AIDs/HIV

Question 1

What is the most common mode of exposure for AIDS

Answer 1

Sexual Transmission across the exposed mucosal epithelium

Question 2

How does the HIV virus work?

Answer 2

The proliferation of infected CD4+ T lymphocytes + migration of infected macrophages = appearance of viral RNA in the bloodstream

Question 3

What is the MC transmission of HIV to healthcare workers

Answer 3

In inadvertent needle stick.

Question 4

What is the best measure of the status of the immune system and disease progression of HIV?

Answer 4

CD4 Cell Count- Measures the progression after person ins already infected.

Question 5

What does the CD4 cell count tell you?

Answer 5

Demonstrates the risk of opportunistic infections.

Question 6

What is used to measure the response to and efficacy of HAART therapy. gives corresponding predictive information to the CD4 count?

Answer 6

Viral Load Serology

Question 7

What is the presentation of acute HIV infection?

Answer 7

Initially appears with a syndrome similar to that seen with mononucleosis

Occurs about 2-4 weeks after exposure to HIV

Question 8

What are the presenting symptoms of HIV?

Answer 8

Just like Cancer

Fever, Night Sweats, Weight loss

Question 9

When does it go from HIV to AIDs

Answer 9

CD4 < 200

Question 10

What is the risk of HIV transmission with prolonged breast feeding?

Answer 10

50%

Question 11

What is the postexposure prophylaxis recommended therapy?

Answer 11

emtricitabine, raltegravir, and tenofovir

Question 12

What are the SE of the antiretroviral therapy NRTI’s

Answer 12

Bone marrow suppression - Check CBC
Peripheral neuropathy
Megaloblastic anemia (ZDV)
Pancreatitis (ddl)

Question 13

What SE for NNRTIs (Nonnucleoside reverse transcriptase inhibitors have CNS symtpms

Answer 13

Efavirenz

Question 14

What Protease inhibior cases cyrstal induced nephropathy>?

Answer 14

Indinavir

Question 15

What is the link between HIV and TB?

Answer 15

HIV-positive patients co-infected with tuberculosis have 20-30x greater risk for development of active tuberculosis and subsequent infectious state compared with HIV-negative patients

Question 16

What are opportunistic infections with ANY CD4 Count?

Answer 16

Tuberculosis

Oral candidiasis

Kaposi sarcoma

Question 17

What are opportunistic infections with < 250 CD4 Count?

Answer 17

Coccidioidomycosis

Question 18

CD4 Count < 200 Opportunistic Infections

Answer 18

Bacterial Pneumonia

Pneumocystis pneumonia

Isosporiasis

Question 19

CD4 Count < 150 Opportunistic Infections

Answer 19

Histoplasmosis

Question 20

CD4 Count < 100

Opportunistic Infections

Answer 20

Esophageal candidiasis
Toxoplasmosis
Cryptococcosis
Cryptosporidiosis
Microsporidiosis

Question 21

CD4 Count < 50

Opportunistic Infections

Answer 21

Cytomegalovirus infections

Mycobacterium avium complex

Bacillary angiomatosis

Question 22

What is the treatment for Oral Candidiasis?

Answer 22

Nystatin swish and sallow 4-5/day

Question 23

Pneumocystis Pneumonia?

Answer 23

An AIDS-defining illness
Caused by yeast-like fungus Pneumocystis jiroveci (formerly P. carinii)
Sx: fever, chills, nonproductive cough, pleuritic chest pain, dyspnea
Dx: suspected based on symptomology, particularly if low CD4 count
CXR: normal in early disease; often reveals bilateral, ground-glass, interstitial infiltrates in butterfly or bat wing pattern

Question 24

Pneumocystis Pneumonia prophylaxix?

Answer 24

TMP/SMX (initiated when CD4 count < 200)

Question 25

Esophageal Candidiasis-

Answer 25

Commonly occurs concurrent with oropharyngeal candidiasis (but not always) Sx: retrosternal chest pain and pain with swallowing (odynophagia) This form of candidal infection more likely with CD4 counts < 100 Dx: often based on symptomology, confirmed with EGD Tx: systemic antifungals Symptomatic involvement within days of treatment initiation Preferred tx: fluconazole (PO or IV) or itraconazole (PO) x 2-3 weeks

Question 26

Cryptococcosis-

Answer 26

Yeast (Cryptococcus neoformans) causing disseminated disease in immunocompromised individuals Often presents as meningoencephalitis or meningitis Presentation: fever, malaise, headache (often without photophobia and meningimus) Dx confirmed by LP and CSF analysis (increased opening pressure) Cryptococcal antigen (CrAg) testing on CSF and serum CSF microscopy (w/ India ink): encapsulated, budding yeast Treatment regiments using amphotericin B, flucytosine, fluconazole, and/or combinations thereof

Question 27

Cryptosporidiosis-

Answer 27

Protozoal infection affecting the small bowel mucosa Associated with PROFUSE WATERY, NON-BLOODY DIARHEA with fever and abdominal pain (usually asymptomatic in immunocompetent patients) Lower CD4 counts = more severe disease, prolonged duration Treatment focuses on improving CD4 counts with ART Adjunctive therapy: paromomycin or nitazoxanide

Question 28

Cytomegalovirus Infections-

Answer 28

CMV retinitis: Most common presentation of CMV infection Two-thirds of cases are usually unilateral Vision changes, loss of peripheral vision, scotoma, and/or floaters CMV esophagitis: Presents with chest pain, odynophagia, and nausea EGD: ulcerations in distal esophagus, biopsies to confirm dx

Question 29

Women Living with HIV Infection-

Answer 29

AIDS is 9th leading cause of death in women 35-44 years of age in United States Fourth leading cause of death in African American women (same age group) Women account for nearly 50% of all AIDS cases worldwide and 20% of those in the United States (as of 2014) Women Living with HIV Infection-

Question 30

Women Living with HIV Infection-

Answer 30

transplacental

Question 31

Elderly People with HIV- increased likelyhood

Answer 31

Increased incidence likely because of: Divorces and death of spouse Erectile dysfunction medications Contraception no longer a concern postmenopause Vaginal atrophy = small cuts and tears = increased blood exposure Less discussion during encounters with PCPs

Question 32

Pre-Exposure Prophylaxis-

Answer 32

Truvada (emtricitabine/tenofovir DF) approved by FDA in 2012 as first prevention medication for HIV

Question 33

Patients for whom PrEP should be considered as an option for HIV prevention:

Answer 33

Sexually active homosexual and bisexual men Male-to-female transgender persons Heterosexual and bisexual women who are likely to have partners with HIV risks Injection drug users

Question 34

Pre-Exposure Prophylaxis-Follow-Up Assessment-

Answer 34

HIV antibody testing every 3 months

Question 35

What is the preferred treatment for Toxoplasmosis?

Answer 35

pyrimethamine and sulfadiazine with leucovorin