Infectious Disease Flashcards
What are the four H’s of HIV patient populations?
- Homosexuals
- Hemophiliacs
- Haitians
- Heroin addicts
How is HIV measured now?
- HIV RNA is the main method
- 90% of people will have detectable HIV Ab 1 month after exposure (ELISA)–very sensitive but has some false positives (if positive, it’s always repeated before next step)
- Western blot if ELISA is positive
What is the the general rule for acute HIV infection?
10 signs and symptoms in 24 hours
What is the best marker for following HIV progression?
- Serial CD4 counts
* Viral loads (measures RNA)
What conditions are associated with HIV+ CD4 > 500?
- Asymptomatic
* Increased bacterial infections, shingles, TB
What conditions are associated with HIV+ CD4 200-500?
- Adenopathy
- Thrush
- Kaposi’s
What conditions are associated with HIV+ CD4 <200?
- PCP
- Toxoplasmosis
- Cryptococcus
What conditions are associated with HIV+ CD4 <50?
- CMV (in eyes)
- Mycobacterium avium
- ↑ risk lymphoma
What are the main classes of HIV drugs?
- Reverse transcriptase inhibitors (can’t make DNA)
- Fusion/entry inhibitors (block entry into WBCs)
- Protease inhibitors (stops cleaving of HIV proteins after transcription)
- Integrase (can’t insert DNA–newest group of drugs)
Example of integrase inhibitor?
Raltegravir
Example of fusion inhibitor?
Enfuvirtide
Example of CCR5 antagonist?
Maravioc
What are some complications of HIV treatment?
- Lipodystrophy
- Lactic acidosis
- Osteopenia and porosis
- Avascular necrosis of hip
- Peripheral neuropathy
What type of vaccines should be given with care in HIV patients?
Live vaccines. Seem to be more effective if given earlier in disease course.
PCP symptoms?
- Gradual onset fever, dry cough, dyspnea
* CXR normal in 50% of PTs
How do you diagnose PCP?
- Immunofluorescent antibody staining
* Sputum or bronchoscopy
Best treatment for PCP (Meyers)?
Bactrim or a few other agents
What is a side effect of bactrim use in HIV PTs?
Increased incidence of rash
PCP prophylaxis in HIV PTs?
Use daily bactrim in PTs with CD4 < 200
Cryptococcal meningitis in HIV patients?
- C. neoformans
- Subacute meningitis (looks different in HIV PTs)
- Often few symptoms with ↑ ICP
- Huge amounts of fungus in CSF
- Diagnose Ag in serum and CSF
How do you treat cryptococcal meningitis?
- AmphoB and flucytosine
* Manage ↑ ICP
Symptoms of CMV in HIV patients (typically in PTs below CD4 < 50)
- End organ manifestation
- Retinitis (most common)
- Colitis
- Esophagitis
- Neurological disease
How does TB differ in AIDS patients?
- Not typical cavitary lesions (don’t have the immune system)
- Extra pulmonary manifestations more common
- More diffuse pattern in the lungs
How does MAC (myco avium) present in HIV patients?
- Fever, sweats, diarrhea, hepatosplenomegaly
- Dx with blood culture
- Treat with azithromycin and prophylaxis < 50
