S13C149 - HIV and AIDS

Question 1

Diseases that present early in course of HIV but are not AIDS-indicators:

Answer 1

• thrush, vulvovaginal candidiasis
• peripheral neuropathy
• cervical dysplasia
• recurrent zoster
• ITP

Question 2

HIV: indicators of AIDS

Answer 2

-esophageal candidiasis
-cryptococcus
-CMV retinintis
-HSV
-kaposi sarcoma
-MAC
-pneumocystis jiroveci pna
-progressive ultifocal leukoencephalopathy
-toxoplasmosis
-HIV encephalopathy
=disseminated histoplasmosis
-pulmonary TB
-invasive cervical Ca.

Question 3

HIV: MAC infection

Answer 3

• mycobacterium avium-intracellulare

- disseminated infection occurs with CD4 count

Question 4

HIV: CMV retinitis

Answer 4

-tx: foscarnet or ganciclovir

Question 5

HIV: neurologic complications

Answer 5

• AIDS dementia: aphasia, motor deficits, AMS, CT shows cortical atrophy
• toxoplasma gondii: focal encephalitis, h/a, fever, focal deficits, AMS, seizures, CT shows ring enhancing lesions in basal ganglia
• c. neoformans: cryptococcosis, may be focal lesions or diffuse meningoencephalitis, fever, ha/, nausea, AMS, meningismus uncommon, dx by antigen CSF test, elevated openieng pressure

-others: bacterial meningitis, CNS lymphoma, TB, neurosyphilis

Question 6

HIV: CSF studies

Answer 6

-pressures, cell count, glucose, protein, gm stain, india ink stain, culture, viral vulture, fungal culture, toxo, crypto antigen assay, coccidoidomycosis titire

Question 7

PJP

Answer 7

-tx: septra

Question 8

TB

Answer 8

-isonizid and rifampin and pyrazinamide and ethambultol

Question 9

toxoplasmosis

Answer 9

pyrimethamine and sulfadiazine and folinic acid +/- leucovorin

Question 10

crytococcosis (CNS infxn)

Answer 10

-amphotericin and flucytosin the fluconazole

Question 11

HIV ophthalmologic complications

Answer 11

• CMV retinitis:asymptomatic vision loss, photophobia, scotoma, red eye, fundoscopy shows fluffly white lesions around vessles, hemorrhage
• HSV ophthalmicus: CN V1, paresthesias followed by rash, conjuncitivitis, episclreitis, irtiis, keratitis, glaucoma, retinintis

Question 12

Fungal PNA in HVI

Answer 12

• cryptococcus

- aspergillus

Question 13

Scabies

Answer 13

-tx: permethrin 5% cream

Question 14

Vaccinations for HIV pts

Answer 14

• no live vaccines EXCEPT MMR
• killed vaccines ok
• tetanus, MMR (if CD4 count ok), meningococcal, pneumococcal, influenza (inactivated) hep a/b, varicella

Question 15

Post-exposure prophylaxis for HIV

Answer 15

-lopinavir/ritonavir, lamivudine, tenofovir