HIV

Question 1

What does the acute retroviral syndrome of HIV look like?

Answer 1

fever, fatigue, LAD, HA, pharyngitis, n/v/d, +/- aseptic meningitis.

Question 2

How long after exposure does the acute retroviral syndrome present?

Answer 2

2-3 weeks s/p exposure.

Question 3

Other HIV clues?

Answer 3

• young pt new b/l Bell’s palsy
• young pt w unexplained thrombocytopenia + fatigue
• young pt unexplained weight loss >10%
• young pt w Thrush, zoster, kaposi

Question 4

If known exposure to HIV?

Answer 4

AZT, lamivudine, and nelfinavir for 4 weeks

Question 5

When to start HAART?

Answer 5

CD4 55,00

Preggos if viral load > 1000

Question 6

What HIV med causes GI issues, leukepenia, macrocytic anemia?

Answer 6

Zidovudine

Question 7

What HIV med causes HS rash, fever, n/v, muscle aches, SOB in 1st 6 weeks? What should you do?

Answer 7

Abacavir. D/C and never use again!

Question 8

What HIV med causes nephrolithiasis and hyperbilirubinemia?

Answer 8

indinavir (protease inhibitor)

Question 9

What HIV med causes sleepiness, confusion, psycho sx?

Answer 9

Efavirenz

Question 10

HIV+ patient w/ DOE, dry cough, fever, chest pain

Answer 10

Think p. jirovecci pneumonia.

Question 11

What CD4 count to be concerned w/ p. jirovecci ?

Question 12

CXR for p. jirovecci shows?

Answer 12

bilat diffuse symmetric interstitial infiltrates.

Question 13

Best test for p. jirovecci ? possible lab value finding?

Answer 13

After CXR, do bronchoscopy w/ BAL to visualize bug. May see elevated LDH.

Question 14

1st line treatment for p. jirovecci pneumonia?:

Answer 14

trim-sulfa

Question 15

2nd line treatment for p. jirovecci pneumonia?:

Answer 15

trim-dapsone, or primaquine-clinda, or pentamidine.

Question 16

When to add steroids to p. jirovecci pneumonia treatment?

Answer 16

PaO2 35

Question 17

When to add prophylaxis against p. jirovecci?

Answer 17

When CD4

Question 18

Three causes of HIV diarrhea?

Answer 18

CMV, MAC, Cryptosporidium. CD4 count

Question 19

Sx of CMV diarrhea?

Answer 19

Can be bloody

Question 20

Dx of CMV diarrhea?

Answer 20

Colonoscopy/biopsy.

Question 21

Treatment of CMV diarrhea?

Answer 21

gangiclovier (se: neutropenia), or foscarnet (se: renal tox).

Question 22

Sx of MAC diarrhea?

Answer 22

Diarrhea, wasting, fevers, night sweats.

Question 23

Tx of MAC diarrhea?

Answer 23

clarithromycin, ethambutol +/- rifampin. Prophylax w/ azithromycin weekly.

Question 24

Sx of cryptosporidum diarrhea?

Answer 24

transmitted via dog poo, swimming pools. Water diarrhea w/ mucus, oocysts are acid fast.

Question 25

HIV pt w/ neurologic sx and multiple ring enhancing lesions?

Answer 25

Toxoplasmosis.

Question 26

Treatment of HIV toxo?

Answer 26

pyramethamine + sulfadiazine + folic acid for 6 weeks. If no imporvement after 1 week, consider biopsy.

Question 27

HIV pt w/ neurologic sx and 1 ring enhancing lesions?

Answer 27

CNS lymphoma.

Question 28

What virus is CNS lymphoma associated with?

Answer 28

EBV infection of b-cells.

Question 29

Treatment of CNS lymphoma?

Answer 29

HAART.

Question 30

If HIV+ patient has seizure w/ de ja vu aura and 500 RBCs in CSF? Treat?

Answer 30

HSV encephalitis (temporal lobe). acyclovir ASAP.

Question 31

If HIV+ patient w/ s/s of meningitis? DX & TX?

Answer 31

think crypto, + india ink. Tx w/ ampho IV for 2 weeks then fluconazole maintenance.

Question 32

If HIV+ patient has hemisensory loss, visual impairment, + babinski?

Answer 32

PML. JC polyomavirus demyelinates at grey-white jxn.

Question 33

Dx of PML?

Answer 33

Brain bx.

Question 34

If memory problems or gait disturbance in HIV patient?

Answer 34

AIDS-Dementia complex. Check serum, CSF and MRI to r/o treatable causes.

Question 35

HIV+ patients with exophytic purple lesions that look vascular?

Answer 35

Bartonella sp. Bacillary angiomatosis.

Question 36

Other sx of bacillary angiomatosis?

Answer 36

visceral lesions to. Prone to hemorraghe. Also non specific symptoms like malaise, fever, weight loss, abd pain, etc.

Question 37

What HIV med causes pancreatitis?

Answer 37

didanosine

Question 38

What HIV med causes liver failure?

Answer 38

nevirapine

Question 39

What class of HIV meds cause SJS?

Answer 39

NNRTI

Question 40

What class of HIV meds cause lactic acidosis

Answer 40

NRTI