HIV PCP

Question 1

HIV RNA can be detected in all patients with HIV except:

Answer 1

Patient who underwent cytoreductive therapy after a bone marrow transplant from a CCR5,32 homozygous donor

Question 2

Determining CCR5 and CXCR4 tropic viruses:

Answer 2

Commercial assays: Trofile assay and Phenoscript assay

Question 3

A gram positive, pleomorphic, acid fast, spore-forming bacillus that can cause pulmonary/disseminated infection in patients with advanced HIV

Answer 3

Rhodococcus equi

Question 4

A mold that is endemic in southwest US that can cause reactivation pulmonary syndrome which presents as fever, weight loss, cough, and extensive diffuse pulmonary infiltrates. Seen with CD4 <250.

Answer 4

Coccidiodes immitis

Question 5

This enteric pathogen have a 20-fold increased risk for infection in UNTREATED HIV:

Answer 5

Salmonella typhimurium

Question 6

Cryptosporidia, a protozoal infection may also cause biliary tract disease (leading to cholecystitis without cholangitis). Treatment includes:

Answer 6

Nitazoxanide 2000mg/d

Characteristic finding: presence of oocysts that stain with acid fast dyes

Question 7

Microsporidia are small, unicellular, obligate intracellular parasites residing in cytoplasm of enteric cells. Main species causing disease in humans:

Answer 7

Enterocytozoon bieneusi

Question 8

Coccidian parasite in HIV commonly causing diarrhea in tropical and subtropical places (Cysts are large, acid fast)?
Usually treated by?

Answer 8

Isospora belli

Treated witg TMP-SMX. Relapse is common thus 3x weekly regimen is needed to prevent recurrence.

Question 9

Drugs used in HIV management that may cause renal damage:

Answer 9

PFACAT
Pentamidine
Amphotericin
Cidofovir
Adefovir
Tenofovir

Question 10

Pharmacokinetic booster component of cART formulations that inhibits renal tubular secretiob of creatinine leading to inc crea WITHOUT a true decline in GFR

Answer 10

Cobicistat

Question 11

A GUT infection in HIV patients that present as an ulcerating lesion of skin due to necrotizing vasculitus

Answer 11

Lues maligna

Question 12

Nucleosid analog with Fatal hypersensitivity reactions and advised not to rechallenge

Answer 12

Abacavir

Question 13

The only autoimmune disease that may occur with increased frequency in HIV patients (characterized by parotid gland enlargement, dry eyes, dry mouth, lymphocytic infiltrates of salivary gland and lung)

Answer 13

Diffuse infilitrative lymphocytosis syndrome (DILS)

• a variant of primary Sjogrens syndrome
• not anti Ro and anti Lo positive
• usu african american male

Question 14

This disseminated infection is transmitted by LICE and has been assoc with case reports of trench fever, endocarditis, adenopathy, bacillary angiomatosis. Uses Warthin-Starry stain for biopsy specimens.

Answer 14

Bartonella quintana

Treated with doxycycline or erythromycin for 3 months

Question 15

A fungal disseminated infection in southeast Asia (3rd most common in Thailand) which presents as fever, generalized lymphadenopathy, HSM, anemia, thrombocytopenia, papular skin lesions with central umbilicatiob (like molluscum contagiosum).

Answer 15

Penicillum marneffei

Treatment is amphotericin B ff by itraconazole until CD4 is >100 at least 6 months

Question 16

Rare sybdrome characterized by Cd4 T cell <300 or <20% on 2 occasionals at least 6 weeks apart WITHOUT HIV or HTLV infection

Answer 16

Idiopathic CD4 T Lymphocytopenia

Question 17

Staining used in identifying Cryptococcus species

Answer 17

Mucicarmine staining