May7 M1-HIV Flashcards
(EXAM) most important opportunistic pathogen in HIV patients and its pathology
pneumocystis jeroveci. a fungus. gives a pneumonia that gives hypoxia. 10-20% mortality.
(EXAM) drug given in prophylaxis to prevent PCP (pneumocystis jeroveci pneumonia)
Septra (the sulfa Abx)
(EXAM) if an HIV patient is infected with PCP (pneumocystis pneumonia), what’s the management
Septra and maintain Septra until the patient is immune recovered
(also give CSs for the inflammation)
(EXAM) to what HIV patients do you give Septra prophylaxis
- ALL children (bc higher risk of HIV becoming AIDS + higher risk of PCP)
- Adults that are getting close to the AIDS level (so not all adults)
(EXAM) opportunistic pathogens in HIV patients other than pneumocystis jeroveci
- mycobacterium avium complex
- mycobacterium tuberculosis
- cryptococcus neoformans
- herpesviruses CMV, HSV, VZV, HHV-8
- HBV and HBC
- JCV (virus)
- toxoplasma gondii
what is slim disease (or runting syndrome)
progressive involuntary weight loss seen in patients with HIV infection; may be due to a number of factors acting alone or in combination
(imp) mycobacterium avium complex (MAC): disease it causes in HIV patients
- slim disease
- disseminated GIT disease and wasting syndrome
- big lymph nodes block bronchi, especially in IRS
(imp) management of mycobacterium avium complex in HIV pts (prophylaxis and tx)
- prophylaxis: macrolide (azithro or clarithro mycin) for people with certain levels of CD4
- tx: macrolide (azithro or clarithromycin) + rifabutin and keep until immune system reconstitutes
three main pathogens test for in an HIV patient and that can change the immediate course of the disease
- TB
- HBV
- HCV
(imp) mycobacterium TB: disease it causes in HIV patients
- lymphadenopathy, pulm disease, intra-abd disease
- higher burden of TB bacilli in the lung, transmit easier
(imp) cryptococcus neoformans disease it causes in HIV patients
-meningitis with very high ICP, etc.
(imp) cryptococcus neoformans infection management in HIV patients
- amphotericin B + fluconazole IV (followed by fluconazole po for weeks to months)
- lifelong SECONDARY prophylaxis (after infection)
(imp) disease that reactivated CMV causes in HIV patients
eye disease (retinitis, uveitis, retinal detachment, visual loss)
(imp) disease that HHV-8 reactivation causes in HIV patients
Kaposi’s sarcoma
(imp) disease that HBV, HCV cause in HIV patients
progressive cirrhosis
(imp) disease that JCV (JC or John Cunningham virus) causes in HIV patients
progressive multifocal leukoencephalopathy
- an irreversible encephalopathy
- movement disorder
- severe neuro problems
(imp) disease that toxoplasma gondii causes in HIV patients
- protozoa goes in the brain and causes brain ABSCESSES
- encephalitis
- seizures
- disseminated CNS lesions (ring enhancing abscesses)
(imp) management of toxoplasma gondii infection in HIV patients
- tx: sulfadiazine + pyrimethamine + folinic acid (leucovorin) (is a toxic tx)
- secondary prophylaxis (AFTER tx): sulfadiazine + clindamycin until immune reconstituted
(EXAM) 3 categories of HIV patients that have to be treated for sure (more now, but the 3 initial ones)
- children under age 1 and developing AIDS rapidly
- pregnant women with HIV
- symptomatic HIV patients (no matter CD4)
(EXAM) on top of the 3 categories of HIV patients, who should be treated for HIV
- all patients with CD4 count <350 (moderate immune suppression) or viral load of a log > 5, even if are asymptomatic
- basically everyone who gets dx (bc if you wait for immune suppression, you get chronic inflam, CVD, heart disease, dementia, etc. in the meantime)
(EXAM) severe immune deficiency definition in HIV
CD4 count below 200 cells per mL of blood
(EXAM) normal immune system definition in HIV
CD4 count above 500 cells per mL of blood (IN ADULTS)
in children, 501 is severe immune suppression
(EXAM) intestinal infections that cause disorders of the intestines and that are much more common in HIV and immunodeficiencies
spora type parasitic infections (intestinal protozoa)
- giardia lamblia
- cryptosporidium
- microsporidia
- cyclospora
- isospora
- emtamoeba histolytica (only parasite to cause bloody diarrhea)
- (FUNGUS) histoplasma capsulatum
(important) mainstay of therapy in HIV nowadays
HAART: highly active antiretroviral therapy. is a combination of
- NRTI (nucleoside RT i)
- NNRTI (non nucleoside RT i)
- PI (protease i)
- FI (fusion i)
- integrase inhibitors
- CCR5 R antagonists
goals of HAART
- reduce HIV viral load to undetectable levels
- elevate CD4 T helper lymphocyte count
(EXAM) 3 main components of HIV in children
- growth failure
- neurodev deterioration (brain growth, cognitive fct and motor dysfunction)
- lymphoid interstitial pneumonitis (LIP)
(EXAM) what’s LIP
- the hallmark of AIDS caused by HIV, in CHILDREN ONLY (not seen in adults)
- an immune mediated lymphocitic infiltration of the lungs
- NOT related to immune suppression
- related to EBV
(EXAM) why LIP is said to not be related to immune suppression
because you have an immune mediate lymphocitic infiltration in the lung so it means that the immune system is working
(EXAM) treatment of lymphoid interstitial pneumonitis (AIDS defining illness in children with HIV) and how it compares to PCP tx
tx is corticosteroids. (for pneumocystis pneumonia, would give Septra + CS)
(imp) possible way of HIV transmission that we have to remember
occupational exposures (health care or lab workers)
- percutaneous (stabbed, needles)
- mucosal (splashing of body fluids)
- never been a case of non occup exposure of HIV like kid touching needle in a park*
(imp?) what to do and not to do if stuck by a non sterile needle in health care setting
- DO: pour chlorhexidine on wound or pour open water on hand to decrease risk of infection (decreases risk a LOT)
- DONT’: rub the wound (makes the infection go deeper)
(exam) how children get HIV
- perinatal exposure (vertical), mostly intra partum
- sexual abuse
- blood transfusion
- teens = sexual intercourse + IVDU
