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HIV/AIDS & Opportunistic Infections Flashcards

(47 cards)

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1
Q

Which has the highest risk of HIV transmission: receptive anal intercourse, insertive anal intercourse, receptive vaginal intercourse, insertive vaginal intercourse, IV drug use by shared needles with an HIV-infected source, or needlestick with infected blood?

A

**Receptive Anal Intercourse: 1 in 65

  • IV drug use with shared needle: 1 in 150
  • needlestick w/ infected blood: 1 in 300
  • insertive anal intercourse: 1 in 1,000
  • receptive vaginal intercourse: 1 in 1,000
  • insertive vaginal intercourse: 1 in 10,000
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2
Q

Which population is least likely to know they’re infected with HIV?

A

-young people ages 13-24

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3
Q

Which population counts for the majority of new HIV diagnoses?

A

gay and bisexual men

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4
Q

Which ethnicity has the highest rate of HIV infection?

A

Black/African American

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5
Q

Which world region bears the heaviest burden of HIV/AIDS worldwide?

A

Sub-Saharan Africa (accounting for 66% of all new HIV infections)

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6
Q

True or False: Globally, the majority of new HIV infections are found in the general population.

A

True; 56% of new HIV infections globally are found in the general population

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7
Q

What is the average time between HIV infection and development of AIDS?

A

10 yrs

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8
Q

True or False: A combination of complaints is more suggestive of HIV infection than any single symptom.

A

True

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9
Q

What are some conditions that are highly specific for HIV infection?

A
  • hairy leukoplakia of the tongue
  • disseminated Kaposi Sarcoma
  • cutaneous bacillary angiomatosis
  • generalized lymphadenopathy (in early infection)
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10
Q

What two things are tested in the combined immunoassay for HIV?

A
  • HIV antibody
  • HIV p24 antigen

-p24 Ag becomes detectable a week before the Ab

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11
Q

True or False: if the combined immunoassay for HIV returns positive, no further testing is required.

A

False; it is followed by an HIV-1/2 Ab differentiation immunoassay

-THEN, detection of HIV-1, HIV-2, or both… confirms Dx.

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12
Q

What happens if a sample is negative or indeterminate on the Ab differentiation test?

A

the sample is tested with an HIV-1 nucleic acid amplification test (NAAT)

(+) is a confirmation of HIV-1

(-) is a false positive from the initial combined immunoassay and Ab differentiation test

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13
Q

What is the most widely used marker to provide prognostic information and guide HIV therapy?

A

CD4 count

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14
Q

What are some limitations to using the CD4 count?

A
  • -diurnal variation
  • -depression with intercurrent illness
  • -intra-laboratory and interlaboratory variability
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15
Q

True or False: the CD4 count trend is more important than a single determination.

A

True

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16
Q

What are some opportunistic infections that can be found in HIV patients, even when their CD4 count is >300?

A
  • pneumococcal PNA
  • pulmonary TB
  • Herpes zoster
  • oral/vaginal candidiasis
  • fatigue (HIV Fatigue Syndrome)
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17
Q

What are some opportunistic infections that can be found in HIV patients when their CD4 count is < 300?

A
  • oral hairy leukoplakia
  • thrush
  • fever
  • weight loss
  • diarrhea
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18
Q

What are some opportunistic infections that can be found in HIV patients when their CD4 count is <200?

A
  • pneumocystic jirovecii PNA
  • disseminated histoplasmosis
  • Kaposi Sarcoma
  • extrapulmonary/miliary TB
  • NHL
  • CNS lymphoma
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19
Q

What are some opportunistic infections that can be found in HIV patients when their CD4 count is <100?

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A
  • cryptococcosis (cryptococcal meningitis)
  • esophageal candidiasis
  • toxoplasmosis
20
Q

What are some opportunistic infections that can be found in HIV patients when their CD4 count is <50?

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A
  • -mycobacterium-avian complex (MAC)
  • -CMV
  • -primary CNS lymphoma
21
Q

How often should CD4 counts be monitored in HIV patients on anti-retroviral therapy?

22
Q

True or False: CD4 counts provide a measure of how actively HIV is replicating in the body.

Study These Flashcards
A

False: HIV Viral Load tests the level of viral replication

23
Q

Name some AIDS-defining illlnesses.

Study These Flashcards
A
  • multiple or recurrent bacterial infections
  • pneumocystis jirovecii PNA
  • Kaposi Sarcoma
  • lymphoma
  • CMV infection
  • histoplasmosis
  • coccidioidomycosis (disseminated or extrapulmonary)
  • extrapulmonary cryptococcosis
  • TB
24
Q

What is the most common opportunistic infection associated with AIDS?

Study These Flashcards
A
  • Pneumocystis jirovecii (Dx by a chest radiograph)

- -shows diffuse or perihilar infiltrates, apical infiltrates

25
What type of procedure would you do if you suspect Pneumocystic jirovecii in a patient, but the sputum sample returns negative?
-bronchoalveolar lavage (BAL)
26
What are two lab tests that can be run for Pneymocystis jirovecii and which of the two is more sensitive and specific?
- -elevated serum lactate dehydrogenage (LDH) | - -serum beta-glucan (<
27
What is the likelihood of an infection with Pneumocystis jirovecii if the diffusing capacity of carbon monoxide is normal?
very unlikely
28
What is the likelihood of an infection with Pneymocystis jirovecii if a chest CT shows no signs of interstitial lung disease?
very unlikely
29
Does a CD4 count > 250 within 2 months prior lessen the likelihood that a respiratory infection is caused by Pneumocystis jirovecii?
Yes, because only about 3% of cases occur above this count
30
What is the most common cause of pulmonary disease in HIV-infected persons?
community-acquired PNA | bacterial, mycobacterial, or viral
31
What is the most common space-occupying lesion in HIV patients?
Toxoplasmosis
32
What are the symptoms of Toxoplasmosis?
- multiple subcortical lesions with a predilection for the basal ganglia - HA, fever, focal neurologic deficits, AMS, and seizures
33
Why are serologic tests not useful in making or excluding Dx of Toxoplasmosis?
- antibodies to T. gondii are prevalent in the general population - the presence of T. gondii in the CSF is helpful, but there is a high rate of false-negative results
34
Which is more sensitive in detecting toxoplasmosis: MRI or contrast-enhanced CT?
MRI | --it will display multiple ring-enhancing lesions with surrounding areas of edema
35
Besides Toxoplasmosis, what are some other Ddx that can present as ring-enhancing lesions on a contrast-enhanced CT?
- CNS lymphoma - fungal infection - cerebral TB
36
What is the second most common cause of space-occupying lesions (after Toxoplasmosis) in HIV patients?
primary CNS lymphoma | --typically a single ring-enhancing lesion
37
What tests is used to detect cryptococcal meningitis in HIV patients?
- latex agglutination test of serum that shows cryptococcal antigen (CRAG) - culture of CSF for Cryptococcus
38
Primary CNS Lymphoma in HIV patients is highly associated with which virus?
EBV, detected by a CSF PCR
39
What are the symptoms of Primary CNS Lymphoma?
- mass lesion - HA - confusion, disorientation - altered balance/gait, falls, focal deficits - seizures
40
What are common skin infections of HIV patients?
- herpes simplex - herpes zoster - molluscum contagiosum - Staph, Strep - bacillary angiomatosis - fungal
41
What is a considerable cause of morbidity in severely compromised HIV-infected individuals?
-CMV
42
What are major problems encountered in CMV of HIV patients?
- Retinitis (most common) - -"cottage cheese and ketchup" appearance -colitis, esophageal ulceration, encephalitis, pneumonitis
43
What is Kaposi Sarcoma?
--low-grade vascular tumor associated with HHV-8 --extracutaneous spread to oral cavity, GI tract, and respiratory tract is common
44
Describe the lesions of Kaposi Sarcoma?
- most often on lower extremities, face (especially nose), oral mucosa, and genitalia - papular, several mm to several cm in diameter
45
What are pulmonary symptoms of Kaposi Sarcoma?
-SOB, fever, cough, hemoptysis, CP - -despite an asymptomatic x-ray finding - -Dx confirmed via bronchoscopy
46
When would you start prophylaxis for Pneumocystis jirovecii?
- CD4 count < 200 - when the pt has oropharyngeal candidiasis - prior bout of Pneumocystic jirovecii
47
What drug is used as prophylaxis for Pneumocystis jirovecii?
--trimethoprim-sulfamethoxazole (TMP-SMX) (aka Bactrim) --1 double-strength table daily PO

SBL (4 decks)

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