HIV lecture Flashcards by Annalyse bigatti

when does HAART medication come out?

1996

reduces mortality from AIDS in US by 60-80%

How well did you know this?

Not at all

Perfectly

what are Kaposi’s sarcoma

purple red skin lesions

How well did you know this?

Not at all

Perfectly

high risk 4 H’s

homosexual
herion addicts
hemophiliacs
hatians

How well did you know this?

Not at all

Perfectly

HAART stands for

highly active antiviral retroviral therapy

How well did you know this?

Not at all

Perfectly

where did HIV likely occur?

western Africa in the 1930’s

How well did you know this?

Not at all

Perfectly

most popular ways to transmit HIV

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

How well did you know this?

Not at all

Perfectly

CDC testing guidelines

screen all healthy patients

high risk person be tested annually
high risk persons prevention counseling

How well did you know this?

Not at all

Perfectly

what are some diseases that indicate testing for HIV?

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

How well did you know this?

Not at all

Perfectly

when do you see virus in blood

10 days after being infected

How well did you know this?

Not at all

Perfectly

what is used now instead of detecting p24 antigen?

now have HIV RNA (plasma)

How well did you know this?

Not at all

Perfectly

when do people show antibody showing HIV infection?

within 30 days of being infected

How well did you know this?

Not at all

Perfectly

common DDI instead of HIV?

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

How well did you know this?

Not at all

Perfectly

what are some clinical clues of primary HIV infection?

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

How well did you know this?

Not at all

Perfectly

what is the screening test for HIV

ELISA

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

How well did you know this?

Not at all

Perfectly

what test is done to confirm a positive ELISA test?

western blot

How well did you know this?

Not at all

Perfectly

what should never be used to diagnosis HIV?

low CD4 cell count

How well did you know this?

Not at all

Perfectly

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

below 200

How well did you know this?

Not at all

Perfectly

monitoring HIV progression

) follow CD4 count (main surrogate marker for HIV progression)
) viral loads-> measuring viral RNA, by PCR or bDNA technique

How well did you know this?

Not at all

Perfectly

what is the normal range of CD4 cell count?

350-1100/mm ^cubed

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

How well did you know this?

Not at all

Perfectly

early in disease CD4 count

> 500/mm^3

asymptomatic

How well did you know this?

Not at all

Perfectly

later disease CD4 count

500-200/mm^3

still relatively asymptomatic

How well did you know this?

Not at all

Perfectly

CD4 below 200

PCP, toxoplasmosis, cryptococcosis

How well did you know this?

Not at all

Perfectly

CD4 cell count below 50

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

How well did you know this?

Not at all

Perfectly

when to start HIV treatment

CD4 cell count < 500/mm^3

-pregnancy with planned carriage of fetus to term

targets of drugs

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

integrase inhibitor

raltegravir

fusion inhibitor

enfuvirtide

CCR5 antagonist

Maravioc

what should always be done before start HIV treatment?

test for resistance in person by using genetic sequencing

to initiate ART

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

complications from HIV treatment

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

vaccinations

avoid live vaccines | *list vaccines later*

risk factor for contracting HBV

3-40%

risk factor for contracting HCV

2-10%

risk factor for contracting HIV

.1-.5% (average .3)

what is the medication used for post exposure to HIV

Zidovudine

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

Trivada

opportunistic infections to HIV

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

pneumocystis jiroveci treatment

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

pneumocystis jiroveci prophylaxis

CD4 < 200

cryptococcal meningitis

C. neoformans var neoformans - aubacute meningitis with or without fever, HA, malaise, occasional encephalopathic symptoms, elevated ICP - meningeal signs in minority

CSF findings with cryptococcal meningitis

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

diagnosis of cryptococcal meningitis

serum and CSF cyrpto Ag blood cultures CSF fungal culture

cryptococcal meningitis treatment

antifungal therapy | managing elevated ICP-> LP or CSF shunt

CMV infection

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

TB in HIV

test HIV patients with LTBI | -first performed at CD4 <200

treat LTBI

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

disseminated M. avium complex in HIV

decreased in HAART era | -fever, weight loss, sweats, diarrhea, lymphadenopathy, hepatosplenomegaly

abnormal lab values with disseminated M. avium complex in HIV

anemia elevated alkphos. CD4<50

diagnosis of disseminated M. avium complex in HIV

bone culture

prevention of disseminated M. avium complex in HIV

recommended for CD4 100 for more than 3 months

toxoplasmosis encephalitis

``` headache fever behavorial lethargy seizure coma ataxia aphasia ```

diagnosis of toxoplasmosis

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

what can toxoplasmosis be indistinguishable from?

primary CNS lymphoma

primary CNS lymphoma clinical presentation

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

primary CNS lymphoma diagnosis

neuroimaging-> multiple lesions as frequent as single lesion, nodular or patchy enhancement, localization of cortex, deep structures CSF: mild monoculeated pleocytosis, elevated proteins

PML and JC virus

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

diagnosis of PML and JC virus

brain biopsy or CSF PCR detection of JCV DNA