Bafl Exam 3: Hiv

Front 1

Differences between HIV 1 and 2?

Back 1

HIV 1 has higher viral loads, accelerated progression

HIV 2 is 5-8x less transmissible, rare vertical transmission, longer latency, slower CD4 decline

Front 2

Diagnosis of HIV depends on...

Back 2

positive serology!

ELISA + (screen)

and

2 viral protein markers on Western blot (p24, gp41, gp120/160)

Front 3

If a patient has a positive ELISA and 1 viral protein marker for HIV, what is the next step?

Back 3

They must have TWO protein markers for HIV to be diagnosed

Test them in 1 month

Several things can give a false positive: OTR, CT disease, pregnancy

Front 4

AIDS criteria?

Back 4

positive serology and either:

1. presence of an AIDS defining condition

2. CD4 count <200 (normal CD4 is 500-1500)

Front 5

Basic structure of HIV?

Back 5

single stranded RNA virus

Front 6

How does co-infection with HTLV-1 affect CD4 counts?

Back 6

Co-infection with HTLV-1 increases IL2 signaling --> this falsely elevates the CD4 count (via nonfunctional CD4 lymphocytes)

Front 7

Why can't we just wipe out CD4 cells and start a persons immune system over to get rid of HIV?

Back 7

HIV can be harbored in dendritic cells

Front 8

What is the acute retroviral syndrome? How long does it last?

Back 8

Initial replication in lymphatics --> produces a viremia in 2-4 weeks, which correlates with the initial maculopapular exanthem, fever and LAD

this morbiliform eruption lasts for 4-5 days

Front 9

When are antibodies to HIV detectable?

Back 9

6-12 weeks after exposure, IgG, IgM, IgA are present and detectable

Front 10

There are tons of AIDS defining conditions... the ones we are concerned about are:

1. fungal infections (coccidio, crypto, histo, candida)

2. active HSV

3. kaposi sarcoma

4. mycobacterial infection

How long does the patient need to have HSV to meet AIDS defining criteria?

Back 10

>1month!

Front 11

Side effect of foscarnet?

Back 11

genital ulcers

Front 12

Criteria for disseminated zoster? Internal manifestation?

Back 12

more than 20 lesions outside of a contiguous dermatome

increased risk of fatal pulmonary VZV

Front 13

Which type of molluscum contagiosum is sexually transmitted?

Back 13

MCV2 is sexually transmitted

MCV1 is in kids

Front 14

HAART therapy and HPV?

HAART therapy and HSV?

Back 14

HAART therapy does not decrease incidence of progression of HPV, HPV and HIV are both independent risk factors for anal SCC (HIV regulatory protein increases HPV expression)

HAART therapy does decrease incidence of HSV

Front 15

Candidal infections are AIDS defining if located where?

Back 15

esophagus, trachea, bronchial

NOT tongue

Front 16

Retinitis d/t CMV is AIDS defining when...

Back 16

it is associated with blindness

Front 17

causes?

Back 17

Bacillary angiomatosis!!

B. henselae= visceral, cats

B. quintana= subcutaneous and osseous, poor living conditions

Front 18

How does syphilis increase risk of HIV?

Back 18

increased CCR5 on monocytes at ulcer base increases the transmission of HIV

Front 19

Cause?

Back 19

Proximal subungual onychomycosis, t.rubrum

very rare, almost always in HIV patients

Front 20

Cause?

Back 20

White superficial onychomycosis, t.mentag usually

if t.rubrum, think about HIV

Front 21

Thumb print purpura around the umbilicus in an HIV patient?

Back 21

larva currens!!

Front 22

What is the most common HIV ectoparasite?

Back 22

scabies

look in hyponychium, reservoir for recurrence

Front 23

New onset Reiters should always prompt HIV test. Triad?

Back 23

conjunctivitis, urethritis, arthritis

Front 24

What is HIV associated follicular syndrome?

Back 24

follicular spines

acne conglobata

hidradenitis suppurativa

Front 25

What is the best treatment for generalized pruritis in HIV?

Back 25

nbuvb

Front 26

Which HAART therapy is this patient on?

Back 26

Zidovudine

Front 27

Zidovudine can cause what cutaneous manifestation?

Back 27

increased melanin in nails

Front 28

Indinavir can cause what cutaneous manifestation?

Back 28

protease inhibitor

paronychia

Front 29

What is the most common cause of facial lipoatrophy in Caucasians on long term HAART therapy?

Back 29

PI > NRTIs > NNRTIs

Front 30

What is the most common cause of visceral obesity in a female on long term HAART therapy?

Back 30

Protease inhibitors (protease pouch)

Front 31

Virus associated with Kaposi's sarcoma? Most common internal manifestations?

Back 31

HHV8

GI, lymphatics, lung tumors

Front 32

Protocol for all patients on Abacavir is what?

Back 32

To have HLA-B*5701 screening --> hypersensitivity syndrome

Abacavir (NRTI)

Front 33

Which HAART therapy is the most common cause of morbiliform drug eruptions?

Back 33

NNRTI

Front 34

side effects with Didanosine?

Back 34

optic neuritis, peripheral neuropathy, pancreatitis

Front 35

Side effects of protease inhibitors?

Back 35

lipodystrophy

Front 36

CYP3A4 interactions:

inhibitors?

inducers?

Back 36

Inhibitors- protease inhibitors, delaviradine

Inducers- efavirenz, nevirapine (both NNRTI)

This is a big deal bc it can decrease efficacy of birth control... WFT these people shouldn't have sex anyways

Front 37

HAART therapy decreases the incidence of many other infective viruses EXCEPT:

Back 37

molluscum

HPV --> HIV Tat (transactivator of transcription) protein, HIV regulartory protein increases HPV expression

Front 38

Treatment for apthaea major in HIV patients?

Back 38

thalidomide

Front 39

HIV patients are at a higher risk for cutaneous neoplasms, including...

Back 39

BCC:SCC, 6:1

Increased polyoma virus --> increased merkel cell carcinomas

Front 40

HIV patients are at an increased risk for lymphomas, which types?

Back 40

non-Hodgkins

Front 41

Side Effects:

Side Effects:

Zidovudine

Didanosine

Stavudine

Lamivudine

Abacavir

Tenofovir

Back 41

Zidovudine- melanonychia, mucosal hyperpigmentation

Didanosine- pancreatitis, lactic acidosis

Stavudine- peripheral neuropathy, lactic acidosis

Lamivudine- alopecia

Abacavir- hypersentivitity (HLA B 5701)

Tenofovir- lactic acidosis, morbilloform rash