclovir if resistant? and why do they work?
Foscarnet, cidofovir, imiquimod
*don’t rely on thymidine kinase activity
How is VZV in HIV?
- much higher risk getting and reactivation of zoster
- Tend to get multiple lesions over longer period time
- more lesions, longer to heal
- lesions tend to be multiple dermatomes, disseminated lesions, hyperkeratotic verrucous plaques or chronic non healing ulcers
- more likely to develop systemic involvement (pneumonitis, hepatitis, encephalitis)
Treatment VZV
Acyclovir until lesions resolve
VZV immunoglobulin within 10 days exposure if non immune
Molluscum in HIV
LARGE molluscum, widespread, persistent, on the face
Treatment molluscum
Destructive
With ART (or can re-appear with IRIS)
Cidofovir
What do you need to r/o with molluscum in HIV?
Disseminated fungal
Cryptococcus
How does HPV presenting in HIV-infected individuals?
Multiple, coalescent and extensive: Common warts, condyloma acuminata, squamous intra-epithelial neoplasia and carcinoma.
Higher incidence high risk anogenital HPV and CIN (cervical) and higher risk progression to carcinoma
AEDV?
Acquired epidermodysplasia verruciformis
hypopigmented to pink tinea versicolor-like lesions and numerous flat-topped papules that are due to HPV-5, -8, and other β HPV types
Effect of ART on HPV?
Does not tend to clear them or prevent occurrence (can also represent IRIS)
MAY prevent progression to AIN or CIN
What is oral hairy leukoplakia caused by?
EBV