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Flashcards in HIV Clinical Monitoring and Progression Deck (14)
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How is HIV diagnosed?

Combined Ab/Ag test:

-looks for anti-HIV Ab -and- HIV p24 Ag (detectable before Ab)

-if positive -> Ab differentiation

-if negative -> no HIV or too early to detect


Ab differentiation:

-specifically idenitifies HIV-1, HIV-2, or mixed infections based on Ab

-if positive -> HIV diagnosis confirmed

-if negative -> NAAT


NAAT (nucleic acid amplification):

-if positive -> acute HIV (too early for other tests to detect)

-if negative -> no HIV/combined Ab/Ag was false positive


What tests are used to assess the progression and current state of HIV?

CD4 count:


-represents immune function; lower count -> higher risk of serious infections


Viral load:


-represents viral replication

-higher viral load -> more infectious

-increasing viral load = progression of disease (failure of treatment?)


What conditions can present with a CD4 count >300 in HIV?

-reactivation of tuberculosis (pulmonary) and herpes zoster (shingles) infections

-HIV fatigue syndrome

-oral/vaginal candidiasis

-pneumococcal pneumonia (normal pneumonia but in people who nomrally would not be considered at risk)


What conditions can present with a CD4 count of 200-300 in HIV?

-oral hairy leukoplakia (EBV; non-scrapable plaques on side of tongue)

-thrush (scrapable w/ pseudohyphae, w/o esophageal involvement)

-worsening fatigue syndrome (fever, weight loss, diarrhea)


What conditions can present with a CD4 count of 100-200 in HIV?

These are AIDS defining


-Pneumocystis jiovecii pneumonia

-disseminated histoplasmosis


Worsening reactivations:

-Kaposi sarcoma (HHV-8; skin/mucosal lesions initially facial/oral)

-extrapulmonary/miliary TB

-progressive multifocal leukoencephalopathy/PML (JC virus; non-enhancing, demylination lesions in white matter)

-lymphoma (EBV -> Burkitt (NHL) or HL)



What conditions can present with a CD4 count of 50-100 in HIV?

-CNS toxoplasmosis (multiple ring-enhancing lesions)

-esophageal/pulmonary candidiasis

-cryptococcal meningitis


What conditions can present with a CD4 count of <50 in HIV?

-mycobacterium-avium complex/MAC

-primary CNS lymphoma (EBV; diffuse large B-cell)



When is AIDS diagnosed?


CD4 count <200


pressence of AIDS-defining illness


What are AIDS-defining illnesses?

-multiple/recurrent bacterial infections (ie. CAP)

-pneumocystis jirovecii

-cancer (Kaposi sarcoma or lymphomas)



-tuberculosis (any site)




What is the most common AIDS-defining illness? 

Pneumocystis jirovecii/pneumocystis pneumonia


What are identifying characteristics of Pneumocystis jirovecii?

-"ground glass" appearing

-apical infiltrates -> apical cysts/pneumoatoceles


What AIDS-defining conditions appear with ring-enhancing brain lesions?

What differentiates them?


-multiple lesions


Primary CNS lymphoma:

-single lesion


What symptoms are associated with CMV?

Which is most common?



-retinitis (most common)

-esophageal ulceration




What prophylacitic treatments should be given in HIV/AIDS and when?

Bactrim (Pneumocystis jirovecii):

-CD4 <200 or after oropharyngeal candidiasis



-hepatitis A/B (all)

-Influenza (yearly)

-Strep. pneumoniae (all)

-HPV (all between 13-26)