HIV

Question 1

Where do we find HIV1 and HIV 2 in the world?

Answer 1

America, Europe, central Africa

West Africa

Question 2

Talk about the 3 main proteins of HIV?

Answer 2

P7 protein holds together the two positive single stranded RNA
Virus is enclosed bu the conical capsid viral protein P24
RNA genome consists of 9 genes, gag, pol and env are most important in making structural proteins for new virus particles.

Question 3

Capsid contains 3 enzymes required for HIV replication, what are they and why are they important to us?

Answer 3

Reverse transcriptase, integrate and protease

We go after these with medicine

Question 4

What cell does HIV infect and what are the 4 main outcomes because of infection of the cell?

Answer 4

CD 4 T cell 
Cell death
Severe immunodeficiency 
Opportunist infections
Malignancy

Question 5

Big picture, explain how HIV gets distributed throughout the body?

Answer 5

CD4 T cell gets infected, goes to GALT in the gut, then gets sent to lymphoid organs throughout the body, massive immune/inflammatory response to the infection and rapid replication everywhere basically.

Question 6

The hallmark pathogenesis of symptomatic HIV infection is what?

Answer 6

Immunodeficiency caused by continuing viral replication

Question 7

What is the antigen HIV uses to attach to cells, which means what cells can it infect? What are the two fates of the virus once inside the cell?

Answer 7

Cd4
Once inside it can replicate and kill the cell
It can also cause a latent state and integrate itself into the host cell genome and not replicate right away.

Question 8

Top 3 transmission risks of HIV?

Answer 8

Butt sex, needles and butt sex and anal sex

Question 9

What is another high risk transmission for HIV we must always be cautious about?

Answer 9

Blood transfusions

Question 10

Which race is more at risk for HIV?

Answer 10

Blacks, Hispanics and whites

Question 11

3 main pathophysiology processes of HIV?

Answer 11

Immunodeficiency
Autoimmunity
allergic Hypersensitivity reactions

Question 12

At about 250-500 cd4 count what infections/conditions are presenting in the HIV patient? 4

Answer 12

Bacterial infections
Pneumococcal pneumonia
Pulmonary TB
Herpes zoster
Oral candiasis

Question 13

When we go less than 200 cd4 count, what infections is the HIV patient getting? 4

Answer 13

Pneumocystis jiroveci pneumonia
Histoplasmosis
Kaposi sarcoma
Extrapulmonary TB

Question 14

At cd4 counts less than 100, 3 infections?

Answer 14

Cryptococcal meningitis
Esophageal candiasis
Toxoplasmosis

Question 15

2 infections and 1 tumor that presents at less than 50 cd4 counts?

Answer 15

MAC and CMV

CNS lymphoma

Question 16

3 specific physical exam findings for HIV and what is common in early infection?

Answer 16

Hairy leukoplakia of tongue
Kaposi sarcoma
cutaneous bacillary angiomatosis
generalized LAD

Question 17

What is the first lab test to do when testing for HIV?

Answer 17

HIV 1/2 Ag/Ab combination assay (testing for HIV ab and HIV p24 antigen)

Question 18

If that is positive, what do we do next?

Answer 18

If positive, test the sample with HIV 1/2 ab differtiaiton which will confirm the diagnosis.

Question 19

What happens if the differentiation test is negative, what do you do next?

Answer 19

Do a HIV 1 NAAT and if positive, acute HIV is diagnosed.

Question 20

What would be considered a false positive test result?

Answer 20

Positive combo test, negative differentiation test and negative HIV NAAT.

Question 21

What prophylaxis measures do we take when cd 4 counts drop below 200 and 75?

Answer 21

Jiroveci

Mycobacterium Avium

Question 22

What are 6 complicating symptoms of HIV?

Answer 22

Weight loss and muscle wasting
Nausea
Anorexia
Depression
Isolation
Decrease in quality of life

Question 23

What is the most common opportunist infection associated with AIDS and what are the symptoms?

Answer 23

Pneumonia from jiroveci

Pulmonary problems so cough, fever, SOB

Question 24

What is the cornerstone of diagnosis of jiroveci pneumonia with these patients and what will we see most of the time?

Answer 24

Chest x ray
Diffuse or perihilar infiltrates
Pleural effusions uncommon

Question 25

What technique can confirm the diagnosis of jiroveci pneumonia?

Answer 25

Bronchoalveolar lavage, so basically sputum

Question 26

2 lab markers in helping diagnose pneumocystis?

Answer 26

Serum LDH and serum beta glucan

Question 27

What is the most common cause of pulmonary disease in HIV infected persons?

Answer 27

Community acquired pneumonia

Question 28

What is the most common space occupying lesion in HIV, what is the CD4 count typically in these patients, symptoms, what does CT can show, and what does MRI show?

Answer 28

Toxoplasmosis Less than 100 HA, fever, neuro problems Multiple subcortical lesions commonly in basal ganglia Multiple ring enhancing lesions with surrounding areas of edema

Question 29

3 GI conditions because of HIV?

Answer 29

Enterocolitis Liver disease Candidiasis in esophagus

Question 30

What are the 5 major problems encountered with HIV patients infected by CMV in order of frequency?

Answer 30

``` Retinitis Colitis Esophageal ulceration Encephalitis Pneumonitis ```

Question 31

How do we characterize kaposi sarcoma?

Answer 31

Low grade vascular tumor associated with HHV8

Question 32

What part of the body is characteristically involved and what 3 areas of the body can it spread to?

Answer 32

Skin | Oral cavity, GI, and respiratory tract

Question 33

The skin lesions typically show up in what 4 places?

Answer 33

Lower extremities, face (nose), oral mucosa, and genitalia

Question 34

What are the symptoms usually in AIDS related KS?

Answer 34

Pulmonary