HIV - Opportunistic Infections

Question 1

CD4+ count in Early Stage HIV:

Answer 1

> 500

Question 2

Opportunistic infections that occur in early stage HIV when CD4+ count is > 500:

Answer 2

Varicella Zoster, Herpes Simplex Virus, Strep pneumo

Question 3

CD4+ count in Middle Stage HIV:

Answer 3

250-500

Question 4

Opportunistic infections that occur in middle stage HIV when CD4+ count is between 250 and 500:

Answer 4

Bartonella, Salmonella, Candida, Syphilis, Kaposi sarcoma, Mycobacterium TB

Question 5

CD4+ count in Late Stage HIV:

Answer 5

<200

Question 6

Opportunistic infections that occur in late stage HIV when CD4+ count is below 200:

Answer 6

PCP, Cryptococcus, Histoplasma, Coccidiodes, Toxoplasma, Rhodococcus equi

Question 7

CD4+ count in very late stage HIV:

Answer 7

<100

Question 8

Opportunistic infections that occur in very late stage HIV when CD4+ count is below 100:

Answer 8

MAC, Cryptosporidiosis, PML, CMV

Question 9

When does “HIV become AIDs?”

Answer 9

When CD4+ count drops below 200

Question 10

If a patient’s CD4+ count drops to 100 and then returns to 300, does that patient have HIV or AIDs?

Answer 10

AIDs

Question 11

Causative agent of Pneumocystis Carnii Pneumonia (PCP):

Answer 11

Pneumocystitis jirovecii

Question 12

Symptoms of PCP

Answer 12

non-specific, “I just don’t feel good,” hypoxia might be severe

Question 13

CXR findings of PCP:

Answer 13

“Bilateral, fluffy whiteness that is everywhere”

Question 14

When do you start prophylaxis for PCP? / What do you use?

Answer 14

Undiagnosed fever, night sweats, thrush, weight loss & CD4+ count is over 200 OR CD4+ count is below 200 & no symptoms / TMP-SMX, bactrim

Question 15

Describe Kaposi Sarcoma:

Answer 15

Purple, non-blanching lesions; can require chemo if severe

Question 16

Do you prophylax for Candidiasis?

Answer 16

No

Question 17

Candidiasis is usually seen in a CD4+ count less than what?

Answer 17

100

Question 18

Most common spots for candidiasis?

Answer 18

Esophageal, oral, vaginal, dermal

Question 19

Most common space-occupying CNS lesion in HIV infected patients? / Symptoms

Answer 19

Toxoplasmosis / AMS & neuro defecits

Question 20

Prophylaxis for Toxoplasmosis?

Answer 20

TMP-SMX, bactrim (like PCP, convenient)

Question 21

What is Progressive Multifocal Leukoencephalopathy?

Answer 21

PML = viral infection in white matter of brain

Question 22

Classic finding of PML / Symptoms

Answer 22

Nonenhancing white matter lesions without mass effect / aphasia, hemiparesis, cortical blindness

Question 23

Mycobacterium Avium Complex (MAC):

Answer 23

Organism ubiquitous in the environment but can be deadly to HIV patients

Question 24

CD4+ count associated with MAC?

Answer 24

less than 50

Question 25

Prophylaxis for MAC:

Answer 25

Azithromycin

Question 26

DX for MAC:

Answer 26

It is a MYCOBACTERIUM so you acid-fast stain it! Culture will take way too long.

Question 27

Treatment for Cryptosporidium?

Answer 27

We don't have one

Question 28

When does enterocolitis occur? / what usually causes it? / Dx?

Answer 28

All stages of HIV / viral, bacterial, or protozoal / Dx using stool Cx

Question 29

Cytomegalovirus is the most common cause of what? / Dx

Answer 29

Retinitis (blurred vision, loss of central vision, retinal detachment) / Fundascopic exam

Question 30

Do you prophylax for CMV? / When / with what?

Answer 30

Yes / CD4 lower than 50 / Ganciclovir

Question 31

All opportunistic infections you use prophylaxis for and with what?

Answer 31

PCP, CD4 under 200, Bactrim / Toxoplasmosis, Bactrim / Mycobacterium Avium Complex, Azithromycin / Enterocolitis, proper hygiene & avoid raw oysters / Cytomegalovirus, under 50, Ganciclovir

Question 32

Causative agent of oral hairy leukoplakia

Answer 32

EBV

Question 33

Viral cause of Kaposi Sarcoma

Answer 33

HHV 8