N304 Exam 2

Front 1

What are the symptoms of an HIV infection?

Back 1

Infection by HIV virus and development of HIV-specific antibodies (seroconversion) accompanied by flu-like symptoms of fever, lymphadenopathy, sore throat,headache, malaise, nausea, muscle and joint pain, diarrhea and a diffuse rash

Front 2

What is seroconversion?

Back 2

Development of HIV-specific antibodies

Front 3

What is the effect of an HIV infection on the CD4 count?

Back 3

CD4 counts remain above 500

Front 4

What is the interval from an HIV infection to a diagnosis of AIDS?

Back 4

Median interval between untreated HIV infection and a diagnosis of AIDS is about 10 years

Front 5

What is AIDS?

Back 5

1. Acquired Immunodeficiency Syndrome = an acquired dysfunction of the immune system caused by a retrovirus (HIV-1 or HIV-2) that infects and destroys CD4 lymphocytes

2. End stage of chronic HIV infection

Front 6

What is the difference between HIV and AIDS?

Back 6

1. AIDS is not the same as HIV infection

2. HIV is a virus that causes AIDS, however, not everyone infected with HIV has AIDS

Front 7

What is the estimated incidence of HIV?

Back 7

56,300 new HIV infections yearly

(retro-calculated as of 2006)

Front 8

What is the estimated percentage of HIV by gender?

Back 8

73% Male
27% Female

Front 9

What is the estimated percentage of HIV by race/ethnicity?

Back 9

45% African Americans
35% Caucasians
17% Hispanic/Latino
2% Asian/Pacific Islander
1% American Indian/Alaskan Native

Front 10

What is the estimated percentage of HIV infections by transmission category?

Back 10

53% Male-to-male sexual contact
31% Heterosexual contact
12% Injection drug use
4% Male-to-male sexual contact & injection drug use

Front 11

What is the estimated percentage of HIV infections by age?

Back 11

34% 13-29 yrs
31% 30-39 yrs
25% 40-49 yrs
10% > or = 50 yrs

Front 12

What is the decline in pediatric AIDS incidence associated with?

Back 12

1. More HIV testing of pregnant women

2. The use of zidovudine (AZT) by HIV-infected pregnant women and their newborn infants

Front 13

What is the "down low" phenomenon?

Back 13

Situation in which black men, while not identifying themselves gay or bisexual, have sex with other men, often behind the backs of their wives and girlfriends

Front 14

What is the prevalence of a black woman having an HIV infection?

Back 14

A black woman is 23 times more likely to be infected with HIV than a white woman

Front 15

What is the main cause of HIV of black women?

Back 15

In 2001, 67% of black women with AIDS contracted HIV through heterosexual sex

Front 16

What are the new research findings regarding HIV/AIDS?

Back 16

1. Recent studies suggest that 30% of all black bisexual men may be infected with HIV, and up to 90% of those men do not know

2. Researchers have referred to these men as a “bridge” to infection from gay men to heterosexual women

Front 17

Which group is referred to as the "bridge" of HIV infections?

Back 17

Bisexual men

Front 18

What are the global trends of HIV/AIDS?

Back 18

1. The number of people living with HIV has risen from around 8 million in 1990 to 33 million today, and is still growing

2. Around 67% of people living with HIV are in sub-Saharan Africa

3. The overwhelming majority of people with HIV, some 95% of the global total, live in the developing world

4. The proportion is set to grow even further as infection rates continue to rise in countries where poverty, poor health care systems and limited resources for prevention and care fuel the spread of the virus

Front 19

What is the regional distribution of HIV/AIDS?

Back 19

64.4% Africa
21.4% Asia
5.4% High income countries
5.0% Latin America & the Caribbean
3.9% Eastern Europe & Central Asia

Front 20

What is the life expectancy of Americans with AIDS today?

Back 20

24.2 years

(compared to 6.8 yrs in 1993)

Front 21

What is the lifetime cost of AIDS treatment?

Back 21

At least $385,000

Front 22

What do AIDS patients eventually die from?

Back 22

Heart disease, stroke and other diseases of aging, rather than infections that prey upon weakened immune systems

Front 23

What are the criteria for AIDS diagnosis?

Back 23

1. CD4+ T cell count drops below 200 cells

2. Development of one of the following opportunistic infections

3. Development of one of the following opportunistic cancers

4. Wasting syndrome occurs (loss of 10% or more of ideal body mass)

5. Dementia develops

Front 24

What are the opportunistic infections?

Back 24

1. Fungal: Candidiasis of bronchi, trachea, lungs or esophagus; disseminated or extrapulmonary histoplasmosis

2. Viral: CMV disease/ retinitis, herpes simplex with chronic ulcers, pneumonitis, esophagitis

3. Protozoal: Coccidiomycosis, toxoplasmosis, chronic intestinal cryptosporiodosis, PCP

4. Bacterial: Mycobacterium TB, extrapulmonary TB, MAC; recurrent pneumonia

Front 25

What are the opportunistic cancers?

Back 25

Invasive cervical cancer, Kaposi’s sarcoma, Burkitt’s lymphoma, or primary lymphoma of the brain

Front 26

What is wasting syndrome?

Back 26

Loss of 10% or more of ideal body mass

Front 27

What is Clinical Category A?

Back 27

1. HIV positive

2. Either asymptomatic, has persistent lymphadenopathy, or has acute HIV infection with accompanying illness or history of illness

Front 28

What are the types of Clinical Category A?

Back 28

1. Category A1
2. Category A2
3. Category A3

Front 29

What is category A1?

Back 29

HIV positive with CD4>500

Front 30

What is category A2?

Back 30

HIV positive with CD4 between 200-499

Front 31

What is category A3?

Back 31

HIV positive with CD4 <200

Front 32

What is clinical category B?

Back 32

If one or more of the following conditions are present and are (1) attributed to HIV infection; or are indicative of a deficiency in cell mediated immunity, or (2) are complicated by HIV infection:
Bacterial endocarditis
Oropharyngeal candidiasis
Severe cervical dysplasia or carcinoma
Pulmonary Mycobacterium Tuberculosis
PID, Peripheral neuropathy, HerpesZoster, Fever, diarrhea lasting > 1 month

Front 33

What is clinical category C?

Back 33

AIDS with any one of these conditions present:

*Bronchial, tracheal, pulmonary or esophageal candidiasis
*Invasive cervical cancer
*CMV disease of other than the liver, spleen or lymph nodes
*CMV retinitis with vision loss
*HIV-related encephalopathy
*Chronic intestinal cryptosporidiosis
*Kaposi’s sarcoma

Front 34

When can HIV be transmitted?

Back 34

A person with HIV infection can transmit the virus to others at all stages of disease

Front 35

What is the etiology of HIV?

Back 35

1. HIV belongs to a special class of viruses known as retroviruses. (They replicate in a “backward” manner—going from RNA to DNA)

2. Like all viruses, HIV cannot replicate unless it is inside a living cell

3. Retroviruses have only RNA as their genetic material—no DNA

4. Retroviruses have special enzymes called Reverse Transcriptase (RT) and Integrase

5. Through the use of RT, the viral RNA is converted to DNA and inserted into the infected human cell’s genetic material, where it acts as a template for viral reproduction

Front 36

What is the pathogenesis of HIV?

Back 36

1. HIV infects human cells that have CD4 receptors on their surfaces—lymphocytes, monocytes, macrophages, astrocytes, oligodendrocytes

2. HIV then spreads quickly throughout the lymphoid system, hiding in macrophages and in the centers of lymph nodes (they act as reservoirs for the HIV)

3. Throughout the course of infection, HIV is actively replicated by the infected T-lymphocytes, synthesizing up to 2 billion viral particles daily, eventually exhausting the immune system

4. Immune dysfunction in HIV is caused predominantly by damage to and destruction of CD4+ T cells (they have more CD4 receptors on their surfaces than other CD4 receptor-bearing cells)

5. Viral activity destroys about 1B CD4+T cells daily

6. HIV can replicate at an estimated rate of 10B copies per day

Front 37

How is HIV transmitted?

Back 37

1. Sexual
2. Parenteral
3. Perinatal

Front 38

How is HIV sexually transmitted?

Back 38

Through genital, anal, or oral sexual contact with exposure of mucous membranes to infected semen or vaginal secretions

Front 39

How is HIV parenterally transmitted?

Back 39

Through the sharing needles or equipment, contaminated blood or receiving contaminated blood products

Front 40

How is HIV perinatally transmitted?

Back 40

From the placenta, contact with maternal blood and body fluids during birth, or from breast milk

Front 41

What bodily secretions have been isolated to carry HIV?

Back 41

1. Blood
2. Semen
3. Vaginal secretions
4. Breast milk
5. Amniotic fluid
6. Urine
7. Saliva
8. Feces
9. Tears
10. CSF

Front 42

What bodily tissues have been isolated to carry HIV?

Back 42

1. Lymph nodes
2. Cervical cells
3. Langerhans’ cells
4. Corneal tissue
5. Breast tissue

Front 43

Which bodily fluids do not show evidence of ability to transmit HIV?

Back 43

There is no evidence that the virus is spread by contact with saliva, sweat, tears, urine, or feces (the # of virus is not high enough)

Front 44

How can HIV-positive pregnant women reduce the incidence of transmitting HIV to their baby?

Back 44

If mother takes AZT during pregnancy and deliver the baby by C-section, the chances of the baby being infected can be reduced to a rate of 1%

Front 45

What laboratory assessments are used for HIV?

Back 45

1. CBC with lymphocyte count

2. CD4 and CD8 count

3. Antibody Tests: Enzyme-Linked Immunoabsorbent Assay (ELISA)Western Blot

Front 46

What is the result of the CBC with lymphocyte count for HIV?

Back 46

WBC and lymphocytes usually decreased

Front 47

What is the result of the CD4 and CD8 count for HIV?

Back 47

CD4 decreased; normal CD8; therefore the CD4/CD8 ratio is decreased

Front 48

What is the normal CD4/CD8 ratio?

Back 48

2:1

Front 49

What is Enzyme-Linked Immunoabsorbent Assay (ELISA)?

Back 49

Measures the presence of HIV antibodies in the blood

Front 50

What is the incidence of false positive ELISA?

Back 50

False positive results occur in approximately 0.1% of those tested

Front 51

What are the interpretations of a positive ELISA?

Back 51

1. ELISA positive does not predict if the donor will develop AIDS

2. ELISA positive is not conclusive of current infection by HIV

Front 52

What is the interpretation of a negative ELISA?

Back 52

ELISA negative does not predict donor immunity to HIV because the infected person may not produced the antibodies yet

Front 53

What is a Western blot?

Back 53

Also detects presence of HIV antibodies

Front 54

When is a Western blot conducted?

Back 54

Done if ELISA is positive to confirm results

Front 55

What is the interpretation of the Western blot?

Back 55

A positive Western Blot test indicates presence of antibodies and confirms diagnosis of HIV infection

Front 56

What problem is associated with the Western blot?

Back 56

There is a median delay of 2 months after infection before antibodies can be detected (window period). The infected individual will not test HIV antibody positive.

Front 57

What is the window period of the Western blot?

Back 57

2 months

Front 58

What is the rapid HIV test?

Back 58

1. Approved by FDA 3/04, OraQuick rapid HIV test for oral fluid

2. Procedure: gently swab completely around outer gums, both upper and lower, one time around

3. Placed in a vial containing developer solution

4. Takes as little as 30-40 mins

Front 59

What is a positive rapid HIV test result?

Back 59

Positive test displays two reddish-purple lines in a small window in the device

Front 60

What are the advantages of the rapid HIV test?

Back 60

1. Takes as little as 30-40 mins

2. Has a 99.3% accuracy rate

Front 61

What are the disadvantages of the rapid HIV test?

Back 61

A reactive HIV test result on oral fluid is preliminary positive and needs to be confirmed with either Western Blot or immunofluorescent assay

Front 62

What is the viral load testing(plasma HIV RNA)?

Back 62

1. Also called viral burden testing

2. Measures the amount of HIV RNA (genetic material) in plasma

Front 63

What is the purpose of the viral load testing?

Back 63

1. A more direct measure of disease progression

2. Measures effectiveness of therapy

Front 64

How are the results of the viral load testing expressed?

Back 64

Expressed as copies/ml
(i.e. 10,000 copies/ml)

Front 65

What are other tests to measure viral load?

Back 65

1. Quantitative RNA Assays:
(a) RT Polymerase Chain Reaction (RT-PCR)
(b) Branched –DNA method (bDNA)
(c) Nucleic Acid Sequence-based assay (NASBA)

2. P24 Antigen Assay—measures viral core protein

Front 66

How often should the viral load and CD4 cell count be done?

Back 66

Typically, viral load and CD4 cell count are measured at baseline and every three months thereafter, unless otherwise indicated by a clinical event (such as opportunistic infection), non-adherence, or a suspected treatment failure

Front 67

What is the interpretation of an undetectable viral load?

Back 67

1. An undetectable viral load means that the amount of virus is extremely low and viruses cannot be found in the blood using the current technology

2. It does NOT mean that the virus is gone because much of the virus will be in lymph nodes (reservoir) and organs that the tests cannot detect

3. It also does NOT mean that the individual is no longer able to transmit HIV to others

Front 68

Does an undetectable viral load indicate that the HIV is gone?

Back 68

NO

Front 69

Does an undetectable viral load mean that the individual is no longer able to transmit HIV to others?

Back 69

NO

Front 70

What are the drug therapies available for HIV?

Back 70

1. Antiretroviral therapy

2. Multiple drugs (3 or more) are used together in regimens called “cocktails” or “highly active antiretroviral therapy” or HAART

3. Combination therapy

Front 71

What is the purpose of antiretroviral therapy?

Back 71

Inhibits viral replication only

(does not kill the virus)

Front 72

What is the purpose of combination drug therapy?

Back 72

Attack the virus at various points of the HIV replication cycle and decrease drug resistance

Front 73

What are the advantages of combination drug therapy?

Back 73

1. Promotes a more sustained antiviral effect

2. Delays drug resistance

3. Has a greater effect on a wider range of cellular and tissue reservoirs of HIV

Front 74

Which drug or combination of drugs can cure HIV?

Back 74

NO drug or combination of drugs can cure HIV (yet) --- but can decrease viral replication and delay progression of disease

Front 75

What are the indications for deferred treatment of antiretroviral therapy in HIV-infected persons?

Back 75

Asymptomatic, CD4 >350, <30,000 bDNA

Front 76

What are the indications for initiation of antiretroviral therapy in HIV-infected persons by some clinicians but not others?

Back 76

Asymptomatic, CD4 >350, >30,000 bDNA

Front 77

What is the risk of developing AIDS in untreated person?

Back 77

A 3-year risk of developing AIDS of >30% in untreated persons

Front 78

What are the indications for offering antiretroviral therapy in HIV-infected persons?

Back 78

Asymptomatic, CD4 >200 but <350, any value bDNA

Front 79

What are the indications for definite initiation of antiretroviral therapy in HIV-infected persons?

Back 79

Symptomatic, any value CD4 and any value bDNA

Front 80

What are the goals of antiretroviral therapy?

Back 80

1. Maximal and durable suppression of viral load (< 50 copies/ml- undetectable level)

2. Restoration and /or preservation of immunologic function (Maintain or raise CD4+T cell count to >200 cell/ul)

3. Delay the development of HIV-related symptoms and opportunistic diseases

4. Improvement of quality of life

5. Reduction of HIV-related morbidity and mortality

Front 81

What is an undetectable level of viral load?

Back 81

< 50 copies/ml

Front 82

How is immunologic function restored or preserved?

Back 82

By maintaining or raising CD4+T cell count to >200 cell/ul

Front 83

What tools are used to achieve the goals of antiretroviral therapy?

Back 83

1. Maximize adherence to the antiretroviral regimen

2. Rational sequencing of drugs

3. Preservation of future treatment options

4. Use of resistance testing in selected clinical settings

Front 84

What assessments are required prior to antiretroviral therapy?

Back 84

1. Nutritional status

2. Renal and hepatic functions

3. Hydration status—electrolyte balance

5. Pregnancy and lactation status

6. History of seizure disorder (adverse drug reaction)

7. Motivation and ability to comply with treatment

Front 85

What are the antiretroviral drug classes?

Back 85

1. Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

2. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

3. Protease Inhibitors (PIs)

4. Fusion or Entry Inhibitors

5. Integrase Inhibitors

Front 86

What are the actions of Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)?

Back 86

1. Interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself

2. Suppress production of reverse transcriptase and inhibit viral DNA synthesis and genetic replication

Front 87

What are the actions of Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)?

Back 87

1. Stop HIV from replicating within cells by inhibiting the synthesis of the enzyme reverse transcriptase (RT)

2. Suppresses viral replication but does not kill the virus

Front 88

What are the actions of Protease Inhibitors (PIs)?

Back 88

1. Inhibit the protease enzyme, which is another protein involved in the HIV replication process

2. Prevent viral replication and release of viral particles

Front 89

What are the actions of Fusion or Entry Inhibitors?

Back 89

Fusion or entry inhibitors prevent HIV from binding to or entering human immune cells

Front 90

What are the actions of Integrase Inhibitors?

Back 90

Integrase inhibitors interfere with the integrase enzyme, which HIV needs to insert its genetic material into human cells

Front 91

What proteins are involved in the HIV replication process?

Back 91

1. Transcriptase

2. Protease

Front 92

What are the examples of Nucleoside Analog Reverse Transcriptase Inhibitors (NRTIs)?

Back 92

1. Zidovudine (Retrovir, AZT)
2. Didanosine (ddI)
3. Zalcitabine (ddC)
4. Lamivudine (Epivir)
5. Stavudine (Zerit)

Front 93

What are the examples of Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)?

Back 93

1. Neviraline (Viramune)
2. Delavirdine (Rescriptor)
3. Efavirenz (Sustiva)

Front 94

What are the examples of Protease Inhibitors (PIs)?

Back 94

1. Ritonavir (Norvir)
2. Indinavir (Crixivan)
3. Nelfinavir (Viracept)
4. Saquinavir (Invirase)

Front 95

What are the advantages of protease inhibitors (PIs)?

Back 95

Fewer side effects

Front 96

What are the disadvantages of protease inhibitors (PIs)?

Back 96

Shown rapid resistance

Front 97

What have researchers from Stanford and Harvard found to be the best combination of drugs?

Back 97

1. Efavirenz (Sustiva- NNRTI)

2. Combination drug Zidovudine (AZT-NRTI ) and Lamivudine (Epivir- NRTI) sold under the brand name Combivir

Front 98

What is the preferred treatment for HIV/AIDS according to WHO?

Back 98

AZT or TDF

Front 99

What are the WHO's recommended drug combinations for treatment of HIV/AIDS?

Back 99

1. AZT is also called zidovudine or ZDV

2. TDF is also called tenofovir

3. d4T is also called stavudine

4. ABC is also called abacavir

5. 3TC is also called lamivudine

6. FTC is also called emtricitabine

7. EFV is also called efavirenz

8. NVP is also called nevirapine

Front 100

What is HIV drug resistance?

Back 100

The failure of one or more antiretroviral drugs to keep viral replication suppressed in a treated individual because of breakthrough replication of drug-resistant viral strains

Front 101

When is HIV drug resistance suspected?

Back 101

Resistance is suspected when the viral load begins to rise, CD4 count begins to decrease, or symptoms increase or worsen

Front 102

What is HIV drug resistance indicative of?

Back 102

Resistance indicates treatment failure

Front 103

What are the reasons for treatment failure?

Back 103

1. Lack of access to costly drugs (“failure of medical economics”)

2. Lack of access to clinicians experienced in treating HIV and AIDS (“failure of informatics”)

3. Inappropriate pharmacokinetics including insufficient potency of the drug regimen, poor GI absorption of the drug, and adverse drug-to-drug or drug-food interactions

4. Failure of patient to adhere to the drug regimen

Front 104

What are the significances of adherence to HIV/AIDS therapy?

Back 104

1. Critical component of ART

2. Missing a dose can lead to viral mutations that allow HIV to become resistant to the drugs

3. Adherence rates of better than 95% are required to prevent disease progression, opportunistic diseases, and viral drug resistance

4. Subtherapeutic levels of the drug can promote resistance and cross-resistance

Front 105

What is an opportunistic infection?

Back 105

1. Infections caused by pathogens that usually do not cause disease in a person with a healthy immune system, but can affect people with a poorly functioning or suppressed immune system

2. These pathogens take this "opportunity" to cause an infection

Front 106

What causes an opportunistic infection?

Back 106

1. Those caused by microorganisms that are continually present as part of the normal flora and are kept in check by normal immune function

2. When immune function is depressed or compromised, these microoganisms cause infection

Front 107

What viral load correlates with the onset of an opportunistic infection?

Back 107

Increased viral load (>100,000 copies) correlates with opportunistic infection onset

Front 108

What is the most common opportunistic infection in HIV persons?

Back 108

Pneumocystis Carinii Pneumonia (PCP)

Front 109

What is Pneumocystis Carinii Pneumonia (PCP)?

Back 109

Protozoal infection caused by Pneumocystis Carinii

Front 110

What is the incidence range of Pneumocystis Carinii Pneumonia (PCP)?

Back 110

Incidence ranges from 75-80%.

Front 111

What are the clinical manifestations of Pneumocystis Carinii Pneumonia (PCP)?

Back 111

Pneumonia

Front 112

What are the treatments of Pneumocystis Carinii Pneumonia (PCP)?

Back 112

1. Trimethoprim Sulfamethoxazole (Bactrim. Septra)

2. Pentamidine

3. Dapsone

4. Mepro

5. Prednisone

Front 113

What is Toxoplasmosis Encephalitis?

Back 113

Protozoal infection caused by Toxoplasma gondii

Front 114

How is Toxoplasmosis Encephalitis acquired?

Back 114

Through contact with contaminated cat feces or by ingesting infected, undercooked meat

Front 115

What are the clinical manifestations of Toxoplasmosis Encephalitis?

Back 115

Disseminated retinitis

Front 116

What are the pharmacological treatments of Toxoplasmosis Encephalitis?

Back 116

1. Pyrimethamine
2. Sulfadiazine
3. Clindamycin
4. Leukovorin

Front 117

What is Cryptosporiodosis?

Back 117

Protozoal infection caused by Cryptosporidium

Front 118

What are the clinical manifestations of Cryptosporiodosis?

Back 118

Gastroenteritis — ranges from mild diarrhea to cholera-like syndrome

Front 119

What are the treatments for Cryptosporiodosis?

Back 119

Investigational only, symptomatic treatments

Front 120

What is Candidiasis?

Back 120

Fungal infection caused by the Candida species

Front 121

What are the clinical manifestations of Candidiasis?

Back 121

1. Stomatitis
2. Sophagitis
3. Vaginal candidiasis

Front 122

What is stomatitis?

Back 122

Thrush

Front 123

What is sophagitis?

Back 123

Cottage cheese-like, yellow-white plaques and inflammation

Front 124

What is vaginal candidiasis?

Back 124

Severe pruritus (itchiness), thick white vaginal discharge

Front 125

What are the treatments for Candidiasis?

Back 125

1. Nystatin
2. Clotrimazole
3. Ketoconazole
4. Fluconazole
5. Amphotericin B

Front 126

What is Cryptococcosis?

Back 126

Fungal infection caused by Cryptococcus Neoformans

Front 127

What are the clinical manifestations of Cryptococcosis?

Back 127

1. Severe, debilitating meningitis
2. Encephalitis
3. Pneumonia
4. Disseminated disease

Front 128

What are the treatments for Cryptococcosis?

Back 128

1. Amphotericin B
2. Fluconazole

Front 129

What is Histoplasmosis?

Back 129

Fungal infection caused by Histoplasma Capsulatum

Front 130

What are the clinical manifestations of Histoplasmosis?

Back 130

1. Begins as respiratory infection (Pneumonia)

2. Progresses to widespread infection

3. Hepatomegaly

4. Splenomegaly

5. Lymphadenopathy

Front 131

What are the treatments for Histoplasmosis?

Back 131

1. Amphotericin B
2. Fluconazolet

Front 132

What are the risk factors for Histoplasmosis?

Back 132

Exposure to bird or bat droppings

Front 133

What is Mycobacterium Avium-Intracellulare Complex (MAC)?

Back 133

Bacterial infection caused by Mycobacterium Avium of Mycobacterium Intracellulare

Front 134

What are the clinical manifestations of Mycobacterium Avium-Intracellulare Complex (MAC)?

Back 134

1. Pneumonia

2. GI tract infection (diarrhea)

3. Systemic infection—fever, weight loss, anorexia

4. Positive cultures from blood, lymph nodes, bone marrow

Front 135

What are the treatments for Mycobacterium Avium-Intracellulare Complex MAC)?

Back 135

1. Clarithromycin + Ethambutol + possibly Rifabutin

2. May use Azithromycin

Front 136

What is Tuberculosis?

Back 136

Bacterial infection caused by Mycobacterium Tuberculosis

Front 137

What % of patients with AIDS and TB have extrapulmonary disease sites?

Back 137

More than 50% of patients with AIDS and TB have extrapulmonary disease sites

Front 138

What are the extrapulmonary disease sites of patients with AIDS and TB?

Back 138

1. CNS
2. Bones
3. Liver
4. Spleen
5. Skin
6. GI tract

Front 139

What is the PPD test result of patients with AIDS and TB?

Back 139

The person with TB and CD4 <200 mm3 may NOT have a positive PPD because of an inability to mount an immune response to the antigen

Front 140

What is anergy?

Back 140

A false negative PPD test in patients with AIDS and TB

Front 141

What causes anergy?

Back 141

An inability to mount an immune response to the antigen

Front 142

What are the treatments for Tuberculosis?

Back 142

Isoniazid (INH) + Rifampin + Ethambutol +/- Pyrazinamide

Front 143

What defines an AIDS case?

Back 143

Two or more episodes of pneumonia in a 12-month period is an AIDS case definition

Front 144

What are the opportunistic viral infections of persons with HIV/AIDS?

Back 144

1. Cytomegalovirus
2. Herpes Simplex Virus (HSV)
3. Varicella Zoster Virus (VSV)

Front 145

What are the clinical manifestations of Cytomegalovirus (CMV)?

Back 145

1. CMV Retinitis
2. CMV Pneumonia
3. CMV colitis
4. CMV esophagitis
5. CMV hepatitis

Front 146

What are the treatments for Cytomegalovirus (CMV)?

Back 146

1. Ganciclovir
2. Foscarnet
3. Cidifovir

Front 147

What are the clinical manifestations of Herpes Simplex Virus (HSV)?

Back 147

1. Mucocutaneous (mouth, genital, rectal) blisters and/or ulcers

2. Pneumonia

3. Proctitis

4. Esophagitis

5. Encephalitis

Front 148

What are the treatments for Herpes Simplex Virus (HSV)?

Back 148

1. Acyclovir
2. Valacyclovir
3. Famcyclovir

Front 149

What is the 1st line treatment for Herpes Simplex Virus (HSV)?

Back 149

Acyclovir

Front 150

What are the clinical manifestations of Varicella Zoster Virus (VSV)?

Back 150

1. Dermatomal skin lesions (shingles)

2. Encephalitis

Front 151

What are the treatments for Varicella Zoster Virus (VSV)?

Back 151

1. Acyclovir
2. Foscarnet

Front 152

What is the most common malignancy occurring in 1-21% of clients with AIDS?

Back 152

Kaposi’s Sarcoma

Front 153

What is Kaposi’s Sarcoma?

Back 153

A malignancy caused by the Human Herpes Virus-8

Front 154

Which group has the highest incidence of Kaposi’s Sarcoma?

Back 154

Men infected through homosexual contact (MSM)

Front 155

What are the clinical manifestations of Kaposi’s Sarcoma?

Back 155

1. Disseminated mucocutaneous lesions often involving skin, lymph nodes, visceral organs (lungs, GI)

2. Purplish-brown, raised lesions that are not usually painful or pruritic

Front 156

What are the treatments for Kaposi’s Sarcoma?

Back 156

1. Surgical excision or radiation to small, localized lesions

2. Chemotherapy with Vincristine and Bleomycin, Interferon, Etoposide (VP-16), Pactitaxel (Taxol)

Front 157

What are the nursing diagnoses for persons with HIV/AIDS?

Back 157

1. Impaired gas exchange

2. Pain

3. Imbalanced nutrition: less than body requirements

4. Diarrhea

5. Impaired skin integrity

6. Disturbed thought process

7. Situational low self esteem

8. Social isolation