Lecture 6: HIV, AIDS and Opportunistic Infections Flashcards

1
Q

How are HIV1 and HIV2 different in terms of virulence and geographical distribution?

A
  • HIV1 isolated in America, Europe and Central Africa
  • HIV2 in West Africa; less virulent and not spread as rapidly and widely
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2
Q

HIV consists of 2 positive ssRNA held together by which protein?

A

p7 protein

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3
Q

What is the HIV capsid protein?

A

p24

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4
Q

Which 3 genes of HIV are the most important for making structural proteins for new virus particles?

A

gag, pol, env

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5
Q

The capsid of HIV contains which 3 enzymes required for HIV replication?

A
  • Reverse transcriptase
  • Integrase
  • Protease
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6
Q

In regards to the pathogenesis of HIV the hallmark of symptomatic HIV infection is what?

A

Immunodeficiency caused by continuing viral replication

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7
Q

What are 7 opportunistic infections of HIV when CD4 counts are around 500?

A
  • Bacterial infections
  • Tuberculosis
  • Herpes simplex
  • Herpes zoster
  • Vaginal cadidiasis
  • Hairy leukoplakia
  • Kaposi sarcoma
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8
Q

What are the 5 opportunistic infections for HIV patients with CD4 <200?

A
  • Pneumocystosis
  • Toxoplasmosis
  • Cryptococcosis
  • Coccidioidomycosis
  • Cryptosporidiosis
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9
Q

What are 4 opportunistic infections of HIV when CD4 is <50?

A
  • Disseminated MAC infection
  • Histoplasmosis
  • CMV retinitis
  • CMV lymphoma
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10
Q

HIV diagnosis is made using a combo immunoassay for what?

A

HIV Ab with a test for HIV p24 Ag

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11
Q

A positive result on HIV-1/2 Ag/Ab combination assay is followed by which test?

A

HIV-1/2 Ab differentiation immunoassay

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12
Q

If HIV samples on HIV-1/2 Ab differentiation test are negative, what test is done next?

A

HIV-1 nucleic acid amplification test (NAAT)

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13
Q

If HIV specimens are positive on initial combination assay, and then are negative on Ab differentiation immunoassay and NAAT, this tells us what?

A

False-positive test

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14
Q

What is the most widely used marker to provide prognostic information and to guide therapy decisions in HIV patient?

A

CD4 lymphocyte count

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15
Q

What is the most common opportunistic infection associatd with AIDS?

A

Pneumocystis Jirovicii

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16
Q

What is the cornerstone of diagnosis for pneumocystis jirovecii pneumonia and what will be seen?

A
  • Chest radiograph
  • Diffuse or perihilar infiltrates are most characteristic
17
Q

If pleural effusions are seen on CXR of pt with suspected pneumocysti jirovecii pneumonia, how does this change the DDx?

A

Think bacterial pneumonia, TB, or pleural Kaposi’s

18
Q

How is the definitive diagnosis of Pneumocystis made; what if this test is negative and pneumocystis is still suspected?

A
  • Definitive dx via Wright-Giemsa stain or dirext fluorescence antibody (DFA) test of the SPUTUM
  • If negative, can do a Bronchoalveolar lavage to establish diagnosis
19
Q

Which lab values may be elevated in Pneumocystis Pneumonia; which is more sensitive and specific?

A
  • ↑↑↑ LDH
  • Serum beta-glucan test = more sensitive and specific
20
Q

A CD4 count >______ within 2 months prior to evaluation of respiratory sx’s makes a diagnosis of Pneumocystis pneumonia unlikely.

A

A CD4 count >250 within 2 months prior to evaluation of respiratory sx’s makes a diagnosis of Pneumocystis pneumonia unlikely.

21
Q

Which DLco and findings on high-resolution CT scan of the chest would make dx of Pneumocystis pneumonia very unlikely?

A
  • A normal diffusing capacity of CO (DLco)
  • NO interstitial lung disease on CT of chest
22
Q

What are the most common causes of pulmonary disease in HIV-infected patients?

A
  • Community-acquired pneumonia
  • Bacterial, mycobacterial, and viral pneumonias
23
Q

What is seen on unenhanced CT scan of Toxoplasmosis infection?

A

Multiple subcortical lesions w/ a predilection for the basal ganglia

24
Q

Imaging showing multiple ring-enhancing lesions with surrounding areas of edema is characteristic of what?

A

Toxoplasmosis

25
Q

A patient with known HIV infection presents with changes in his vision and upon fundoscopic exam you see this; what should you be thinking about?

A

CMV retinitis