Common diseases of HIV-positive adults

Question 1

CD4+ cell count 500

Answer 1

• Candida albicans (oral thrush)
• EBV (oral hairy leukoplakia)
• Bartonella henselae (bacillary angiomatosis)
• HHV-8 (Kaposi sarcoma)
• Cryptosporidium spp. (chronic, watery diarrhea)
• HPV (squamous cell carcinoma, common of anus or cervix)

Question 2

CD4+ cell count 200

Answer 2

• HIV (dementia)
• JC virus reactivation (progressive multifocal leukoencephalopathy)
• Pneumocystis jirovecci (pnemocystis pneumonia)

Question 3

CD4+ cell count 100

Answer 3

• Aspergillus fumigatus (hemoptysis, pleuritic pain)
• Cryptococcus neoformans (meningitis)
• Candida albicans (esophagitis)
• CMV (retinitis, esophagitis, colitis, pneumonitis, encephalitis)
• EBV (B-cell lymphoma - non-Hodgkin lymphoma, CNS lymphoma)
• Histoplasma capsulatum (fever, weight loss, fatigue, cough, dyspnea, nausea, vomitting, diarrhea
• Mycobacterium avium-intracellulare, MAC (nonspecific systemic symptoms - fever, night sweas, weight loss; lymphadenitis)
• Toxoplasma gondii (brain abscesses

Question 4

Scrapable white plaque, pseudohyphae on microscopy

Answer 4

• Oral thrush by Candida albicans

- CD4+ 500

Question 5

Unscrapable white plaque on lateral tongue

Answer 5

• Oral hairy leukoplakia by EBV

- CD4+ 500

Question 6

Biopsy with neutrophilic inflammation

Answer 6

• Bacillary angiomatosis by Bartonella henselae

- CD4+ 500

Question 7

Biopsy with lymphocytic inflammation

Answer 7

• Kaposi sarcoma by HHV-8

- CD4+ 500

Question 8

Acid-fast oocysts in stool

Answer 8

• Chronic, watery diarrhea by Cryptosporidium spp.

- CD4+ 500

Question 9

Squamous cell carcinoma (commonly of anus or cervix)

Answer 9

• HPV

- CD4+ 500

Question 10

Dementia

Answer 10

• HIV

- CD4+ 200

Question 11

Nonenhancing areas of demyelination on MRI

Answer 11

• Progressive multifocal leukoencephalopathy by JC virus

- CD4+ 200

Question 12

“Ground-glass” opacities on CXR

Answer 12

• Pneumocystis pneumonia

- CD4+ 200

Question 13

Cavitation or infiltrates on chest imaging

Answer 13

• Hemoptysis, pleuritc pain by Aspergillus fumigatus

- CD4+ 100

Question 14

Encapsulated yeast on India ink stain or capsular antigen positive

Answer 14

• Meningitis by Cryptococcus neoformans

- CD4+ 100

Question 15

White plaques on endoscopy; yeast and pseudohyphae on biopsy

Answer 15

• Esophagitis by Candida albicans

- CD4+ 100

Question 16

Linear ulcers on endoscopy, cotton-wool spots on fundoscopy; biopsy reveals cells with intranuclear (owl-eye) inclusion bodies

Answer 16

• Retinitis, esophagitis, colitis, pneumonitits, encephalitis by CMV
• CD4+ 100

Question 17

CNS lymphoma - ring enhancing, may be solitary

Answer 17

• B-cell lymphoma (non-Hodgkin lymphoma, CNS lymphoma) by EBV
• CD4+ 100

Question 18

Oval yeast cells within macrophages

Answer 18

• Fever, weight, loss, fatigue, cough, dyspnea, nausea, vomitting, diarrhea by Histoplasma capsulatum

Question 19

Nonspecific systemic symptoms (fever, night sweats, weight loss) or focal lymphadenitits

Answer 19

• Mycobacterium avium-intracellulare, MAC

- CD4+

Question 20

Multiple ring-enhancing lesions on MRI

Answer 20

• Brain abscesses by Toxoplasma gondii

- CD4+

Question 21

Prophylaxis CD4+ 200

Answer 21

• TMP-SMX

- Pneumocystis pneumonia

Question 22

Prophylaxis CD4+ 100

Answer 22

• TMP-SMX

- Pneumocystis pneumonia and Toxoplasmosis

Question 23

Prophylaxis CD4+ 50

Answer 23

• Azithromycin or clarithromycin

- Mycobacterium avium complex