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Infectious Disease > Opportunistic Infections of HIV > Flashcards

Opportunistic Infections of HIV Flashcards

1
Q

What kinds of cells does HIV infect?

A

All cells expressing the CD4 antigen

-Generally infects helper T lymphocytes

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2
Q

What do the immunologic deficits of HIV stem from?

A

Lower quantity of CD4 cells and qualitative changes in cell function

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3
Q

What are two remarkable features of HIV immunodeficiency?

A
  • Low incidence of certain infections such as listeriosis and aspergillosis
  • Frequent occurrence of certain neoplasms such as lymphoma or Kaposi sarcoma
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4
Q

What is the relationship between HIV-infected individuals and allergic reactions?

A

-HIV infected peeps have a higher rate of allergic reactions to unknown allergens (eg. “itchy red bump syndrome”) and an increased rates of hypersensitivity reactions to medications

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5
Q

When does HIV become AIDS?

A
  • Opportunistic infections/malignancies that rarely occur in the absence of severe immunodeficiency
  • Several nonspecific conditions, including dementia and wasting in the presence of a positive HIV serology
  • When the CD4 cell count falls below 200/mm3 regardless of the presence or absence of symptoms
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6
Q

What are some major conditions that define an AIDS diagnosis?

A
  • P.carinii pneumonia (PCP): 42%
  • Esophageal candidiasis: 15%
  • Wasting: 11%
  • Kaposi’s sarcoma: 11%
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7
Q

What is the median time from onset of severe immunosuppression (CD4 count<200/mm3) to an AIDS-defining diagnosis?

A

12-18 months w/o antiretrovirals

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8
Q

What improves dramatically after the initiation of antiretroviral therapy?

A

Humoral immunity

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9
Q

What classifies advanced HIV infection?

A

A CD4 count under 50 cells/microL

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10
Q

What defines a chronic nonprogressor with HIV?

A

HIV-seropositive with high levels of CD4 cells

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11
Q

What defines an elite controller with HIV?

A

HIV-seropositive with no evidence of viremia

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12
Q

What is included i the clinical spectrum of HIV infection?

A
  • Primary infection
  • Asymptomatic infection
  • Early symptomatic infection
  • Late symptomatic infection
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13
Q

What kinds of symptoms present during primary infection of HIV?

A

Acute retroviral syndrome

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14
Q

What kinds of symptoms present during asymptomatic latency of HIV?

A

Clinical latency - no accompanying symptoms

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15
Q

What kinds of symptoms present during early symptomatic infection of HIV?

A

Constitutional symptoms

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16
Q

What kinds of symptoms present during late symptomatic infection of HIV?

A

Advanced immunodeficiency with opportunistic infections/cancers

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17
Q

What kinds of infections present in the early stage of HIV (CD4>500 cells/microL)?

A
  • Pneumococcus
  • VZV
  • HSV
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18
Q

What kinds of infections present in the middle stage of HIV (CD4 250-500 cells/microL)?

A
  • Mycobacterium TB
  • Bartonella
  • Salmonella
  • Candida
  • Syphilis
  • Kaposi sarcoma
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19
Q

What kinds of infections present in the late stage of HIV (CD4<200 cells/microL)?

A
  • PCP
  • Cryptococcus
  • Histoplasma
  • Coccidiodes
  • Toxoplasma
  • Rhodococcus equi
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20
Q

What kinds of infections present in the very late stage of HIV (CD4<100 cells/microL)?

A
  • MAC
  • Cryptosporidiosis
  • PML
  • CMV
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21
Q

What are some opportunistic infections of the lungs that can occur with HIV?

A
  • Community acquired pneumonia
  • PCP pneumonia
  • Tuberculosis
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22
Q

What are some opportunistic infections of the skin that can occur with HIV?

A
  • Fungal cutaneous (anywhere)
  • Kaposi sarcoma
  • Herpes zoster/Herpes simplex
  • KMolluscum contagiosum
  • Stevens-Johnson/Toxic epidermal necrolysis
23
Q

What are some opportunistic infections of the HEENT that can occur with HIV?

A
  • Cytomegalovirus retinitis
  • Oral candidiasis
  • Oral hairy leukoplakia
  • Sinusitis
  • Uveitis
24
Q

What are some opportunistic infections of the central nervous system that can occur with HIV?

A
  • AIDS dementia complex
  • Cryptococcal meningitis
  • HIV myelopathy
  • Progressive multifocal leukoencephalopathy
  • CNS lymphoma
  • Toxoplasmosis
25
Q

What are some opportunistic infections of the peripheral nervous system that can occur with HIV?

A
  • Mononeuropathies
  • Polyneuropathies
  • Sensory neuropathies
26
Q

What are some opportunistic infections of the GI tract that can occur with HIV?

A
  • Anal carcinoma
  • Cryptosporidiosis
  • Entrocolitis
  • Esophageal candidiasis
27
Q

What are some opportunistic infections of the GU tract that can occur with HIV?

A
  • Cervical cancer

- Vaginal candidiasis

28
Q

What are the signs and symptoms of pneumocystitis carinii pneumonia?

A
  • -Non specific
  • Fever, cough, SOB
  • Varying degrees of severity
  • Hypoxia may be severe (PO2 under 60%)
29
Q

How do you diagnose PCP?

A

Chest radiograph: the foundation of diagnosis

-Definitive diagnosis: Wright-Giemsa stain or direct fluorescent antibody test on induced sputum

30
Q

What is the prophylaxis for PCP and when might you give it?

A 
Prophylaxis: BactrimSS or DS qd
When to give it:
- CD4 count under 200
-Undiagnosed fever, night sweats, thrush, unintentional weight loss
-History of a previous PCP
31
Q

What is the treatment for PCP?

A

-2 TMP-SMX DS tabs q 8 hours for 10-21 days

32
Q

What do Kaposi sarcoma look like?

A
  • Purplish, non-blanching lesions that can appear anywhere, especially on gums
  • Can be papular or nodular
33
Q

What does candidiasis look like in HIV patients?

A
  • Often esophageal, but can be oral, vaginal, or dermal

- Usually seen with CD4 count under 100 cells/microL

34
Q

What is the prophylaxis for candidiasis?

A
  • Systemic prophylaxis not recommended

- Itraconazole, fluconazole

35
Q

What is the most common space-occupying CNS lesion in HIV infected persons?

A

-Toxoplasmosis

36
Q

What are the signs and symptoms of toxoplasmosis in a patient w HIV?

A
  • Headache
  • Focal neurologic deficits
  • Altered mental status
37
Q

How is diagnosis of toxoplasmosis in an HIV patient made?

A

Diagnosis is presumed based on characteristic lesions on MRI

38
Q

What is the prophylaxis for toxoplasmosis in HIV patients?

A
  • One DS Bactrim tab daily

- Avoid undercooked meats and avoid the cat’s litter box

39
Q

What is the treatment for toxoplasmosis in HIV patients?

A

-Pyrimethamine + sulfadiazine + leucovorin

40
Q

What is progressive multifocal leukoencephalopathy and how does it present?

A

PML is a viral infection in the white matter of the brain

-S/Sx: aphasia, hemiparesis, cortical blindness

41
Q

What is the classic radiographic finding in HIV patients with PML?

A

Non-enhancing white matter lesions without “mass effect” (means a mass is not actually taking up space and pushing brain matter over)

42
Q

What is the treatment for HIV patients with PML?

A

SOME patients stabilize or improve on antiretroviral therapy (ART)

43
Q

What is mycobacterium avium complex (MAC) and who does it infect?

A

MAC is a cousin of TB, and infects late-stage HIV patients with CD4 counts under 50 cells/microL

44
Q

How is MAC diagnosed?

A

Blood culture or PCR

45
Q

What is the treatment for MAC?

A

Clarithromycin 500 mg bid OR azithromycin 600 mg qd

46
Q

What is enterocolitis?

A
  • A very common complication of HIV

- Characterized by profuse, watery, recurrent diarrhea

47
Q

What are the pathogens responsible for enterocolitis in patients with HIV?

A

Bacterial (campylobacter, salmonella, shigella)
Viral (cytomegalovirus, adenovirus)
Protozoal (cryptosporidium, entamoeba, giardia, isospora)

48
Q

What is the prophylaxis for enterocolitis in those w HIV?

A

Proper hygiene, avoid raw oysters

49
Q

How do you diagnose enterocolitis?

A

Stool culture, o & p

50
Q

How do you treat enterocolitis in those w HIV?

A
  • Treat based on the organism cultured
  • Hydration
  • There is no effective treatment for cryptosporidium
51
Q

What is the most common result of a cytomegalovirus infection in those with late stage HIV?

A 
Progressive retinitis (blurred vision, loss of central vision, can lead to retinal detachment)
-HAART has had great effects on preventing this
52
Q

How is progressive retinitis due to CMV diagnosed?

A

Fundoscopic exam

53
Q

What is the prophylaxis for progressive retinitis due to CMV?

A

IF the CD4 count is under 50 cells/microL

-oral ganciclovir 1000 mg TID

54
Q

How is CMV treated in those w HIV?

A

Oral valganciclovir 900 mg BID w food x 21 days THEN 900 mg daily maintenance

Infectious Disease (8 decks)

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