HIV and Opportunistic Infections

Question 1

Highest risk activity for HIV?

Answer 1

Receptive anal sex

Question 2

Acute HIV infection

Answer 2

• Flu like symptoms
• easily attributed to other illnesses

Question 3

Chronic asymptomatic HIV

Answer 3

• Can last years
• Asx
• diagnosed after routine testing or high risk exposure

Question 4

AIDS

Answer 4

• Variable timing but years after infection
• Constitiutional sx and opportunitsic infections

Question 5

What is the first test to be positive?

Answer 5

HIV RNA PCR or HIV NAAT (Viral Load)

Question 6

When is the HIV p24 ag positive?

Answer 6

Second to be positive during acute HIV

Question 7

HIV ab test?

Answer 7

• Last to be positive and may be negative during acute HIV

Question 8

What is the window period?

Answer 8

• Period in early HIV infection before HIV ab tests are positive

Question 9

What is the CDC recommended algorithm for HIVdiagnosis?

Answer 9

1. HIV1/2 ag/ab combination immunoassay
   
   1. if positive use
2. HIV-1 HIV-2 ab differentiation immunoassay
   
   1. if negative use
3. HIV RNA PCR (NAT)

Question 10

25 yo male sexually active with other men has regular unprogected receptive anal sex. Recently he has had flu like illness with fever, rash, sore throat. PCP has HIV testing done.

• HIV 1/2 Ag/Ab combo: positive
• HIV 1/2 differentiation immunoassay: negative
• HIV1 NAAT: positive

What do these results mean?

Answer 10

Acute HIV infection

Question 11

65 year old female with Htn for routine care. HIV testing done as routine screening, no known HIV risks, monogamous 40 year relationship one male partner.

• HIV 1/2 Ag/ab combo: positive
• HIV 1/2 ab differentiation immunoassay:
  
  • HIV-1 indeterminate
  • HIV-2 negative
• HIV-1 NAAT: Negative

what do the results indicate?

Answer 11

Negative for HIV, False positive

Question 12

CD4 <200 indicates?

Answer 12

• AIDS
• high risk OI’s

Question 13

Chronic immune activation in HIV has higher risk for certain conditions such as…

Answer 13

• MI
• Stroke
• Cervial cancer

Question 14

Process of becoming undetectable?

Answer 14

• 1-6 months to become undetectable after starting treatment
• 6 months to stay undetectable after first undetectable test result
• Can’t pass HIV through sex as long as they stay undetectable

Question 15

What is PrEP?

Answer 15

• Given to HIV negative people at risk for HIV to help prevent acquiring HIV
• Taken daily to block HIV infection if exposed
• Medication is taken daily to block HIV infection if exposed
  
  • Tenofovior disoproxil-emtricitabine 2 nucleoside reverese transcriptase inhibitors

Question 16

38 yo male with HIV not engaged in care has a CD4 count of 86 6 months ago. Goes to clinic with 2-3 weeks of fever, non productive cough, sharp chest pain, dyspnea on exertion.

• T: 100
• O2 : 95% RA but walk 84%
• CT shows ground glass opacities

what is happening?

Answer 16

• Pneumocystis Jirovecii Pneumonia
• Most common AIDS assoc AI
• Elevated LDH
• Exertional hypoxia
• Ground glass infiltrates on CT but possibly normal Cxr

Question 17

What presents with an apical cavitary lesion and fever, cough, dyspnea, weight loss and night sweats?

Answer 17

• Mycobacterium TB with a CD4 count <500

Question 18

Community acquired pneumonia occurs at what CD4 count in patients with HIV?

Answer 18

• Any CD4 count
• Most common HIV assoc Pulmonary infection
• Fever cough SOB inflitrates on CXR

Question 19

Focal neuro deficits such as siezures, aphasia or hemiparesisis are present in a patient who has been off ART for 6 months. What could this be?

Answer 19

• reactivation of latent tissue cysts in patients wit htoxxoplasma infection
• Multiple ring enhancing lesions are seen on MRI

Question 20

What could be mistaken for Toxoplasmosis?

Answer 20

• Primary CNS Lymphoma CD4 <50
• Presentation similar to toxo with focal neurologic deficits
  
  • less common than toxo
• MRI shows single ring enhancing lesion
• CSF may show malignant lymphoid cells in 40% patients
• Brain biopsy needed

Question 21

29 yo male with history of HIV not on ARV’s brought to hospital with 2 week history of HA, photophobia, nausea, vomiting, poor appetite, night sweats. Last known CD4 count was 86. CT brain shows no mass lesion and no midline shift. Lumbar puncture demonstrates elevated pressure of 32 (high). Diagnosis is?

Answer 21

• Cryptococcal meningitis with CD4 <100
• Leading cause of meningitis in patients with AIDS
• Fever altered mental status HA,
  
  • focal neuro less common

Question 22

33 yo woman with HIV who was LTFU comes to ED. CD4 count is 22 and HIV RNA level is 215,000 copies. COmplains of night sweats low fever, weigh tloss, malaise, diarrhea, generalized abdomen pain.

What is diagnosis?

Answer 22

Mycobacterium avium intracellulare infection with CD4 <50

Question 23

46 yo women with HIV not having medical care last CD4 count of 35. She is having new visual problems complaining of floaters and blurry vision in her right eye for 2 days. Opthalmologic eval demonstrates region of opacified discolored retinia involving optic nerve head extending to the macula.

What is the diagnosis?

Answer 23

• CMV reactivation can cause problems such as retinitis and colitis
• CMV Retinitis:
  
  • Presents with floaters scotomas and visual field cut
• CMV colitis:
  
  • diarrhea abdominal pain and weight loss
    
    • owl’s eye cytoplasmic inclusion bodies

Question 24

32 yr old women with HIV not on tx comes to clinic with altered taste and abnormal “white stuff” on tongue. Last CD4 count was 180 six months ago. White plaques can be scraped off with tongue depressor. What is the diagnosis?

Answer 24

• Candidiasis in HIV with low CD4 count

Question 25

Describe Esophageal candidiasis

Answer 25

• Odynophagia and retrosternal pain
• Can be caused by HSV or CMV also

Question 26

What is oral hairy leukoplakia?

Answer 26

• Assoc. with EBV
• White frondlike lesions on lateral tongue that don’t scrape off

Question 27

What prophylaxis is given for those with CD4 counts of 200-100 to treat PJP or toxo?

Answer 27

Trimethoprim-sulfamethoxazole daily