Week 3: pathology of acquired immune deficiency syndrome

Question 1

Category A HIV

Answer 1

• asymptomatic
• persistent generalized lymphadenopathy
• acute (primary) HIV infection
• conditions in B and C must not have occured

Question 2

Category B symptomatic conditions: intermediate disease

Answer 2

• bacilary angiomatosis
• thrush, persistent vulvovaginal candidiasis
• oral hairy leukoplakia-EBV
• ITP
• constitutional symptoms: fever, diarhhea more than 1 month
• peripheral neuropathy
• herpes zoster, more than 2 epodes or more than 1 dermatome

Question 3

Categorhy C symptomatic conditions: AIDS

Answer 3

• AIDS defining conditions
• recurrent bacterial pneumonia, candidiasis of respiratory tract
• cervical carcinoma
• coccidiodomycosis cryptococcosis, CMV,
• Kaposi sarcoma
• lymphoma, burkitt, MAC, TB, PCP, PML, toxoplasmosis, wasting syndrome
• and more

Question 4

Bacillary epithelioid angiomatosis

Answer 4

• cat B
• systemic disease, affects skin with red papillose due to proliferation of small round blood vessels
• caused by Bartonella henseli bacterial
• assoc. with cat scratch fever in normal individuals.

Question 5

Pneumocystic jiroveci (formerly PCP)

Answer 5

• almost everyone exposed, but mostly latent until immunocompromised
• usually when CD4<200/uL
• microscopic: alveoli filled with foamy pink material. Ovoid to cup shaped cyst with dot-like wall thickening. Never see budding

Question 6

Fungal infections of HIV

Answer 6

1. cryptococcus
   - most common form of fungal pneumonia in AIDS
   - cell wall stained with GMS or PAS
   - AIDS defining when extra pulmonary
2. Coccidiomycosis: Valley fever
   - spherules filled with endospores or empty. Nonbudding
   - AIDS defining when disseminated or extra pulmonary
3. Candida
   - cat B: persistent vulvovaginal or oral
   - cat C: esophageal

Question 7

Bacterial infections of HIV

Answer 7

1. Mycobacterium tuberculosis
2. Mycobacterium avium intracellular complex (MAC), disseminated or extra pulmonary
   - was very common prior to ART
3. recurrent pneumonias due to non opportunistic bacteria such as strep and staph

Question 8

Viral infections of HIV

Answer 8

1. CMV: usually latent in normal ppl
   - reactivated in HIV, infects pneumocytes, endothelial cells, glandular epithelial cells
   - “owl eyes”
   - interstitial pneumonia
   - GI involvement can occur
   - variable tissue reaction
2. Progressive multifocal leukoencephalopathy (PML)
   - demyelinating disease caused by JC virus, starts at gray white junction
   - affects oligodendroglial and astrocytes, but only lytic in former
   - also seen in transplant patients and chemotherapy
3. Herpes
   - kaposi sarcoma-HHV8
   - herpes zoster -varicella

Question 9

Tumors in HIV

Answer 9

1. Kaposi Sarcoma
2. lymphomas
   - Burkitt
   - Diffuse large B cell
   - primary CNS
   - assoc. with EBV

Question 10

Degenerative states in HIV

Answer 10

• nicoglial nodules
• multinucleated giant cells-HIV encephalitis
• subcortical dementia with impaired memory, concentration , mental and motor slowing, apathy
• p24 stain: HIV in brain