Oral Path Exam 3 - HIV Flashcards by A G

HIV is a _________ virus

ss-RNA

How well did you know this?

Not at all

Perfectly

What are the 2 types of HIV?

HIV-1 (worldwide)
HIV-2 (west Africa)

How well did you know this?

Not at all

Perfectly

Eastern/Southern Africa cases account for greater than _______% of people living with HIV worldwide

50%

How well did you know this?

Not at all

Perfectly

The HIV virus is in most ________ ________

body fluids

How well did you know this?

Not at all

Perfectly

How is HIV transmitted?

Sexual contact
Injection drug use

How well did you know this?

Not at all

Perfectly

What is the incidence rate of HIV infection?

Blacks > hispanics > whites

How well did you know this?

Not at all

Perfectly

What is the occupational risk of HIV infection?

0.3% percutaneous
0.09% mucous membrane

How well did you know this?

Not at all

Perfectly

What are the target cells of HIV?

CD4+ helper T cells
Macrophages

How well did you know this?

Not at all

Perfectly

HIV binds through _________ and ________ with CD4+ and CCR4/CCR5 interaction. ________ is reverse transcribed into DNA which integrates into the host genome

gp41 and gp120; RNA

How well did you know this?

Not at all

Perfectly

In HIV, what occurs with decrease in CD4+ helper T cells, leading to decreased response to fungi, viruses, and encapsulated bacteria?

Cell lysis or latency

How well did you know this?

Not at all

Perfectly

How long after exposure would you expect the following clinical presentation of HIV?

Acute retroviral syndrome, followed by latency

1-6 weeks post-exposure

How well did you know this?

Not at all

Perfectly

How long after exposure would you expect the following clinical presentation of HIV?

Increased viremia
Decreased CD4+ helper T cells
AIDS-related complex + opportunistic infections

10 years post-exposure

How well did you know this?

Not at all

Perfectly

T/F: In HIV, latency can be established within the first few days of infection. 80% risk reduction for infection if post-exposure prophylaxis (2 drugs x 4 weeks) given within hours of exposure

True

How well did you know this?

Not at all

Perfectly

What are the following symptoms associated with?

Chronic fever
Weight loss
Diarrhea
Oral candidiasis
Herpes zoster
Oral hairy leukoplakia

AIDS-related complex (ARC)

How well did you know this?

Not at all

Perfectly

What are the bacterial opportunistic infections in HIV?

Mycobacteria (like TB)

How well did you know this?

Not at all

Perfectly

What are the viral opportunistic infections in HIV?

CMV
HSV

How well did you know this?

Not at all

Perfectly

What are the fungal opportunistic infections in HIV?

Pneumocystis jiroveci (fungal pneumonia)
Cryptococcus meningitis

How well did you know this?

Not at all

Perfectly

What are the protozoal opportunistic infections in HIV?

CNS toxoplasmosis

How well did you know this?

Not at all

Perfectly

What are the neurologic dysfunctions in HIV?

Seizures
Dementia

How well did you know this?

Not at all

Perfectly

HIV is diagnosed by a screening test, followed by a ____________ ________

Western blot

How well did you know this?

Not at all

Perfectly

Which diagnosis method for HIV?

Enzyme immunoassay or rapid antibody test

Screening test

How well did you know this?

Not at all

Perfectly

The screening test for HIV only works if the pt has had _______________, which is 3-12 weeks post-exposure

seroconversion

How well did you know this?

Not at all

Perfectly

What is the AIDS defining criteria? (ON EXAM)

CD4+ T cell count < 200/mL
CD4+ T cell < 14% of total lymphocytes
AIDS-defining condition

How well did you know this?

Not at all

Perfectly

How is HIV treated?

Combination antiretroviral therapy (cART)

(targets RT, protease, fusion, integrase, and CCR5)

How well did you know this?

Not at all

Perfectly

T/F: The tx goal for HIV is for the viral load to be "undetectable" or at least < 50 copies/mL

True

What may be the first sign of HIV infection?

Oral lesions

What is the most common oral manifestation of HIV infection?

Oral candidiasis

T/F: All subtypes of oral candidiasis may be seen in HIV

True

What is the tx for oral candidiasis in HIV?

Clotrimazole Fluconazole

What should you do if you see recurrent oral candidiasis infections in an undiagnosed pt?

Refer for HIV testing

What does the PAS stain highlight in HIV?

Hyphae + yeast forms

Which lesion associated with HIV? Red, linear band at marginal gingiva that extends 2-3 mm apically

Linear gingival erythema

Which lesion associated with HIV? Spontaneous bleeding, petechiae may be noted

Linear gingival erythema

Which lesion associated with HIV? Lack of response to improved OH

Linear gingival erythema

Which lesion associated with HIV? Rxn to subgingival bacteria or unusual pattern of candidiasis has been suggested (most cases respond to antifungals)

Linear gingival erythema

Which lesion associated with HIV? Similar to that seen in non-immunocompromised pts: loss of interdental papillae w/o bone loss, bleeding, pain, halitosis

Necrotizing ulcerative gingivitis (NUG)

Which lesion associated with HIV? May be seen in a setting of relatively few apparent local factors

Necrotizing ulcerative gingivitis Necrotizing ulcerative periodontitis

Which lesion associated with HIV? Similar to NUG (pain, bleeding, edema) but with extensive bone loss

Necrotizing ulcerative periodontitis (NUP)

Which lesion associated with HIV? May be multifocal or generalized

Necrotizing ulcerative periodontitis

Which lesion associated with HIV? Don't see deep pocketing due to gingival necrosis as the bone is lost

Necrotizing ulcerative periodontitis

Which lesion associated with HIV? Extensive destruction of gingiva, periodontal bone, adjacent soft tissue and deeper osseous structures

Necrotizing stomatitis

Which lesion associated with HIV? Tx = extensive debridement, systemic antibiotics, close follow-up, possible additional debridement

Necrotizing stomatitis

Which lesion associated with HIV? Most are HIV infected or other immunocompromised; rare in healthy pts

Hairy leukoplakia

Which lesion associated with HIV? Non-removable white plaques of the lateral tongue

Hairy leukoplakia

Which lesion associated with HIV? Caused by Epstein-Barr virus (EBV); often there is superimposed candidiasis

Hairy leukoplakia

Which lesion associated with HIV? No tx necessary, will resolve if pt is on effective cART

Hairy leukoplakia

Which lesion associated with HIV? In US, primarily associated with HIV infection w/ decreasing incidence

Kaposi sarcoma

Which lesion associated with HIV? Caused by human herpes virus 8 (HHV-8), high titers in saliva, and oral/oropharyngeal tropic

Kaposi sarcoma

Which lesion associated with HIV? Skin or visceral involvement, with 70% of AIDS-related having oral involvement on the palate, gingiva, or tongue

Kaposi sarcoma

Which lesion associated with HIV? Reddish-purple, flat or nodular; usually multiple lesions noted

Kaposi sarcoma

Which lesion associated with HIV? Tx = often regresses with effective cART For non-responsive lesions = topical therapy, excision, intralesional chemo (5 yr survival = 70%)

Kaposi sarcoma

Which lesion associated with HIV? Generalized, non-tender lymphadenopathy; cervical lymph nodes are frequently affected, including posterior cervical nodes

Persistent lymphadenopathy

Which lesion associated with HIV? Other causes of lymphadenopathy may have to be ruled out before associating with HIV

Persistent lymphadenopathy

Which lesion associated with HIV? Most common malignancy in AIDS population

AIDS-related lymphoma

Which lesion associated with HIV? Usually extra-nodal in CNS or GI tract

AIDS-related lymphoma

Which lesion associated with HIV? Oral examples may resemble kaposi sarcoma; also can involve bone, appearing as diffuse bone loss

AIDS-related lymphoma

Which lesion associated with HIV? Many cases are associated with EBV

AIDS-related lymphoma

Which lesion associated with HIV? Usually very aggressive with a poor prognosis (median survival of 3-4 months)

AIDS-related lymphoma

Which lesion associated with HIV? Bilateral parotid enlargement is typically seen

Salivary gland involvement in HIV

Which lesion associated with HIV? Due to lymphocytic infiltration of glandular tissue

Salivary gland involvement in HIV

Which lesion associated with HIV? Accompanied by formation of lymphoepithelial cyst-like changes

Salivary gland involvement in HIV

Which lesion associated with HIV? Xerostomia may be present

Salivary gland involvement in HIV

What are the HIV-related viral infections?

Herpes simplex Varicella zoster EBV HPV

Which viral lesion in HIV? Represents reactivation of virus in most cases

Recurrent herpes simplex

Which viral lesion in HIV? Lesions are more widespread and have an atypical pattern (persistent, painful, diffuse, shallow ulcerations)

Recurrent herpes simplex

Which viral lesion in HIV? Must be treated w/ acyclovir or one of the acyclovir analogues

Recurrent herpes simplex

Which viral lesion in HIV? May see in younger than normal patients (under 40 yrs old)

Herpes zoster

Which viral lesion in HIV? Typically unilateral vesicles and ulcers following trigeminal nerve branches; may show cutaneous spread beyond the expected dermatome

Herpes zoster

Which viral lesion in HIV? Intense pain, may see bone loss

Herpes zoster

Which viral lesion in HIV? Seen w/ increased frequency intraorally in HIV+ pts

HPV

Which viral lesion in HIV? Exophytic lesions, solitary or multiple, may resemble routine squamous papilloma, condyloma, or focal epithelial hyperplasia

HPV

What is the AIDS-defining illness?

Histoplasmosis

What illness associated with AIDS is generally pulmonary, but dissemination to oral mucosa may occur?

Histoplasmosis

What illness associated with AIDS presents as non-healing, painful ulcer?

Histoplasmosis

What illness associated with AIDS may require IV amphotericin B?

Histoplasmosis

What lesion associated with HIV? Probable immune-mediated etiology

Aphthous-like ulcer

What lesion associated with HIV? Painful and persistent - may be solitary or multiple

Aphthous-like ulcer

What lesion associated with HIV? May need to rule out infectious causes Responds to topical corticosteroids

Aphthous-like ulcer

What lesion associated with HIV? Caused by pox virus

Molluscum contagiosum

What lesion associated with HIV? Many more lesions develop compared to non-immunocompromised pt

Molluscum contagiosum

What lesion associated with HIV? Found on the skin on the face

Molluscum contagiosum

What lesion associated with HIV? Lesions tend not to regress, unlike their normal course in immune competent people

Molluscum contagiosum

What lesion associated with HIV? HIV-infected pts have a 2x increased risk and greater risk with increasing immune suppression

Oral squamous cell carcinoma

What lesion associated with HIV? Same clinical appearance and tx

Oral squamous cell carcinoma

How to tell difference between pyogenic granuloma or peripheral giant cell granuloma and kaposi sarcoma tumor since they look so similar in color?

Pyogenic granuloma or peripheral giant cell granuloma = made of granulation tissue, would expect it to be soft/squishy Kaposi sarcoma = would be firm

Which AIDS related lesions look similar?

Kaposi sarcoma + lymphoma look alike Histoplasmosis + NUP look alike

Oral Path Exam 3 - HIV Flashcards

(86 cards)