HIV Dan Flashcards
1
Q
T/F
HIV is an enveloped single stranded DNA virus
A
False
enveloped single stranded RNA virus
2
Q
T/F
HIV belongs to the genus Lentivirus within the family of Retroviridae
A
True
3
Q
What is the incubation period for HIV?
A
3-6 weeks
but shorter when transmitted hematogenously and/or when large viral load
4
Q
HIV uses the bodies own cells to replicate itself
A
True
RNA of virus turned into DNA by reverse transcriptase
viral DNA incorporated into human genome
transcription of viral DNA into RNA which either becomes the genome of new viral particles or is translated into viral proteins
5
Q
T/F
HIV particularly affects CD+ T cells resulting in significant reduction in host immunity
A
True
cell-mediated rather than humoral immunity
6
Q
T/F
HIV replication involves destruction of the host cell
A
True
results in decline in CD4+ count
7
Q
T/F
In established HIV >1 million viral particles are produced in the host each day
A
False
> 1 billion
8
Q
Which HIV linaage is most common in Australia?
A
Cade B of the M (Major) lineage - 3rd highest worldwide incidence
seen in UK, USA, Aus
Cade C has highest incidence - South Africa, India, China
2nd is Cade A - Africa, Eastern Europe
Other lineages are;
O - Outlier - Camaroon region
N - New - West Africa
9
Q
T/F
HIV-2 is more transmissable than HIV (1)
A
False
less transmissable
10
Q
T/F
HIV-2 is identical to HIV-1
A
False
Viral structure, mode of transmission, and immune deficiency syndrome is identical to those of HIV-1
But there are genetic differences and is less transmissable
11
Q
What are the differences between HIV-2 from HIV-1?
A
5-8 fold less transmissibility rare vertical transmission longer period of latency slower rate of cD4+ count decline slower clinical progression
12
Q
What are long-term non-progressor patients?
A
Those whose immune response is sufficient to keep the infection under control so that they do not develop AIDS
13
Q
T/F
The decreased ability of infected helper T lymphocytes to proliferate and produce IL-2 is central to the pathogenesis of HIV infection
A
True
14
Q
T/F
CD8+ cytotoxic T-lymphocyte response is an important factor in controlling HIV infection throughout the disease course
A
True
15
Q
What is the definition of AIDS?
A
CD4+ count of less than 200 cells/mm3 and/or the presence of an AIDS-defining condition
16
Q
T/F
The earliest cutaneous manifestation of HIV infection is an acute morbiliform exanthem that is often accompanied by fever an lymphadenopathy
A
True
seroconversion reaction
During this phase, HIV virus disseminates widely, seeding lymphoid organs and other internal sites such as CNS
17
Q
What are AIDS-defining illnesses?
A
Mostly unusual infections and some rare cancers e.g Kaposi's sarcoma various lymphomas disseminated Coccidioidomycosis extrapulmonary Cryptococcosis Intestinal Cryptosporidiosis for >1 month Mucocutaneous HSV lasting >1 month M. TB of any type other dissemniated Mycobacterial infections Pneumocystis Jiroveci Pneumonia (PCP) Toxoplasmosis Non-typhoid salmonella
18
Q
T/F
Median time for progression of untreated HIV to AIDS is 5 years
A
False
10 years
19
Q
T/F
Rapid progressors develop AIDS within 2-3 years
A
True
20
Q
T/F
Pts on modern ART (HAART) have a normal life expectency
A
True
21
Q
T/F
gender and race do not affect rate of progression of HIV
A
True
22
Q
T/F
MSM HIV pts progress more quickly than transfusion recipients
A
False
other way around
23
Q
T/F
people who contract HIV when they are older progress more quickly than those who are younger
A
True
24
Q
T/F
Pts with asymptomatic seroconversion progress more quickly
A
False
slower progression
25
T/F
| 50% of pts have asymptomatic seroconversion
False
| 10-25% asymptomatic
26
T/F
A single measurement of plasma RNA viral load early in infection is a powerful predictor of the subsequent risk of progression to AIDS and death
True
High viral load earlier is poor prognostic marker
also rapid decline in CD4+ count
27
T/F
Combined measurement of CD4+ counts and viral load is an extremely accurate method for assessing the prognosis of infected patients
True
28
T/F
first-line initial ART includes two nucleotide/nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitor
True
29
```
T/F
Antiretroviral therapy (ART) is recommended for all HIV-infected individuals, irrespective of CD4 count, to reduce the risk of disease progression
```
True
this is new
old guideline is to start ART when CD4+ counts ≤500 cells/mm3 or certain conditions or comorbidities
30
T/F
When HIV replication is adequately suppressed (i.e. below 50 copies/ml plasma), evolution of viral resistance to antiretroviral drugs is minimal
True
31
T/F
| ART results in reduced HPV and poxvirus infections and anal cancer
False
These are increased
probably due to patients surviving longer
32
```
T/F
ART results in reduction of;
• candidiasis
• KS
• Eosinophilic folliculitis
• Opportunistic mycoses/mycobacterioses
• Oral hairy leucoplakia
```
True
33
What is Immune reconstitution Inflammatory Syndrome (IRIS)?
Similar to Jarisch-Herxheimer or reversal or Rx rcn in Buruli ulcer Rx
due to immune reconstitution especially when CD4+ counts rise at least twofold from depressed levels
Exacerbations of clinical severity of infections, neoplasia, and inflammatory diseases
e.g. Herpes zoster, leprosy, disseminated MAC, CMV
34
Which cutaneous conditions can flare during IRIS?
Infections
• TB, leprosy, Mycobacterium avium complex (MAC) and other mycobacterium, HSV, VZV, HPV, Molluscum, Candida, Demodex, Mallassezia (e.g. folliculitis), Leishmaniasis
Inflammatory disorders
• Psoriasis, seborrheic dermatitis, eosinophilic folliculitis, acne vulgaris, rosacea, LE, AA, dyshidrotic eczema, sarcoidosis
Neoplasms
• KS, Non-Hodgkin lymphoma, Multiple eruptive dermatofibromas
35
T/F
| Antiretrovirals are all CYP450 inhibitors
False
many are inducers
some are inhibitors
36
T/F
| HIV +ve pts get more morbilliform drug eruptions
True
37
What is most common drug to cause a cutaneous reaction in HIV-infected patients?
Co-trimoxazole
= TMP-SMX, Bactrim, Septrin
leads to and exanthematous eruption and fever in 50-60% of HIV-infected patients treated IV typically 8-12 days after initiating therapy
Often taken for PCP prophylaxis or toxoplasmosis
38
T/F
| Co-trimoxazole causes sutaneous reactions in HIV pts 20x more than the general population
False
| 10x more
39
T/F
| Retinoid-like AEs are seen with nucleotide inhibitors
False
seen in protease inhibitors
Include;
desquamative chelitis and xerosis, paronychia, ingrown toenails, periungual pyogenic granuloma-like lesions, curly hair
40
what are the common inflammatory dermatoses seen in HIV?
```
Pruritus/xerosis/icthyosis
Pruritic papular eruption
Nodular prurigo
Folliculitis
Eosinophilic folliculitis
Seborrheic dermatitis
Psoriasis
Drug eruptions
```
sometimes;
GA
PCT
Reiter's
41
what are the common cutaneous infections seen in HIV?
```
HSV
VZV
Viral warts
Mollusca
Oral and vaginal candidiasis
Tinea (including onychomycosis)
Scabies
```
42
what are the common skin cancers seen in HIV?
BCC
SCC
Kaposi’s sarcoma
Eruptive atypical melanocytic nevi and melanoma
43
T/F
| Kaposis sarcoma usually occurs in HIV pts with CD4+ count below 250 cells/mm3
False
| Below 500 cells/mm3
44
T/F
| Infection with mycobacteria and atypical fungi usually occur only when the CD4+ count is below 250 cells/mm3
True
45
Whic skin complaints are associated with the lowest CD4+ count range
Major apthae
Acquired ichthyosis
Papular pruritic eruption
Non-healing ulcers esp perianal due to HSV or CMV
Giant molllusca
Mycobacterium avium complex (MAC) infection
Aspergillosis
46
T/F
| seb derm, vaginal candida and oral hairy leukoplakia can occur with high CD4+ counts, >500
True
47
What are the features of seroconversion
| (Acute Retroviral Syndrome/Acute primary HIV infection/Exanthem of Primary HIV infection)?
Occurs 1-6 wks post infection
lasts about 2 wks in most pts
fever, lymphadenopathy, pharyngitis +
generalised morbilliform exanthem (in 75%) most prominent on face and torso and sparring the distal extremities and lasting 4-5 days
Can be arthralgia, myalgia, night sweats, lymphadenopathy, GI upset
rarely oral or genital ulcers, urticaria, EM, intertrigo or enanthem (eruption on mucous membranes)
48
T/F
| The CD4+ count does not decline during seroconversion
False
| declines a little then peaks but not to pre-infection levels before slowly declining over years
49
T/F
| During seroconversion the CD8+ cells peak just after the peak viraemia and trough of CD4+ count
True
50
T/F
| New HIV tests detect the viral protein HIV-1 p24 antigen which is detectable before antibodies appear
True
51
T/F
| Pts can remain negative to traditional HIV Ab tests for up to 3 months after infection
True
52
T/F
| Hyperpigmenattion of skin, nails and mucosae is common in HIV pts
True
Causes include;
drugs (idovudine, hydroxyurea, indinovir)
opportunistic infections such as toxoplasmosis
hypoadrenalism
53
T/F
| HIV-related thrombocytopenic purpura may present and can be mistaken for KS
True
54
T/F
| HIV-infected patients are low risk for venous and arterial thrombosis
False
| increased risk
55
T/F
| 85% of HIV pts get seb derm
True
Most common skin disorder to affect HIV-infected individuals
seen in all stages of disease
more severe if lower CD+ count esp if
56
T/F
| 10-15% of geneal population get seb derm
False
| 1-3%
57
T/F
| HIV pts at increased risk of seb derm erythroderma and pityrosporum folliculitis
True
58
In which seb derm pts should you check HIV test?
Sudden onset or acute worsening of seb derm should alert to possibility of HIV
esp if high risk social group
59
T/F
| Atopic dermatitis is more common in children with HIV
False
60
T/F
| HLA-Cw0602 is associated with psoriasis in HIV pts and with post strep guttate psoriasis
True
61
T/F
| Psoriasis in HIV-infected patients may be florid, severe, of sudden onset and atypical
True
62
T/F
| Psoriasis is more common in HIV pts
False
63
T/F
| HIV pts are at higehr risk of Reiter's syndrome and more severe features of it
True
| may follow chlamydia inf or bacterial gastroenteritis
64
What are the features of Reiter's/ reactive arhtritis?
```
SARA RUCA
Sexually Acquired Reactive Arthritis
Rash - mucocutaneous features
Urethritis (non-gonococcal)
Conjunctivits
Arthritis
mucocutaneous features;
Oral ulcers
scaly red patches/plaques resembling psoriasis
keratoderma blennorrhagicum
balanitis circinata (scaly/eroded rash on glans)
papules and pustules on fingers and toes
paronychia
```
65
What is keratoderma blennorrhagicum?
Feature of reactive arthitis
usually occurs 2 months after the arthritis
hard, tender papules, pustules, bullae or scaly plaques on soles of feet extending up shins - may appear purpuric
66
How is reactive arthritis/ Reiters treated?
Treat cause
| other Rx same as psoriasis - same topicals, nbUVB and systemics
67
T/F
| Eosinophilic folliculitis occurs at CD4+ cell counts of 250-300
True
Cause unknown
Presents as centripetal (face (85%) and trunk) eruption of pruritic, erythematous, perifollicular papules and pustules
68
What is the treatment of Immunosuppression-associated Eosinophilic folliculitis?
```
ARV/HAART NB: immune reconstitution exacerbations have been reported
Phototherapy very affective
TCS
Topical tacrolimus
Oral antihistamines
Oral dapsone
Oral itraconazole (for its antieosinophilic effect)
Oral isotretinoin
```
69
T/F
Pruritic papular eruption of HIV is a sign of an advanced degree of immunosuppression and may often be first sign of HIV (occurring with CD4+ cell counts below 100-200) with severity of the rash inversely proportional to the CD4 count
True
70
T/F
| Pruritic papular eruption of HIV resembles insect bite reactions clinically and histologically
True
Excoriated, erythematous, urticarial non-follicular papules
associated with eosinophilia and elevated IgE
secondary impetiginisation of excoriated lesions common
71
T/F
| Staphylococcus aureus is the most common bacterial pathogen in HIV patients
True
72
T/F
| MRSA is 20x more common in HIV pts
False
| 6x more common
73
What are the uncommon skin infections in HIV?
Botryomycosis - verrucous discharging lesion with fistulae etc - staph or pseudamonas
Bacillary angiomatosis (cat scratch disease)
Mycobacteria - esp if v low CD4+ count
syphylis - May present atypically in HIV, test all HIV pts for syphylis
atypical zoster inc disseminated disease
C
74
T/F
| zoster is the commonest cutaneous manifestation of immune restoration syndrome
True
75
what is the presentation of skin CMV in HIV pts?
Purpura, papules, nodules, verrucous plaques and painful ulcers, including perineum and nodular prurigo
Rx
Prophylaxis and treatment with ARV/HAART
IV foscarnet, ganciclocir, and cidofovir
76
What is acquired epidermodysplasia verruciformis?
Rare presentation of HPV skin infection in HIV pts
| widespread flat warts and pityriasis versicolor-like macules or seb-k like lesions
77
T/F
| purpuric ‘thumbprints’ on the lower abdomen are a feature of atypical infection with leishmaniasis in HIV pts
False
| in strongyloidiasis
78
T/F
| scabies can be recalcitrant in HIV pts
True
| may need several doses of ivermectin + topicals
79
T/F
| Rosacea-like demodicosis may be more frequent in HIV-positive patients
True
80
In what situations should de-sensitization to co-trimoxazole not be considered?
In pts who have had rcns such as DRESS or SJS/TEN
81
T/F
| The cross-reactivity between dapsone and co-trimoxazole is 20%
True
| avoid dapsone in pts who have had severe rcns to co-trimoxazole
82
T/F
| Kaposis sarcoma is a virally induced disease due to HHV8
True
| Controversial whether KS represents neoplasia or hyperplasia of lymphatic/blood vasculature
83
What are the clinical variants of Kaposis's sarcoma?
Chronic or classic KS
African endemic KS
KS due to iatrogenic immunosuppression
AIDS-related epidemic KS
84
What are the features of classic KS?
Jewish (Ashkenazi) descent and/or of Mediterranean/Eastern European descent
age over 50, M>F
growing pink to red-violet macules on distal legs that may coalesce to form large plaques or develop into nodules or polypoid tumours
early lesions may regress while new lesions arise
Can involve mouth and GIT which may be asymptomatic
85
What are the features of African endemic KS?
Affects black Africans, M>F
4 subtypes;
• Nodular – resembles classic KS in course and appearance
• Florid – more biologically aggressive
• Infiltrative - more biologically aggressive
• Lymphadenopathic – predominantly affects children, primary tumours involve LNs (although skin and mucosal lesions may also be present) course is fulminant and fatal
86
What are the features of iatrogenic immunosuppression KS?
Due to meds e.g. pred, calcineurin inhibitors etc
M>F
clinically similar to classic disease
can be aggressive
often resolves if immunosuppression stopped
87
What are the features of AIDS-related KS?
Mainly affects MSM
Affects up to 40% of men who have AIDS and became HIV-infected via homosexual contact
Only 5% of other HIV/AIDS pts
Onset usually when CD4+ cell counts
88
what are the main histological features of Kaposis sarcoma?
Blue Spindle cell tumour with many RBCs in between
Spindle-shaped endothelial cells infiltrate through collagen forming slit-like spaces esp at periphery of lesion
Arranged in fascicles resembling schools of fish or storiform arrangement
Promontory sign is newly formed vessels protruding into an existing space
Only slight pleomorphism and sparse mitoses
May be plasma cells and some lymphocytes
Do HHV8 also +ve for CD31 and CD34
89
What are poor prognsotic factors in AIDS-associated KS?
```
Tumour (T)
- Tumour-associated oedema or ulceration
- Extensive oral KS
- GIT KS
- KS in other non-nodal viscera
Immune status (I)
- CD4+ count
```
90
How is AIDS-associated KS managed?
```
AIDS-defining illness
initiation of ART/HAART recommended
Local treatment (for localised disease):
• Cryotherapy
• Radiotherapy
• Topical antivirals: cidofovir
• Surgery (excision, C+C)
• Laser
• Intra-lesional IFN-alpha, TNF-alpha, vincristine
• PDT
• Cosmetic camouflage
Systemic treatment
• ART/HAART
• Isotretinoin
• Cidofovir
• IV chemotherapy
```
91
T/F
| skin malignancies constitute the most frequent non-AIDS defining cancers amongst HIV-positive people
True
92
T/F
| HIV patients have a 3-5 fold risk of NMSC
True
93
T/F
| HIV patients get more SCCs than BCCs usually
False
| 7x more BCCs than SCC
94
T/F
| HIV patients get NMSC at a younger age
True
95
T/F
| HIV patients get NMSC primarily on the head and neck
False
| more often multifocal and located on trunk and extremities
96
T/F
| Cutaneous SCC in HIV pts have a high risk of recurrence and metastasis
True
97
T/F
| BCC in HIV pts have a high risk of recurrence and metastasis
False
| no more than in other pts
98
T/F
HPV infection increases the risk of anogenital, oral, digital, and HPV-associated cutaneous SCCs in HIV-infected patients
True
| aggressive treatment is often required to prevent recurrences and metastases
99
T/F
| Melanoma in HIV pts behaves the same as in other cases
False
| Melanoma may present atypically and behave more aggressively
100
What modifications should be made when manageing skin cancers in HIV +ve pts?
Special attention to local excisional margin control
More extensive investigation for regional or disseminated disease
Closer follow-up in patients with SCC and melanoma
101
T/F
| HIV–associated lymphomas are most often non-Hodgkin B-cell type and high or intermediate grade
True
| But can be B- or T-cell lineage
102
T/F
| HIV–associated lymphomas most often develop when CD4+ cell counts
True
103
T/F
| nearly all non-Hodgkin Lymphomas in HIV-infected patients are associated with EBV infection
False
| 50%
104
T/F
| HIV pts are at increased risk of adult T-cell leukaemia and lymphoma caused by HTLV-1
True
105
T/F
| Nail changes are common in HIV pts
True
| up to 70% of pts
106
T/F
| In HIV onychomycosis is usually due to T. rubrum or uncommon Candida species
True
107
What are the common oropharyngeal complications of HIV?
Xerostomia is common
Transient intraoral redness, erosions, and ulcers
Distressing mouth ulceration occurs frequently
Oral candida very common
Severe periodontal disease is not unusual
Hairy leukoplakia
Smoking and alcohol ingestion contribute
108
T/F
| Oral Hairy leukoplakia has only emerged with the recognition of HIV
True
109
T/F
| Oral Hairy leukoplakia is a sign of significant reduced immunity (low CD+ count)
False
early specific sign of HIV infection
Can occur with CD4+ count >500
110
T/F
| Oral Hairy leukoplakia portends a poor prognosis as most pts go on to develop AIDS within 3 years
True
| 75% of patients develop AIDS within 2-3 years
111
T/F
| Oral Hairy leukoplakia is painfull
False
| asymptomatic and often unnoticed
112
T/F
| Oral Hairy leukoplakia is thought to be associated with HPV infection
True
113
What is the Rx of Oral Hairy leukoplakia?
```
responds to ART/HAART
topical podophyloin
topical retinoids
topical gentian violet
cryotherapy
surgical excision
```
