HIV

Question 1

What cells are effected by HIV

Answer 1

CD4 helper T cells

Question 2

What do CD4 helper cells do?

Answer 2

• enhance immune response

- tell B cells to make antibodies

Question 3

How does HIV retrovirus infect cells?

Answer 3

reverse transcriptase to make RNA into DNA

Question 4

Acute HIV infection

Answer 4

2-6 weeks after exposure will have flu-like illness (rash on upper trunk, neck and face, ulcers)

-HIGHLY infectious

Labs:
HIV Ab –>negative
HIV RNA (viral load) –> extremely HIGH >100,000

Elevated LFTs
Leukopenia
Anemia
Thrombocytopenia

Question 5

When would you expect a patient infected with HIV to seroconvert (become antibody positive)?

Answer 5

within 3 months

Question 6

HIV symptoms

Answer 6

• Oral hairy leukoplakia (viral=EBV)
• Karposi’s sarcoma***
• Recurrent HZV
• Night sweats
• Lymphadenopathy
• Prolonged diarrhea

Question 7

Normal CD4 Tcell count

Answer 7

600-1200 cells/mcL

Question 8

When can you diagnose AIDS

Answer 8

1. CD4 Tcell count is below 200

or

2. HIV (+) and AIDS defining condition

Question 9

CD4 Tcell count <200

Answer 9

Pneumocystis jiroveci pneumonia

-airborne fungus
-Severe hypoxemia out of proportion*
CXR: diffuse perihilar infiltrates

DX: sputum sample. LDH elevation

Question 10

Pneumocystis jiroveci pneumona: treatment

Answer 10

Bactrim DS

Question 11

CD4 Tcell count <100

Answer 11

Toxoplasmosis

Question 12

Toxoplasmosis

Answer 12

cause: single celled parasite toxoplasma gondii

Clinical manifestation: encephalitis –>MC intracranial lesion in HV

Dx:

1. Multiple contrast-enhancing
2. Lesions on brain CT or MRI
3. Seropositive for Toxoplasmosis

Question 13

CD4 Tcell count <50

Answer 13

Mycobacterium avium complex (MAC)

Question 14

Mycobacterium avium complex

Answer 14

cause: mycobacterium avium

clinical presentation:
systemic disease

Dx:

• sputum acid fast bacillus stain (+)
• positive blood cultures

Question 15

CD4 Tcell count <50

Answer 15

Cytomegalovirus (CMV) retinitis

Question 16

Cytomegalovirus

Answer 16

-herpes family

clinical presentation:

• visual disturbances
• can lead to blindness!

PE:
cotton wool spots
infiltrates
hemorrhages

Dx: seropositive (positive antibodies) for CMV

Question 17

Candida

Answer 17

• esophagus
• vagina

the lower the CD4 count the more invasive

Question 18

Kaposi’s Sarcoma

Answer 18

• vascular neoplasm

- may occur at any CD4 Tcell count

Question 19

Who gets screened for HIV?

Answer 19

everyone 13-64

• if patient presents with another STI
• Annually for MSM

Question 20

How many antibody tests need to be positive to diagnose HIV?

Answer 20

2

Question 21

Which HIV is most common in US

Answer 21

HIV-1