ID - HIV/AIDS

What are the prominent systemic complains of HIV?

Sweating, diarrhea, weight loss and wasting

In HIV, opportunistic infections can often be ___

life-threatening

The number of new HIV diagnoses ___ between 2015 and 2019

decreased

1 multiple choice option

HIV is most often transmitted via ___

male to male sexual contact

People aged ___ accounted for over 50% of people newly diagnosed with HIV

13-34

3 multiple choice options

When should HIV screening be routine?

- ages 13-64

- TB

- other STIs

- new relationship

- pregnancy

Repeated testing for HIV is indicated in:

- people who inject drugs

- people who exchange sex for drugs or money

- men who have sex with men

- partners of someone with HIV

Persons with positive serology who have ever had a CD4 count of below ___ or a CD4 percentage below 14% are considered to have AIDS

200

3 multiple choice options

Persons who are HIV (+) and have an AIDS defining illness regardless of CD4 count are considered to have ___

AIDS

The hallmark of symptomatic HIV infection is ___

immunodeficiency caused by continuing viral replication

Chemokine co-receptors CCR5 and CXCR4 are required for ___

virus entry

Which cells can be infected by HIV?

- CD4 T cells

- Macrophages

- B lymphocytes

Elements of both ___ and ___ immunodeficiency are present especially in children with HIV

humoral and cellular

In HIV ___ act as a reservoir for HIV and disseminate it to other organs

Macrophages

Three known mechanisms of HIV infection syndromes:

auto-immunity, immunodeficiency, and allergic/hypersensitivity reactions

In HIV immunodeficiency is a ___

Result of HIV on immune cells

In HIV autoimmunity causes ___

Disordered cellular immune function or B lymphocyte dysfunction

Individuals with HIV tend to have higher rates of ___ like eosinophilic pustular folliculitis

allergic reactions

The HIV antibody test detects ___

IgG and IgM antibodies

The antigen-antibody HIV test detects ___

HIV p23 antigen and IgG/IgM antibodies

A NAT test detects ___

HIV RNA

Screening test for HIV:

ELISA (high sensitivity) with western blot (high specificity)

Which diagnostic test is most accurate after ~50 days of infection with HIV?

IgG antibody test

Which HIV diagnostic test is most accurate after 10 days of infection?

NAT

Antigen-antibody diagnostic tests are useful between ___ days of infection

~10-40

Bacterial infections, TB, Herpes simplex/zoster, vaginal candidiasis, hairy leukoplakia and kaposi sarcoma happen at a CD4 count of about ___

500

PCP, Toxoplasmosis, cryptococcosis, coccidiomycosis, and cryptosporidosis begin to happen at a CD4 count of about ___

200

Disseminated MAC, histoplasmosis, CMV retinitis and CNS lymphoma begin at a CD4 count of about ___

50

What is HIV seroconversion?

Early stage of HIV infection when antibodies develop

What is acute HIV infection?

Syndrome that often coincides with seroconversion and may have flu-like symptoms

Which symptoms should prompt a high level of suspicion of acute HIV infection?

Fever, fatigue, myalgia, headache, night sweats, pharyngitis (flu-like symptoms)

Is HIV more or less infectious during the acute stage?

More

1 multiple choice option

Symptoms of acute HIV seroconversion last about ___ days

14

Lab workup for newly diagnosed HIV patients:

- CD4 count (3 mo)

- viral load (3 mo)

- resistance testing

- genotype

- CBC (G6-PD cannot tolerate Dapsone)

- renal/liver fxn

- RPR/STD screening

- PPD, CXR

- pap smear

- Toxoplasmosis IgG, CMV IgG, Varicella IgG

NRTIs block ___ an enzyme HIV needs to make copies of itself

reverse transcriptase

NNRTIs bind to and alter ___

reverse transcriptase

Fusion inhibitors block HIV from entering ___

CD4 cells

CCR5 antagonists block CCR5 ___ on the surface of immune cells which stops HIV entry

coreceptors

Attachment inhibitors bind to the ___ protein on the outer surface of HIV to prevent entry in CD4 cells

gp120

Post-attachment inhibitors block ___ receptors on the surface of certain immune cells that HIV needs to enter the cells

CD4

Treatment of HIV can be broadly divided into three categories:

Prophylaxis against opportunistic infections, treatment of opportunistic infections, treatment of the HIV itself

___ is the m/c opportunistic infection associated with AIDS

Penumocystitis jiroveci

___ is the most common cause of pulmonary disease in HIV infected persons

Community-acquired pneumonia

Non-infectious pulmonary diseases associated with HIV infection?

- kaposi sarcoma

- non-hodgkin lymphoma

- interstitial pneumonitis

- chronic sinusitis

What is the most common space occupying lesion in HIV infected patients?

Toxoplasmosis

What is the second most common space occupying lesion in HIV infected patients?

Primary non-hodgkins lymphoma

Peripheral ___ is a common issue amongst HIV infected persons

neuropathy

In HIV infected patients, arthritis typically affects the ___

large joints

M/C retinal infection in AIDS?

CMV retinitis

Hairy leukoplakia is caused by ___

EBV

Presence of oral candidiasis and/or hairy leukoplakia is suggestive of

HIV infection

What is malabsorption syndrome?

Inability to absorb drugs that require an acidic medium

M/C endocrine manifestation of HIV?

Hypogonadism in men

M/C bacterial skin infection in HIV?

Staph

The majority of fungal rashes affecting AIDS patients are ___

Candida and dermatophytes

Anal dysplasia and SCC are strongly correlated with __

HPV

What is TasP?

Treatment as prevention (antiretroviral therapy)

Which types of vaccines are contraindicated for HIV patients?

Live vaccines (varicella and varicella zoster)

Which drug can be administered to pregnant women to reduce risk of transmission of HIV to the infant?

Zidovudine

What are two brands of PrEP medications?

Truvada and Descovy

Baseline labs for beginning PrEP therapy?

- HIV test

- Kidney fxn

- Hep B screening

- Lipid profile

- STI test