Pathology-Metabolic Effects of HIV

Question 1

Why is it that HIV patients, despite ART, have premature death compared to the rest of the population?

Answer 1

Premature aging

Question 2

What is responsible for dyslipidemias seen in HIV patients?

Answer 2

1) HIV infection: decreased lipolysis associated with mitochondrial dysfunction from altered nuclear receptors that control lipid metabolism and inflammation. 2) Drug therapy (especially protease inhibitors)

Question 3

Statins that are best to use to control dyslipidemia in patients with HIV

Answer 3

Prevastatin, pitavastatin, atorvastatin and rosuvastatin.

Question 4

Signs of lipodystrophy

Answer 4

Visceral fat, facial lipoatrophy, peripheral fat wasting, buffalo hump and gynecomastia.

Question 5

Causes of acute renal failure in HIV patients

Answer 5

HIVAN, TTP, Hep C cryoglobulinemia, medication-induced (tenofovir)

Question 6

Causes of chronic kidney disease in HIV patients

Answer 6

Membranous nephropathy, membranoproliferative GN, diabetic nephropathy, hypertensive nephropathy and IgA nephropathy.

Question 7

Pathogenesis of HIV nephropathy

Answer 7

Deposition of circulating immune complexes that are filtered by the glomeruli

Question 8

Histologic findings in HIVAN

Answer 8

Collapsing FSGS with tubulo-interstitial injury

Question 9

Signs of HIVAN

Answer 9

Nephrotic proteinuria, rise in sCr, large kidneys, hypoglobulinemia

Question 10

Common causes of liver disease in patients with HIV

Answer 10

Infection (HAV, HBV, HCV, CMV, MAC and biliary tract infections), substance abuse, NASH, drug toxicity (INH, statins, ART, tylenol), allergic rxns (nevirapine), IRIS

Question 11

Bone diseases associated with HIV

Answer 11

Osteonecrosis from avascular necrosis, osteomalacia from vitamin D deficiency (tenofovir) and osteopenia from drop in bone density (tenofovir)

Question 12

When are DEXA scans recommended for patients with HIV?

Answer 12

> 50 years old

Question 13

Tx for HIV patients with bone disease

Answer 13

Vit D, Ca, exercise, bisphosphonates

Question 14

Cardiac diseases associated with HIV

Answer 14

Pericardial effusion (AIDS), myocardial disease, pulmonary vascular disease, valvular heart disease and vascular disease.

Question 15

Why do HIV patients have so many difficulties with restenosing of catheterized arteries?

Answer 15

Chronic inflammatory state = endothelial dysfunction. Insulin resistance and dyslipidemia contribute to atherosclerosis.