HIV/AIDS and Opportunistic Infections

Question 1

Which route of transmission has the highest risk of transmission?

Answer 1

receptive anal intercourse 1:100 - 1:30

insertive vaginal intercourse is 1:10,000

Question 2

A healthcare provider is working at a mission trip in Uganda. During the course of checking blood samples, they get stuck by a used needle. Which of the following best describes their transmission risk.

A. 1:100
B. 1:10,000
C. 1:2
D. 1:300

Answer 2

D. 1:300

things that change risk factors include depth of penetration, hollow bore needles, blood on needles, advanced stage of disease in source.

*remember to divide incidence in 2 with needle sharing in illicit drug use to 1:150

Question 3

Without prophylactic prevention, what percentage of children born to HIV+ mothers will contract the disease

Answer 3

13-40%

Question 4

Which two groups represent the most likely to be HIV positive?

Answer 4

African americans

Gay/Bixesual men

Question 5

What is the mean time between infection with HIV and development of AIDS

Answer 5

10 years

Question 6

Which diagnostic test, looks for the presence of HIV ab and the HIV p24 antigen?

Answer 6

combines immunoassay

improves ability to detect because p24 is present before Ab

99.6% specificity

Question 7

If a person was negative for the HIV-1/2 Ab differentiation immunoassay, what test would you do to confirm the negative finding.

Answer 7

HIV-1 nucleic acid amplification test (NAAT)

if positive with negative ab test -> acute HIV

if initial positive on ab test, negative NAAT -> false positive.

Question 8

What is the most widely used marker for HIV prognostic information?

Answer 8

absolute CD4 count

trend is more important than single determination

Question 9

What are the limitations to consider when using CD4 count?

Answer 9

Diurnal variation
depression with intercurrent illness
intra-laboratory and interlaboratory variability

Question 10

Which diseases are common with a CD4 count of >300

Answer 10

Pink Penises Hop On Very Fast (300 mph)

Pneumococcal pneumonia 
Pulmonary Tb
Herpes Zoster
Oral Candidiasis 
Vaginal Candidiasis 
Fatigue

Question 11

Which diseases are common with a CD4 count of <300

Answer 11

Over The Worst Fucking Day

Oral Hairy Leukoplakia
Thrush 
Weight Loss
Fever 
Diarrhea

Question 12

Which diseases are common with a CD4 count of <200

Answer 12

Please Dont Kap Every Non Catholic

Pneumocystis Jirovecii (PCP)
Disseminated histoplasmosis 
Kaposi Sarcoma 
Extrapulmonary/miliary TB
Non-Hodgkin's Lymphoma 
CNS Lymphoma

Question 13

Which diseases are common with a CD4 count of <100

Answer 13

Cryptococcosis (cryptococcal meningitis)
Esophageal candidiasis
Toxoplasmosis

Question 14

Which diseases are common with a CD4 count of <50

Answer 14

Mycobacterium-avium complex (MAC)
Cytomegalovirus
Primary CNS lymphoma

marked as important

Question 15

How often should CD4 counts be monitored in patients taking antiretroviral treatment consistently

Answer 15

3-6 Months

Question 16

True or false: CD4 count measures how actively HIV is replicating in the body

Answer 16

False:

this is measured by viral load. provides important prognostic info

Question 17

What are the AIDS defining illnesses?

Answer 17

Pneumocystis jirovecii
CMV infection
Coccidioidomycosis (disseminated or extrapulmonary)
Mycobacterium TB

These were the ones they emphasized but I would also know kaposi sarcoma.

Question 18

What is the most common opportunistic infection associated with AIDS

Answer 18

pneumocystis jirovecii

Fever, cough, shortness of breath
Hypoxemia.

Question 19

What techniques are used to obtain a definitive diagnosis of PJP

Answer 19

Wright-Giemsa stain or Direct Fluorescence antibody

Bronchoalveolar lavage (BAL)

Question 20

Describe the findings in Pneumocystis Pneumonia

Answer 20

elevated serum Lactate Dehydrogenase
serum beta glucan more sensitive and specific than LDH
if normal diffusion capacity of CO make pCP unlikely

Question 21

What is the most common cause of pulmonary disease in HIV+ pts

Answer 21

Community-acquired pneumonia

Question 22

What is the most common space occupying lesion in HIV+ pts

Answer 22

Toxoplasmosis

Question 23

What is the typical CD4 count and and symptoms associated with someone with a toxoplasmosis infection

Answer 23

CD4 <100

headache
fever
focal neuro deficits
altered mental status and seizures

Question 24

how does toxoplasmosis appear on unenhanced CT scan

Answer 24

multiple subcortical lesions with predilection in basal ganglia

Question 25

on MRI you see the typical ring enhancing lesions associated with toxoplasmosis but you confirm 100% it isn’t toxo. what other diseases should remain on your differential

Answer 25

CNS Lymphoma
fungal infection
cerebral TB

Question 26

what is the second most common cause of space-occupying lesion in HIV

Answer 26

Primary CNS lymphoma

Question 27

70-90% of patients with cryptococcal meningitis have a positive result of what?

Answer 27

serum CRAG (cryptococcal antigen)

Question 28

Describe Primary CNS lymphoma

Answer 28

diffuse, large-cell B-cell malignancy
high association with EBV
usually occurs CD4 <50

Question 29

Describe the problems associated with CMV in HIV pts

Answer 29

Retinitis* 
Colitis 
Esophageal ulceration 
Encephalitis 
Pneumonitis

Question 30

Describe Kaposi Sarcoma

Answer 30

caused by HHV-8

skin lesions appear on LE, face, oral mucosa, and genitalia
Pulmonary involvement can occur in HIV pts

Question 31

Describe the situation that would warrant prophylaxis for PCP and what would that be

Answer 31

CD4+ <200 or Oropharyngeal candidiasis or prior PCP

Trimethoprim-sulfamethoxazole (TMP-SMX) (Bactrim)

• -1 DS tablet PO
• • 1 SS tablet PO

Question 32

What drugs are indicated in mycobacterium TB prophylaxis

Answer 32

Isoniazid 300 mg + Pyridoxine 25 mg PO
or
Isoniazid 900 mg PO 2X/week + Pyridoxine 25 mg PO QD

Question 33

What type of vaccines should you avoid in patients with HIV

Answer 33

LIVE vaccines