HIV/AIDS - Sandkovsky

Question 1

What type of virus is HIV

Answer 1

A retrovirus: RNA virus, infects cell, forms DNA, makes more RNA

Question 2

T/F: HIV is able to replicate continuously in their host cells despite a competent host immune response

Answer 2

True

Question 3

Major cellular targets for HIV-1

Answer 3

Lymphocytes

mononuclear phagocytes

Question 4

HIV transmission factors

Answer 4

AIDS
Active STD
presence of genital lesions
frequency and type of unprotected sex
circumcision
viral load

Question 5

How is HIV transmitted

Answer 5

Bodily fluids: blood, semen, breast milk

Needles

Question 6

HIV pathogenesis and progression to AIDS

Answer 6

CD4 depletion in GALT in the acute phase of HIV. Selective loss of Th17, polyclonal B cell activation, increased CD4 and CD8 turnover with decreased half lives

Question 7

T/F: Shingles is suggestive of HIV infection

Answer 7

True- also several other indications

Question 8

AIDS indicators

Answer 8

CD4 count <14% of total lymphocytes

Question 9

Diagnostic testing for HIV

Answer 9

Oral fluid testing, urine testing, home test kit, rapid HIV testing

Question 10

Screening highest sensitivity for HIV

Answer 10

ELISA- detecting antibodies to HIV-1 and HIV-2

Question 11

Confirmation- highest specificity for HIV

Answer 11

Western Blot

Question 12

Acute HIV infection you should perform

Answer 12

HIV RNA by PCR

Question 13

Specific tests used in HIV infection

Answer 13

Quantitative HIV RNA, CD4 cell count/percentage, Total lymphocyte count, HLA B5701 (always before abacavir), Resistance testing

Question 14

Definition of success for HIV

Answer 14

HIV RNA <50 copies/mL

Question 15

A 55 y.o. women has HIV with CD4 count of 344 cells.mm and viral load of 34000 copies/mL. What is treatment

Answer 15

2 nucleoside reverse transcriptase inhibitors and 1 non-nucleoside reverse transcriptase inhibitor
OR
2 nucleoside reverse transcriptase inhibitors and 1 protease inhibitor OR
2 nucleoside reverse transcriptase inhibitors and an integrase inhibitor

Question 16

What drug is used with all PIs to exploit CYP3A4 inhibition to allow for smaller doses

Answer 16

Ritonavir

Question 17

Preferred initial treatments

Answer 17

1) Tenofovir (TDF)/ Emtricitabine (FTC) + Efavirenz

2) Abacavir/lamivudine + dolutegravir

Question 18

Why is anti retrovirus treatment (ART) necessary?

Answer 18

Prevent transmission by lowering viral load

Question 19

HIV in pregnancy- recommended regimen: All infected should be treated regardless of CD4 count with…

Answer 19

ZDV/#TC/lopinavir/ritonavir or TDF/FTC+Atazanavir/ritonavir

Question 20

Protease inhibitors are associated with

Answer 20

Metabolic syndrome

Question 21

Side effects of HIV medication:

Answer 21

Lipodystrophy, Bone disorders, etc…

Question 22

HIV RNA in plasma: HIV RNA should be greater than

Answer 22

10,000 copies

Question 23

Oral complications of HIV

Answer 23

Apthous ulcer
oral hairy leukoplakia
candidiasis
Kaposi's sarcoma
HSV

Question 24

Frequent Dermatologic complications in HIV patients

Answer 24

Herpes zoster (More than 1 dermatome suggests HIV infection)
Eosinophilic folliculitis
MRSA related
Seborrheic dermatitis
purigo nodularis
herpes simplex
bacillary angiomatosis
molluscum contagiosum
cryptococcus
scabies

Question 25

Cardiovascular complications of HIV

Answer 25

Dilated cardiomyopathy pulmonary HTN Tricuspid valve endocarditis

Question 26

Chronic diarrhea in HIV patients is associated with a CD4<____

Answer 26

100

Question 27

Two big neurologic complications in HIV patients

Answer 27

Cryptococcus and Bacterial Meningitis

Question 28

T/F: CMV retinitis the CD4 count is usually less than 50 and fundoscopic exam looks like cottage cheese and ketchup

Answer 28

True

Question 29

What type of pneumonia is associated with HIV patients

Answer 29

Pneumocystitis jirovecci pneumonia

Question 30

What fungal infection is associated with HIV

Answer 30

Coccidioides immitis and Histoplasmosa Capsulatum (<150 CD4)

Question 31

Pneumocytitis pneumonia prophylaxis should be started at CD4+ t cell count less than

Answer 31

200 cell/mm

Question 32

Prophylaxis for toxoplasmosis in HIV patients. What drug and CD4 count?

Answer 32

Bactrim at CD4 <100

Question 33

Definition of virologic management failure

Answer 33

HIV RNA> 200 copies/mL

Question 34

Patients who cannot get HIV have what type of mutation

Answer 34

CCR5 mutation