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HIV Dan Flashcards

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1
Q

T/F

HIV is an enveloped single stranded DNA virus

A

False

enveloped single stranded RNA virus

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2
Q

T/F

HIV belongs to the genus Lentivirus within the family of Retroviridae

A

True

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3
Q

What is the incubation period for HIV?

A

3-6 weeks

but shorter when transmitted hematogenously and/or when large viral load

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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

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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

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6
Q

T/F

HIV replication involves destruction of the host cell

A

True

results in decline in CD4+ count

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7
Q

T/F

In established HIV >1 million viral particles are produced in the host each day

A

False

> 1 billion

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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

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9
Q

T/F

HIV-2 is more transmissable than HIV (1)

A

False

less transmissable

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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

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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
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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

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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

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14
Q

T/F

CD8+ cytotoxic T-lymphocyte response is an important factor in controlling HIV infection throughout the disease course

A

True

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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

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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

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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
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18
Q

T/F

Median time for progression of untreated HIV to AIDS is 5 years

A

False

10 years

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19
Q

T/F

Rapid progressors develop AIDS within 2-3 years

A

True

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20
Q

T/F

Pts on modern ART (HAART) have a normal life expectency

A

True

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21
Q

T/F

gender and race do not affect rate of progression of HIV

A

True

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22
Q

T/F

MSM HIV pts progress more quickly than transfusion recipients

A

False

other way around

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23
Q

T/F

people who contract HIV when they are older progress more quickly than those who are younger

A

True

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24
Q

T/F

Pts with asymptomatic seroconversion progress more quickly

A

False

slower progression

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25
Q

T/F

50% of pts have asymptomatic seroconversion

A

False

10-25% asymptomatic

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26
Q

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

A

True
High viral load earlier is poor prognostic marker
also rapid decline in CD4+ count

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27
Q

T/F
Combined measurement of CD4+ counts and viral load is an extremely accurate method for assessing the prognosis of infected patients

A

True

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28
Q

T/F
first-line initial ART includes two nucleotide/nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitor

A

True

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29
Q 
T/F
Antiretroviral therapy (ART) is recommended for all HIV-infected individuals, irrespective of CD4 count, to reduce the risk of disease progression
A

True
this is new
old guideline is to start ART when CD4+ counts ≤500 cells/mm3 or certain conditions or comorbidities

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30
Q

T/F
When HIV replication is adequately suppressed (i.e. below 50 copies/ml plasma), evolution of viral resistance to antiretroviral drugs is minimal

A

True

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31
Q

T/F

ART results in reduced HPV and poxvirus infections and anal cancer

A

False
These are increased
probably due to patients surviving longer

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32
Q 
T/F
ART results in reduction of;
•	candidiasis
•	KS
•	Eosinophilic folliculitis
•	Opportunistic mycoses/mycobacterioses
•	Oral hairy leucoplakia
A

True

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33
Q

What is Immune reconstitution Inflammatory Syndrome (IRIS)?

A

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

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34
Q

Which cutaneous conditions can flare during IRIS?

A

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

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35
Q

T/F

Antiretrovirals are all CYP450 inhibitors

A

False
many are inducers
some are inhibitors

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36
Q

T/F

HIV +ve pts get more morbilliform drug eruptions

A

True

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37
Q

What is most common drug to cause a cutaneous reaction in HIV-infected patients?

A

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

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38
Q

T/F

Co-trimoxazole causes sutaneous reactions in HIV pts 20x more than the general population

A

False

10x more

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39
Q

T/F

Retinoid-like AEs are seen with nucleotide inhibitors

A

False
seen in protease inhibitors
Include;
desquamative chelitis and xerosis, paronychia, ingrown toenails, periungual pyogenic granuloma-like lesions, curly hair

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40
Q

what are the common inflammatory dermatoses seen in HIV?

A 
Pruritus/xerosis/icthyosis
Pruritic papular eruption
Nodular prurigo
Folliculitis
Eosinophilic folliculitis
Seborrheic dermatitis 
Psoriasis
Drug eruptions

sometimes;
GA
PCT
Reiter’s

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41
Q

what are the common cutaneous infections seen in HIV?

A 
HSV
VZV
Viral warts
Mollusca
Oral and vaginal candidiasis
Tinea (including onychomycosis)
Scabies
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42
Q

what are the common skin cancers seen in HIV?

A

BCC
SCC
Kaposi’s sarcoma
Eruptive atypical melanocytic nevi and melanoma

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43
Q

T/F

Kaposis sarcoma usually occurs in HIV pts with CD4+ count below 250 cells/mm3

A

False

Below 500 cells/mm3

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44
Q

T/F

Infection with mycobacteria and atypical fungi usually occur only when the CD4+ count is below 250 cells/mm3

A

True

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45
Q

Whic skin complaints are associated with the lowest CD4+ count range

A

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

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46
Q

T/F

seb derm, vaginal candida and oral hairy leukoplakia can occur with high CD4+ counts, >500

A

True

47
Q

What are the features of seroconversion

(Acute Retroviral Syndrome/Acute primary HIV infection/Exanthem of Primary HIV infection)?

A

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
Q

T/F

The CD4+ count does not decline during seroconversion

A

False

declines a little then peaks but not to pre-infection levels before slowly declining over years

49
Q

T/F

During seroconversion the CD8+ cells peak just after the peak viraemia and trough of CD4+ count

A

True

50
Q

T/F

New HIV tests detect the viral protein HIV-1 p24 antigen which is detectable before antibodies appear

A

True

51
Q

T/F

Pts can remain negative to traditional HIV Ab tests for up to 3 months after infection

A

True

52
Q

T/F

Hyperpigmenattion of skin, nails and mucosae is common in HIV pts

A

True
Causes include;
drugs (idovudine, hydroxyurea, indinovir)
opportunistic infections such as toxoplasmosis
hypoadrenalism

53
Q

T/F

HIV-related thrombocytopenic purpura may present and can be mistaken for KS

A

True

54
Q

T/F

HIV-infected patients are low risk for venous and arterial thrombosis

A

False

increased risk

55
Q

T/F

85% of HIV pts get seb derm

A

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
Q

T/F

10-15% of geneal population get seb derm

A

False

1-3%

57
Q

T/F

HIV pts at increased risk of seb derm erythroderma and pityrosporum folliculitis

A

True

58
Q

In which seb derm pts should you check HIV test?

A

Sudden onset or acute worsening of seb derm should alert to possibility of HIV
esp if high risk social group

59
Q

T/F

Atopic dermatitis is more common in children with HIV

A

False

60
Q

T/F

HLA-Cw0602 is associated with psoriasis in HIV pts and with post strep guttate psoriasis

A

True

61
Q

T/F

Psoriasis in HIV-infected patients may be florid, severe, of sudden onset and atypical

A

True

62
Q

T/F

Psoriasis is more common in HIV pts

A

False

63
Q

T/F

HIV pts are at higehr risk of Reiter’s syndrome and more severe features of it

A

True

may follow chlamydia inf or bacterial gastroenteritis

64
Q

What are the features of Reiter’s/ reactive arhtritis?

A 
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
Q

What is keratoderma blennorrhagicum?

A

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
Q

How is reactive arthritis/ Reiters treated?

A

Treat cause

other Rx same as psoriasis - same topicals, nbUVB and systemics

67
Q

T/F

Eosinophilic folliculitis occurs at CD4+ cell counts of 250-300

A

True
Cause unknown
Presents as centripetal (face (85%) and trunk) eruption of pruritic, erythematous, perifollicular papules and pustules

68
Q

What is the treatment of Immunosuppression-associated Eosinophilic folliculitis?

A 
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
Q

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

A

True

70
Q

T/F

Pruritic papular eruption of HIV resembles insect bite reactions clinically and histologically

A

True
Excoriated, erythematous, urticarial non-follicular papules
associated with eosinophilia and elevated IgE
secondary impetiginisation of excoriated lesions common

71
Q

T/F

Staphylococcus aureus is the most common bacterial pathogen in HIV patients

A

True

72
Q

T/F

MRSA is 20x more common in HIV pts

A

False

6x more common

73
Q

What are the uncommon skin infections in HIV?

A

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
Q

T/F

zoster is the commonest cutaneous manifestation of immune restoration syndrome

A

True

75
Q

what is the presentation of skin CMV in HIV pts?

A

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
Q

What is acquired epidermodysplasia verruciformis?

A

Rare presentation of HPV skin infection in HIV pts

widespread flat warts and pityriasis versicolor-like macules or seb-k like lesions

77
Q

T/F

purpuric ‘thumbprints’ on the lower abdomen are a feature of atypical infection with leishmaniasis in HIV pts

A

False

in strongyloidiasis

78
Q

T/F

scabies can be recalcitrant in HIV pts

A

True

may need several doses of ivermectin + topicals

79
Q

T/F

Rosacea-like demodicosis may be more frequent in HIV-positive patients

A

True

80
Q

In what situations should de-sensitization to co-trimoxazole not be considered?

A

In pts who have had rcns such as DRESS or SJS/TEN

81
Q

T/F

The cross-reactivity between dapsone and co-trimoxazole is 20%

A

True

avoid dapsone in pts who have had severe rcns to co-trimoxazole

82
Q

T/F

Kaposis sarcoma is a virally induced disease due to HHV8

A

True

Controversial whether KS represents neoplasia or hyperplasia of lymphatic/blood vasculature

83
Q

What are the clinical variants of Kaposis’s sarcoma?

A

Chronic or classic KS
African endemic KS
KS due to iatrogenic immunosuppression
AIDS-related epidemic KS

84
Q

What are the features of classic KS?

A

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
Q

What are the features of African endemic KS?

A

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
Q

What are the features of iatrogenic immunosuppression KS?

A

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
Q

What are the features of AIDS-related KS?

A

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
Q

what are the main histological features of Kaposis sarcoma?

A

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
Q

What are poor prognsotic factors in AIDS-associated KS?

A 
Tumour (T)
- Tumour-associated oedema or ulceration
- Extensive oral KS
- GIT KS
- KS in other non-nodal viscera
Immune status (I)
- CD4+ count
90
Q

How is AIDS-associated KS managed?

A 
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
Q

T/F

skin malignancies constitute the most frequent non-AIDS defining cancers amongst HIV-positive people

A

True

92
Q

T/F

HIV patients have a 3-5 fold risk of NMSC

A

True

93
Q

T/F

HIV patients get more SCCs than BCCs usually

A

False

7x more BCCs than SCC

94
Q

T/F

HIV patients get NMSC at a younger age

A

True

95
Q

T/F

HIV patients get NMSC primarily on the head and neck

A

False

more often multifocal and located on trunk and extremities

96
Q

T/F

Cutaneous SCC in HIV pts have a high risk of recurrence and metastasis

A

True

97
Q

T/F

BCC in HIV pts have a high risk of recurrence and metastasis

A

False

no more than in other pts

98
Q

T/F
HPV infection increases the risk of anogenital, oral, digital, and HPV-associated cutaneous SCCs in HIV-infected patients

A

True

aggressive treatment is often required to prevent recurrences and metastases

99
Q

T/F

Melanoma in HIV pts behaves the same as in other cases

A

False

Melanoma may present atypically and behave more aggressively

100
Q

What modifications should be made when manageing skin cancers in HIV +ve pts?

A

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
Q

T/F

HIV–associated lymphomas are most often non-Hodgkin B-cell type and high or intermediate grade

A

True

But can be B- or T-cell lineage

102
Q

T/F

HIV–associated lymphomas most often develop when CD4+ cell counts

A

True

103
Q

T/F

nearly all non-Hodgkin Lymphomas in HIV-infected patients are associated with EBV infection

A

False

50%

104
Q

T/F

HIV pts are at increased risk of adult T-cell leukaemia and lymphoma caused by HTLV-1

A

True

105
Q

T/F

Nail changes are common in HIV pts

A

True

up to 70% of pts

106
Q

T/F

In HIV onychomycosis is usually due to T. rubrum or uncommon Candida species

A

True

107
Q

What are the common oropharyngeal complications of HIV?

A

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
Q

T/F

Oral Hairy leukoplakia has only emerged with the recognition of HIV

A

True

109
Q

T/F

Oral Hairy leukoplakia is a sign of significant reduced immunity (low CD+ count)

A

False
early specific sign of HIV infection
Can occur with CD4+ count >500

110
Q

T/F

Oral Hairy leukoplakia portends a poor prognosis as most pts go on to develop AIDS within 3 years

A

True

75% of patients develop AIDS within 2-3 years

111
Q

T/F

Oral Hairy leukoplakia is painfull

A

False

asymptomatic and often unnoticed

112
Q

T/F

Oral Hairy leukoplakia is thought to be associated with HPV infection

A

True

113
Q

What is the Rx of Oral Hairy leukoplakia?

A 
responds to ART/HAART
topical podophyloin
topical retinoids
topical gentian violet
cryotherapy
surgical excision

Medical dermatology Dan (41 decks)

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