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ICM lectures > HIV lecture > Flashcards

HIV lecture Flashcards

1
Q

when does HAART medication come out?

A

1996

reduces mortality from AIDS in US by 60-80%

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2
Q

what are Kaposi’s sarcoma

A

purple red skin lesions

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3
Q

high risk 4 H’s

A

homosexual
herion addicts
hemophiliacs
hatians

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4
Q

HAART stands for

A

highly active antiviral retroviral therapy

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5
Q

where did HIV likely occur?

A

western Africa in the 1930’s

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6
Q

most popular ways to transmit HIV

A

transfusion of contaminated blood 90%
needle sharing injection drug use .7%
receptive anal intercourse .5%

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7
Q

CDC testing guidelines

A

screen all healthy patients

  • high risk person be tested annually
  • high risk persons prevention counseling
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8
Q

what are some diseases that indicate testing for HIV?

A 
TB
syphilis
recurrent shingles
unexplained chronic constitutional symptoms
recurrent yeast infections
chronic diarrhea/wasting
unexplained thrombocytopenia 
HIV associated opportunistic diseaes
unexplained encephalopthy
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9
Q

when do you see virus in blood

A

10 days after being infected

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10
Q

what is used now instead of detecting p24 antigen?

A

now have HIV RNA (plasma)

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11
Q

when do people show antibody showing HIV infection?

A

within 30 days of being infected

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12
Q

common DDI instead of HIV?

A 
EBV
CMV
HSV
syphilis
rickettsial diseases
rubella
influenza 
viral hepatitis
toxoplasmosis 
early TSS
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13
Q

what are some clinical clues of primary HIV infection?

A 
mucocutaneous ulcerations
rash
abrupt onset: 10x/signs in 24 hours 
gastrointestinal symptoms
cough/URI (less likely)
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14
Q

what is the screening test for HIV

A

ELISA

-HIV antibody testing performed by using enzyme-linked immunosobent assay

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15
Q

what test is done to confirm a positive ELISA test?

A

western blot

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16
Q

what should never be used to diagnosis HIV?

A

low CD4 cell count

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17
Q

how low does CD4 count go to be considered AIDS category?

A

below 200

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18
Q

monitoring HIV progression

A
  1. ) follow CD4 count (main surrogate marker for HIV progression)
  2. ) viral loads-> measuring viral RNA, by PCR or bDNA technique
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19
Q

what is the normal range of CD4 cell count?

A

350-1100/mm ^cubed

-on average decline of 75-100/mm^ cubed

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20
Q

early in disease CD4 count

A

> 500/mm^3

asymptomatic

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21
Q

later disease CD4 count

A

500-200/mm^3

still relatively asymptomatic

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22
Q

CD4 below 200

A

PCP, toxoplasmosis, cryptococcosis

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23
Q

CD4 cell count below 50

A

CMV, M. avium complex infections
increased risk of lymphoma
mortality high

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24
Q

when to start HIV treatment

A

CD4 cell count < 500/mm^3

-pregnancy with planned carriage of fetus to term

25
Q

targets of drugs

A
  1. )reverse transciptase inhibitors-> block HIV from going to RNA to DNA
  2. ) integrase inhibitors-> block DNA from being integraded
  3. ) protease inhibitors-> stop cleaving of proteins of HIV after using cellular machinery
  4. ) fusion and entry inhibitors-> block fusion and entry into white blood cells
26
Q

integrase inhibitor

A

raltegravir

27
Q

fusion inhibitor

A

enfuvirtide

28
Q

CCR5 antagonist

A

Maravioc

29
Q

what should always be done before start HIV treatment?

A

test for resistance in person by using genetic sequencing

30
Q

to initiate ART

A 
history of AIDS defining illness
CD4 count below 350
CD4 count 350-500
pregnant women
HIV associated nephropathy 
Hep. B coinfection
31
Q

complications from HIV treatment

A

toxic to mitochondria
lipodystrophy syndrome: body morphology changes and metabolic complications
lactic acidemia/acidosis-> peripheral neuropathy, pancreatitis, myopathy, steatosis with liver failure
premature osteopenia and osteoporosis
avascular necrosis of hips
peripheral neuropathy

32
Q

vaccinations

A

avoid live vaccines

list vaccines later

33
Q

risk factor for contracting HBV

A

3-40%

34
Q

risk factor for contracting HCV

A

2-10%

35
Q

risk factor for contracting HIV

A

.1-.5% (average .3)

36
Q

what is the medication used for post exposure to HIV

A

Zidovudine

37
Q

what medication can people take for people who know they are going to be exposed or at risk?

A

Trivada

38
Q

opportunistic infections to HIV

A

pneumocystis jiroveci

  • persistent dry cough, dyspnea
  • bilateral infiltrates on chest X-ray
  • fever, tachypnea, lungs usually sound clear
  • Bronchoscopy or immunofluorescent testing done
39
Q

pneumocystis jiroveci treatment

A

patients usually worsen after 2-3 days of therapy

  • steroids to decrease risk of respiratory failure and decrease mortality
  • antimicrobial: clindamycin-primaquine, atovaquone, IV TMP/SMX or pentamidine
40
Q

pneumocystis jiroveci prophylaxis

A

CD4 < 200

41
Q

cryptococcal meningitis

A

C. neoformans var neoformans

  • aubacute meningitis with or without fever, HA, malaise, occasional encephalopathic symptoms, elevated ICP
  • meningeal signs in minority
42
Q

CSF findings with cryptococcal meningitis

A

lymphocytic pleocytosis, elevated protein, low glucose, OP elevated to >200mmH20

43
Q

diagnosis of cryptococcal meningitis

A

serum and CSF cyrpto Ag
blood cultures
CSF fungal culture

44
Q

cryptococcal meningitis treatment

A

antifungal therapy

managing elevated ICP-> LP or CSF shunt

45
Q

CMV infection

A 
end organ manifestations
-retinitis
colitis 
esophagitis
neurologic disease-> dementia
CMV viremia -> if attacks organ take seriously and treat
46
Q

TB in HIV

A

test HIV patients with LTBI

-first performed at CD4 <200

47
Q

treat LTBI

A

INH daily or twice weekly for 9 months, or rifampin or fibabutin for 4 months

48
Q

disseminated M. avium complex in HIV

A

decreased in HAART era

-fever, weight loss, sweats, diarrhea, lymphadenopathy, hepatosplenomegaly

49
Q

abnormal lab values with disseminated M. avium complex in HIV

A

anemia
elevated alkphos.
CD4<50

50
Q

diagnosis of disseminated M. avium complex in HIV

A

bone culture

51
Q

prevention of disseminated M. avium complex in HIV

A

recommended for CD4 100 for more than 3 months

52
Q

toxoplasmosis encephalitis

A 
headache
fever
behavorial
lethargy
seizure
coma
ataxia
aphasia
53
Q

diagnosis of toxoplasmosis

A

neuroimaging-> focal lesions on CT/MRI
-basal ganglia, grey-white junction, white matter

CSF-> elevated proteins

54
Q

what can toxoplasmosis be indistinguishable from?

A

primary CNS lymphoma

55
Q

primary CNS lymphoma clinical presentation

A

2-4% AIDS patients
-confusions, lethargy, memory loss, seizures, cranial nerves, headache
usually no fever

56
Q

primary CNS lymphoma diagnosis

A

neuroimaging-> multiple lesions as frequent as single lesion, nodular or patchy enhancement, localization of cortex, deep structures

CSF: mild monoculeated pleocytosis, elevated proteins

57
Q

PML and JC virus

A

latency in kidneys, lymphoid organs, bone marrow, as well as brain
-PML can been seen up to 5% of AIDS patients before cART

58
Q

diagnosis of PML and JC virus

A

brain biopsy or CSF PCR detection of JCV DNA

ICM lectures (9 decks)

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