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Flashcards in Pathology-Metabolic Effects of HIV Deck (15)
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Why is it that HIV patients, despite ART, have premature death compared to the rest of the population?

Premature aging


What is responsible for dyslipidemias seen in HIV patients?

1) HIV infection: decreased lipolysis associated with mitochondrial dysfunction from altered nuclear receptors that control lipid metabolism and inflammation. 2) Drug therapy (especially protease inhibitors)


Statins that are best to use to control dyslipidemia in patients with HIV

Prevastatin, pitavastatin, atorvastatin and rosuvastatin.


Signs of lipodystrophy

Visceral fat, facial lipoatrophy, peripheral fat wasting, buffalo hump and gynecomastia.


Causes of acute renal failure in HIV patients

HIVAN, TTP, Hep C cryoglobulinemia, medication-induced (tenofovir)


Causes of chronic kidney disease in HIV patients

Membranous nephropathy, membranoproliferative GN, diabetic nephropathy, hypertensive nephropathy and IgA nephropathy.


Pathogenesis of HIV nephropathy

Deposition of circulating immune complexes that are filtered by the glomeruli


Histologic findings in HIVAN

Collapsing FSGS with tubulo-interstitial injury


Signs of HIVAN

Nephrotic proteinuria, rise in sCr, large kidneys, hypoglobulinemia


Common causes of liver disease in patients with HIV

Infection (HAV, HBV, HCV, CMV, MAC and biliary tract infections), substance abuse, NASH, drug toxicity (INH, statins, ART, tylenol), allergic rxns (nevirapine), IRIS


Bone diseases associated with HIV

Osteonecrosis from avascular necrosis, osteomalacia from vitamin D deficiency (tenofovir) and osteopenia from drop in bone density (tenofovir)


When are DEXA scans recommended for patients with HIV?

> 50 years old


Tx for HIV patients with bone disease

Vit D, Ca, exercise, bisphosphonates


Cardiac diseases associated with HIV

Pericardial effusion (AIDS), myocardial disease, pulmonary vascular disease, valvular heart disease and vascular disease.


Why do HIV patients have so many difficulties with restenosing of catheterized arteries?

Chronic inflammatory state = endothelial dysfunction. Insulin resistance and dyslipidemia contribute to atherosclerosis.