T4 SYMPOSIUM: Respiratory infections and HIV

Question 1

What is cerebral toxoplasmosis?

Answer 1

An opportunistic infection caused by the parasite Toxoplasma gondii. It typically affects patients with HIV/AIDS and is the most common cause of cerebral abscess in these patients

Question 2

What is Kaposi Sarcoma?

Answer 2

A rare type of cancer caused by a human herpesvirus 8, which is also known as Kaposi sarcoma-associated herpesvirus (KSHV)

Question 3

What is CMV retinitis?

Answer 3

Cytomegalovirus (CMV) Retinitis is a virus that may infect the retina and potentially cause irreversible vision loss due to retinal detachment or destruction. CMV is an opportunistic infection

Question 4

What is happening within the body during clinical latency?

Answer 4

The body is fighting back

Question 5

What group makes up most of the HIV cases in the UK?

Answer 5

Gay and bisexual men

Question 6

What % of >50 year old have HIV in Brighton?

Answer 6

42%

Question 7

What is cART?

Answer 7

Combined antiretroviral therapy

Question 8

What is the most common HIV related respiratory infection?

Answer 8

Pneumocytic pneumonia (PCP). 70-80% of AIDS patients get it before ART

Question 9

Name some HIV related respiratory infection

Answer 9

PCP, H influenza, Staphylococcus aureus, C pneumoniae, M pneumoniae, Aspergillosis, Cryptococcis, Histoplasmosis, CMV pneumonitis, Influenza, TB

Question 10

What is Pneumocystis jiroveci pneumonia?

Answer 10

Also known as PCP and it’s a fungal infection. The initial infection usually occurs in early childhood

Question 11

What are some epidemiological risk factors for PCP?

Answer 11

CD4 count <200 cell or <14% CD4, Prior PCP, oral thrush, recurrent bacterial pneumonia, unintentional weight loss, and high HIV RNA

Question 12

What are some clinical presentations of PCP?

Answer 12

Progressive exertional dyspnoea, fever, non-productive cough, chest discomfort. Subacute onset and worsens over days-weeks. Chest exam may be normal, or there may be some dry rales, tachypnoea, and tachycardia.

Question 13

What are dry rales with chest examination?

Answer 13

Small clicking, bubbling, or rattling sounds in the lungs

Question 14

How do you diagnose PCP?

Answer 14

Organism can’t be cultures. Hypoxia is characteristic and may be mild or severe. Lactate hydrogenase (LDH) >500 mg/dl is common but not specific. 1,3 beta-D-glycan may be elevated. CRX may be normal in early disease but will diffuse bilaterally. Pleural effusion is uncommon. ALWAYS BILATERAL

Question 15

Why is PCR not commonly used to diagnose PCP?

Answer 15

Because it’s very sensitive and doesn’t distinguish between disease and colonisation

Question 16

When should primary prophylaxis for PCP be discontinued?

Answer 16

When the patient is on ART and has a CD4 >200

Question 17

How long is PCP treatment?

Answer 17

21 days

Question 18

What is the treatment of choice for PCP?

Answer 18

Septrin. Corticosteroids are also given to reduce inflammation

Question 19

Why do Hep B vaccines not work on the immunocompromised?

Answer 19

Because they don’t have enough CD4 to develop immunity