HIV

Question 1

CD4 count 200-500 cells/mm3

Answer 1

• shingles
• hairy leukoplakia
• oral thrush
• Karposi sarcoma

Question 2

CD4 count 100-200 cells/mm3

Answer 2

• cryptosporidiosis
• cerebral toxoplasmosis
• progressive multifocal leukoencephalopathy
• pneumocystis jirovecii
• dementia

Question 3

CD4 count 50-100 cells/mm3

Answer 3

• cryptococcal meningitis
• oesophageal candidiasis
• aspergillosis
• primary CNS lymphoma

Question 4

CD4 count <50cells/mm3

Answer 4

• cytomegalovirus retinitis

- mycobacterium avium intracellulare infection

Question 5

How do you test for HIV?

Answer 5

• 3-12 weeks post exposure
• HIV Ab test: ELISA and western blot assay
• p24 antigen test
• if asymptomatic test at 4 weeks and repeat at 12 if negative

Question 6

How does Kaposi’s sarcoma present?

Answer 6

• purple papule on skin or mucosa
• skin lesions may ulcerate
• respiratory involvement - haemoptysis and pleural effusion

Question 7

Primary CNS lymphoma vs toxoplasmosis:

Answer 7

• toxoplasmosis: multiple lesions, ring or nodular enhancement, thallium SPECT negative
• lymphoma: single lesion, solid enhancement, thallium SPECT positive

Question 8

Presentation of cryptococcal meningitis:

Answer 8

• CSF: high opening pressure, India ink test positive

- CT: meningeal enhancement, cerebral oedema

Question 9

How do you treat oesophageal candidiasis?

Answer 9

• itraconazole

- fluconazole

Question 10

What should HIV patients receive <200/mm3?

Answer 10

prophylactic co-trimoxazole for pneumocystitis jiroveci pneumonia

Question 11

Investigation and management of pneumocystitis jiroveci:

Answer 11

• exercise induced desaturation
• silver stain shows cysts
• co-trimoxazole or IV pentamidine if severe
• steroids if hypoxic

Question 12

Post exposure prophylaxis:

Answer 12

4 weeks oral antiretroviral therapy