Infectious Disease Flashcards
Which type of HIV is most common?
HIV-1. HIV-2 infection also results in AIDS, but HIV-2 infection has a considerably longer clinically latent period than HIV-1. HIV-2 originates from West Africa. Rare cases in North America have been traced back to there.
Vertical transmission rates to neonate a?
Vertical transmission from mother to child may occur in utero, during labor, or through breastfeeding. In the absence of antiretroviral treatment, HIV infects 25% to 30% of infants born to HIV-infected mothers. The rate of vertical transmission can be reduced to less than 2% by prenatal and perinatal treatment of the mother and postnatal
Opportunistic infections indicative of AIDS infection
Opportunistic Infections Indicative of a Defect in Cellular Immune Function Associated with AIDS
Protozoan Infection
Toxoplasma gondii encephalitis
Cryptosporidium parvum enteritis ( > 1 mo)
Isospora belli enteritis ( > 1 mo)
Fungal Infection Candida esophagitis Crypto occurs neoformans meningitis Disseminated histoplasmosis Disseminated coccidioidomycosis Pneumocystis jirovecii pneumonia (PCP)
Bacterial Infection
Disseminated Mycobacterium avium-intracellulare Active Mycobacterium tuberculosis infection Recurrent Salmonella septicemia
Recurrent bacterial pneumonia
Viral Infection
Chronic ( > 1 mo) mucocutaneous or esophageal herpes simplex virus infection
Cytomegalovirus retinitis, esophagitis, or colitis
Progressive multifocal leukoencephalopathy (JC virus)
Other non-infectious conditions associated with AIDS
Other Conditions Fulfilling Clinical Criteria for AIDS
Neoplasms
Kaposi sarcoma
High-grade, B-cell non-Hodgkin lymphoma Immunoblastic sarcoma Primary brain lymphoma Invasive carcinoma of the cervix
Systemic Illness
Human immunodeficiency virus (HIV) wasting syndrome (unintentional, unexplained loss of > 10% of body weight
Risk of HIV infection from needle injury?
HIV-contaminated hollow needle, the risk of infection is approximately 0.3%. Observational data suggest that this risk can be reduced at least 10-fold by prompt postexposure prophylaxis.
Acute retro viral syndrome signs and symptoms
Over 50% of HIV-infected persons experience a mono nucleosis-like syndrome (acute retroviral syndrome) 2 to 6 weeks after initial infection. Acute symptoms may include fever, sore throat, lymph node enlargement, rash, arthralgias, and headache and usually persist for several days to 3 weeks. A maculopapular rash is common, is short-lived, and usually affects the trunk or face.
Acute, self-limited aseptic meningitis, documented by cerebrospinal fluid (CSF) pleocytosis and isolation of HIV from CSF, is the most common clinical neurologic presentation and occurs in up to 10% of patients. The acute retroviral syndrome is sufficiently severe that a large proportion of patients seek medical attention. In the absence of a high index of suspicion, these symptoms are often mislabeled as an “acute viral syndrome.”
Presenting symptoms of acute retro viral syndrome by percentage?
Acute HIV Retroviral Syndrome: Common Signs and Symptoms
Sign or Symptom Frequency (%) Fever 98% Lymph node enlargement 75 Sore throat 70 Myalgia or arthralgia 60 Rash 50 Headache 35
How many HIV+ will progress to AIDS after 10 years
Untreated HIV infection usually results in a slow, nonlinear progression to severe immunodeficiency. Approximately 50% of untreated individuals develop AIDS within 10 years after HIV infection
What does the early symptomatic phase of AIDS look like?
Mucocutaneous lesions may be the first manifestations of immune dysfunction, especially polydermatomal varicella-zoster infection (shingles), recurrent genital herpes simplex virus (HSV) infections, oral or vaginal candidiasis, or oral hairy leukoplakia (OHL). Patients with only mod erate immunodeficiency (CD4 counts between 200 and 500 cells/mm 3 ) exhibit diminished antibody response to protein and polysaccharide antigens, as well as decreased cell-mediated immune function. These functional impairments are manifested clinically by a threefold to fourfold increase in incidence of bacteremic pneumonias caused by common pulmonary pathogens (especially Streptococcus pneumoniae and Haemophilus influenzae ), as well as a marked increase in incidence of active pulmonary tuberculosis in endemic areas.
What does the advanced symptomatic phase of AIDS look like?
With advanced immunodeficiency, indicated by CD4 counts below 200 cells/mm 3 patients are at high risk for developing OIs .
CD4 counts less than 50 cells/mm 3 indicate profound immunosuppression and, in the absence of effective ART, are associated with a high mortality within the subsequent 12 to 24 months. Cytomegalovirus (CMV) retinitis, which can lead rapidly to blindness, and disseminated Mycobacterium avium-intracellulare (MAI) infections occur frequently. They respond adequately to specific therapy only when it is accompanied by effective control of viral replication.
What are some sex specific manifestations of HIV infection?
- recurrent candida vaginitis
- recurrent HSV outbreaks
- cervical dysplasia or neoplasm
Infections related to CD4 counts in HIV
Relation of CD4 Lymphocyte Counts to the Onset of Certain HIV-Associated Infections and Neoplasms in North America
CD4 Count (cells/mm 3 ) * OI or Neoplasm > 500 Herpes zoster, polydermatomal 200-500 Mycobacterium tuberculosis infection Oral hairy leukoplakia Candida pharyngitis (thrush) Kaposi sarcoma, mucocutaneous (Male) Bacterial pneumonia, recurrent Cervical neoplasia (Female)
100-200
Pneumocystis jirovecii pneumonia
Histoplasmosis capsulatum infection, disseminated
Kaposi sarcoma, visceral (M)
Progressive multifocal leukoencephalopathy Lymphoma, non-Hodgkin
< 100
Candida esophagitis
Cytomegalovirus retinitis
Mycobacterium avium-intracellulare, disseminated Toxoplasma gondii encephalitis
Cryptosporidium parvum enteritis
Cryptococcus neoformans meningitis
Herpes simplex virus, chronic, ulcerative Cytomegalovirus esophagitis or colitis Lymphoma, central nervous system
Management of early HIV
Management of Early HIV
Disease Monitoring
Confirm positive HIV test result
Complete baseline history and physical examination: HIV-specific interval interview and examination every 3-4 mo
Laboratory Evaluation
Baseline plasma HIV RNA level and CD4 cell count with repeat every 3-4 mo Baseline purified protein derivative (PPD) Baseline Toxoplasma antibody, syphilis serology, hepatitis B and C antibodies, liver function tests, and chest radiograph*
Baseline genotypic resistance testing
Health Care Maintenance
Assessment for ongoing counseling needs and referral for significant psychiatric or social problems
Discussions regarding safer sex and avoidance of needle sharing
Pneumococcal vaccine, hepatitis A and B vaccine (if HAV, HBV seronegative)
Yearly influenza vaccine
*many only order cxr when clinically indicated
Principles of anti-retro viral therapy
Antiretroviral treatment is not curative but suppressive; because HIV infection cannot be eradicated, treatment may be lifelong with currently available drugs.
• All effective treatment regimens may be associated with toxicities, some of which can be life threatening.
• There is a risk for the development of resistance to therapy that increases with the degree of nonadherence to therapy.
• Although damage to the host immune system occurs throughout the course of HIV infection, loss of protective immune response to the most serious OIs occurs only with advanced HIV disease.
Treatment Guidelines
Guidelines for the Initiation Therapy in the Chronically HIV-Infected Patient
Symptomatic (eg AIDS, thrush), any valueCD4 + T-Cell Count and HIV RNA, treat
Asymptomatic, CD4350
Treatment may be considered in some cases, although benefit may be limited in this group of patients. Treat Asymptomatic with concomitant (a) pregnancy; Any value (b) hepatitis B with an indication for treatment; or (c) HIV-associated nephropathy
