HIV pt 1 Flashcards
What is the MC opportunistic infection for HIV?
Pneumocystis pneumonia (PCP)
(T/F) HIV is a disease of humoral immunity.
- False. - HIV is a disease of cell-mediated immunity.
Other than pneumocystis pneumonia, what are other very common opportunistic infections for patients with HIV?
- HZV - TB
What type of cells are predominantly impacted by HIV?
- CD4 cells
Host defense system: What are the two main types of immunity present on and within the body?
- Innate immunity - Adaptive immunity
Host defense system: Innate immunity is composed of what cells or structures?
- Skin, mucosa (barrier system cells) - WBCs - Macrophages - NKCs - Complement
Host defense system: What are the two subcategories of adaptive immunity?
- Humoral immunity
- Cell-mediated immunity
Host defense system: What type of lymphocytes are associated with humoral immunity?
- B-lymphocytes
Host defense system: What type of lymphocytes are associated with cell-mediated immunity?
- T-lymphocytes.
Host defense system: A T-lymphocyte becomes a “helper cell” with the addition of what glycoprotein to it’s surface?
CD4
Host defense system: Describe CD4.
- a glycoprotein that can be found on the surface of T-lymphocytes.
Host defense system: A T-lymphocyte becomes a “suppressor cell” with the addition of what glycoprotein to it’s surface?
CD8
HIV transmission: What are the three main routes of HIV transmission?
- Blood - Sexual intercourse - Perinatal
HIV transmission: How can HIV be transmitted via blood?
- Transfusion (very rare in US now)
- Injection drug use
HIV transmission: Which demographics based off of sexuality preferences and practices are the most susceptible to receiving HIV via sexual intercourse?
- Heterosexual - Male-to-Male
HIV transmission: How can HIV be transmitted in a perinatal setting?
- Intrapartum - Breast feeding
HIV transmission: What is “vertical transmission”?
- When an infection is transferred directly from a mother to the child.
HIV transmission: What is the risk of HIV transmission from a needlestick?
0.25
HIV transmission: When comparing a needle stick from a hollow needle to a solid needle, which stick has a higher risk of HIV transmission? Why?
- Higher risk associated with the hollow needle. - Greater surface area exposed to Blood with HIV and to the stick.
HIV transmission: Risk of transmission from a blood transfusion with infected blood?
95%
HIV transmission: Potential risk without antiretroviral therapy (ART)?
13-40%
HIV transmission and prevention: What are the major modes of transmission?
- Mucosa (genital/rectal)
- Blood (transfusion, MTCT, needle stick injury)
- Breast feeding
HIV transmission and prevention: When considering mucosa as a major mode of HIV transmission, what would increase the risk of mucosa serving as the mode of transmission?
- cracked Skin or lesion over the mucosa
HIV transmission and prevention: (T/F) Circumcision decreases the risk of HIV transmission.
- TRUE
HIV transmission and prevention: What are universal precautions associated with prevention of HIV transmission?
- Hand washing - Safe disposal of infected material.
HIV vs AIDS: Describe the diagnosis of HIV without AIDS.
- HIV positive WITHOUT an AIDS defining illness
- Could be asymptomatic
HIV vs AIDS: Describe the diagnosis of AIDS.
- HIV positive WITH an AIDS defining illness. [OR]
- HIV positive with CD4 count < 200
HIV vs AIDS: (T/F) If a patient is HIV positive and presents with thrush, that is technically enough criteria to diagnose someone with AIDS.
- FALSE - HIV positive PLUS thrush (as an exclusive other condition present) is not enough to diagnose a PT with AIDS.
HIV S/Sx: What are the non-specific symptoms associated with HIV?
- Fever - Night sweats - Unexpected weight loss - Lymphadenopathy
HIV S/Sx: What is the MC presentation of an HIV patient?
- asymptomatic
HIV S/Sx: Are patients typically symptomatic or asymptomatic at the time of diagnosis?
- asymptomatic - Discovered via screening tests
HIV S/Sx: What is the common scenario surrounding a symptomatic patient being diagnosed with HIV?
- Commonly presents with an opportunistic infection - then found to have HIV
HIV S/Sx: It is recommended to screen anyone for HIV who has just been diagnosed with what STI?
- Syphilis
HIV S/Sx: (T/F) While it is recommended to test a patient recently diagnosed with syphilis for HIV, it is not recommended to test a patient recently diagnosed with HIV for syphilis.
- FALSE - If one is positive test for the other.
HIV S/Sx: (T/F) Acute HIV PTs are most likely to have symptoms.
- TRUE
HIV S/Sx: Briefly describe Acute HIV.
- When a PT presents with symptoms shortly after exposure. - can be a very serious condition.
PCP: What does PCP (the infection) stand for?
Pneumocystis pneumonia
PCP: This infection goes by a new name in humans. What is it?
Pneumocystis jiroveci
PCP: Is this infection classified as a virus, bacteria, or as a fungus?
- a fungus
PCP: Gold standard test?
- Silver stain on sputum sample
PCP: What is the newer test for diagnosis that actually now has a higher sensitivity than the gold standard test?
- PCR based methodology
PCP: What is the characteristic finding(s) on CXR?
- Bilateral hilar infiltrate
PCP: Bilateral hilar infiltrate is also described as what due to it’s appearance?
- “butterfly appearance” [or] - “bilateral butterfly appearance”
PCP: S/Sx?
- Fever - Dry cough - SOB - Fatigue
PCP: These patients are sometimes described as “happy hypoxemics.” What does that mean?
- They don’t appear to be as dyspneic as the SpO2 or ABG says they are. - SpO2 is usually much lower than how the patient is presenting in clinic.
PCP: Tx drug, route, doseage, and frequency?
- TMP/SMX (Bactrim) - IV - 15-20 mg/kg per day divided into Q6-8H dosing
PCP: While TMP-SMX serves as the primary antibiotic therapy, what other medication is commonly added to the therapy?
- Prednisone 40 mg PO BID
PCP: When is prednisone indicated in the therapy?
- When paO2 < 70 mmHg
PCP: When you do you prophylax HIV PTs for PCP?
- When CD4 count is < 200 mmHg
PCP: Prophylaxis Tx for HIV PTs (first line only)?
- TMP-SMX PO
PCP: If the patient is allergic to sulfa drugs but is indicated for PCP prophylaxis, what are your second-line medication options?
- Dapsone - Inhaled pentamidine
Kaposi’s sarcoma: (T/F) Macules associated with KS are exclusively found on the back and extremities.
- FALSE - Oropharyngeal cavity is an opportunistic location as well. - can be body-wide.
Kaposi’s sarcoma: Associated with what virus?
- Human herpes virus 8
Kaposi’s sarcoma: Describe the appearance of a KS lesion.
- Purplish, brownish lesion.
Kaposi’s sarcoma: Tx?
- Tx by reconstituting the immune system. - Get the PT on HIV medications as soon as possible.
CD4: What is a normal range for a CD4 count?
~500 to 1,500
CD4: What are some complications you may see even if the CD4 count is technically within a normal range?
- Acute retroviral syndrome - thrush - Esophagitis - PCP
CD4: What kind of complications might you expect when the CD4 count is between 200 and 500?
- thrush - Oral hairy leukoplakia - TB - Shingles
CD4: What kind of complications might you see when the CD count is between 100 and 200?
- HSV - Candida Esophagitis - PCP
CD4: What kind of complications might you see when the CD4 count is between 50 and 100?
- Disseminated histoplasmosis - Toxoplasmosis - Cryptococcosis - Cryptoporcollosis - Microsporcollosis
CD4: What kind of complications might you see when the CD4 count is below 50?
- Mycobacterium avium complex (MAC) - CMV
Early indicators of HIV infection: In cases of overwhelming and/or recurring cases of thrush, HIV should be considered in addition to what other condition?
- Hyperglycemia - Metabolic syndrome - DM2
Early indicators of HIV infection: In addition to recurring and severe cases of thrush, what is another condition that may appear in a severe recurring manner that makes you suspect HIV?
- HZV
