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SBL (Skin, Blood, Lymph) Exam 1 and 2 > Lecture 20: HIV/AIDS and Opportunistic Infections (Exam 2) > Flashcards

Lecture 20: HIV/AIDS and Opportunistic Infections (Exam 2) Flashcards

1
Q

What group of people does HIV infection most commonly occur in, and what two ethnicities have higher rates of diagnosis?

A
  • gay and bisexual men
  • African Americans and Latinos

majority of HIV infections happen in the GENERAL POPULATION

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2
Q

What is the mean time of development of AIDS from infection?

A

10 years

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3
Q

What are 3 common physical exam findings specific for HIV infection? (HKB)

A
  • HAIRY leukoplakia of tongue, disseminated KAPOSI sarcoma, cutaneous BACILLARY angiomatosis

physical exam findings can be entirely normal, with abnormal findings ranging from completely nonspecific to high specific for HIV infection

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4
Q

What three tests are used to diagnose a patient suspected of HIV infection?

A
  1. HIV 1/2 Ag/Ab combination assay
    • positive? –> go to HIV 1/2 Ab differentiation assay
    • negative? –> no HIV
  2. HIV 1/2 Ab Differentiation Immunoassay
    • if negative, use HIV-1 NAAT
    • Nucleic Acid Amplification Test
  3. Nucleic Acid Amplification Test (NAAT)
    • if positive w/negative Ab = ACUTE HIV
    • if Positive on combo, but negative for other two
      • FALSE POSITIVE TEST
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5
Q

What is the most widely used marker to provide prognostic information and guide HIV therapy?

A

CD4 LYMPHOCYTE COUNTS

TREND is more important than a SINGLE determination, as dec. counts inc. risk of opportunistic infections

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6
Q

What are 4 infections that can be experienced at a CD4 count > 300? (P, TB, HZ, C)

A
  • Pnuemococcal pneumonia
  • Pulmonary TB
  • Herpes Zoster
  • Candidiasis (oral and vaginal)

also fatigue

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7
Q

What 5 things can be experienced at a CD4 count < 300? (OHL, T, F, WL, D)

A
  • Oral Hairy Leukoplakia
  • Thrush
  • Fever
  • Weight Loss
  • Diarrhea
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8
Q

What are 5 things that can be experienced at a CD4 count < 200?

A
  • Pneumocystis jirovecii pneumonia
  • Disseminated Histoplasmosis
  • Karposi Sarcoma
  • Extrapulmonary TB
  • non-Hodgkins/CNS lymphoma
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9
Q

What are 3 infections that can be experienced at a CD4 count < 100?

A
  • Cryptococcus (meningitis)
  • Esophageal Candidiasis
  • Toxoplasmosis
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10
Q

What are 3 infections that can be experienced at a CDR count < 50?

A
  • Mycobacterium-avium Complex
  • Cytomegalovirus
  • primary CNS lymphoma
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11
Q

When should CD4 counts be measured in pts on antiretroviral treatments? What test can assess the level of viral replication in a patient?

A
  • check every 3-6 months (measures immune dysfunction)

- used HIV Viral Load Tests to assess level of viral replication

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12
Q

Pneumocystis jirovecii pneumonia, Karposi Sarcoma, Lymphoma, CMV, Histoplasmosis, Coccidioidomycosis, Cryptococcosis, and Mycobacterium Tuberculosis are all considered what?

A

AIDS DEFINING ILLNESSES

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13
Q

What is the most common opportunistic infection associated with AIDS?

A

Pneumocystis jirovecii

  • causes pulmonary problems such as cough/shortness of breath, as well as hypoxemia (more severe)
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14
Q

How is Pnemocystis jirovecii diagnosed? What should you think of if pleural effusions are present? (3)

A
  • use chest radiograph to see DIFFUSE or PERIHILAR infiltrates (66%)
  • pleural effusions are uncommon for PJP infection –> think Bacterial Pneumo, TB, or Pleural Kaposi
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15
Q

What two tests give definitive diagnoses of PJP and what can be used if they come back negative?

A
  • used Wright-Giemsa stain or Direct Fluorescence Ab (DFA) test on sputum
  • if sputum exam is negative in pt. still suspected of having PJP, use Bronchoalveolar Lavage (BAL) –> establishes diagnosis in > 95% of cases
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16
Q

What two tests findings are positive in PJP patients and what two findings are usually indicative of NOT having PJP?

A

(+) tests: serum lactate (LDH) and serum beta-glucan
- SBG is MORE sensitive/specific for PJP than LDH

(-) test: normal diffuse carbon dioxide/high res CT scan showing NO lung disease OR CD4 count > 250 within 2 months of prior evaluation for respiratory symptoms

17
Q

What is the most common cause of pulmonary disease in HIV-infected persons?

A

Community Acquired Pneumonia
- bacterial, mycobacterial, viral pneumonias

  • recurrent infection is AIDS DEFINING
18
Q

What is the most common space-occupying lesion in HIV, where is it seen, and what does it commonly cause in AIDS patients?

A

TOXOPLASMOSIS

  • multiple subcortical lesions in the BASAL GANGLIA
  • common cause of FOCAL ENCEPHALITIS in AIDS pts (CD4 count < 100)
19
Q

What is the most sensitive test for identifying Toxoplasmosis infections?

A

MRI (more sensitive than contrast-enhanced CT)

  • typically shows MULTIPLE ring-enhancing lesions with surrounding areas of edema
20
Q

What is the SECOND most common cause of space-occupying lesions in HIV and what does it look like?

A

PRIMARY CNS LYMPHOMA

  • typically single ring-enhancing lesion but can be multiple
21
Q

How can Cryptococcal Meningitis be diagnosed? (2)

A
  • positive latex agglutination test of serum at detects its antigen (CRAG) OR having a positive culture from CSF

70-90% of pts. with CM have a positive serum CRAG

22
Q

What is Primary CNS Lymphoma, when does it usually occur, and what are common symptoms it presents with?

A
  • Diffuse, large B cell malignancy highly associated with EBV (use CSF PCR)
  • occurs when CD4 count < 50
  • headaches, confusion/disorientation, altered gait and balance, falls, local deficits
23
Q

What are 3 gastrointestinal problems that HIV patients can experience?

A

Enterocolitis, Liver Disease, and Candidal Esophagitis

  • usually occur due to opportunistic infections
24
Q

What is a MAJOR problem that CMV can cause in HIV patients? What are 4 other things it can cause? (C, E, E, P)

A
  • most frequently causes RETINITIS

- then colitis, esophageal ulceration, encephalitis, and pneumonitis

25
Q

What is Kaposi Sarcoma, how does it present, and what can be used to diagnose pulmonary involvement?

A
  • vascular tumor associated with HHV-8
  • extracutaneous spread to oral cavity, GI, and respiratory tracts
  • skin lesions usually on lower extremities, face (NOSE), oral mucosa, and genitalia
  • diagnosis of pulmonary KS can be confirmed with BRONCHOSCOPY (asymptomatic chest X-Ray)
26
Q

What 3 things should cause you to treat Pneumocystis jirovecii? What pharmaceutical should you give?

A
  • CD4 count < 200, Oropharyngeal candidiasis, prior bout of PCP
  • give TMP-SMX (Trimethoprim-sulfamethoxazole)
    • 1 double strength table daily PO
27
Q

What kinds of vaccines should be AVOIDED if treating HIV patients prophylaxtically for infections?

A

LIVE VACCINES

SBL (Skin, Blood, Lymph) Exam 1 and 2 (22 decks)

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