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9.27 Clinical Correlates of AIDS
by Dr. Maffei at 10:00
50
Microbiology
Professional
09/27/2011

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Term
How many new infections of HIV are there each year?
Definition
40,000
Term
What is the prevalenc of HIV infection?
Definition
650,000-900,000
Term
How many people die with HIV each year?
Definition
60,000
Term
How many adults were living with US at the end of 2008?
Definition
1.2 million adults
Term
How many undiagnosed HIV+ people are there?
Definition
236,400 (20%)
Term
How do males get HIV?
Definition
74% MSM, 14% heterosexual contact, 8% IVDU 4% MSM and IVDU
Term
How do females get HIV?
Definition
85% heterosexual contact 15% IVDU
Term
Of men with HIV, what is the racial breakdown?
Definition
46% black, 31% white, 20% hispanic/latino
Term
Of women with HIV, what is the racial breakdown?
Definition
65% black, 17% white, 16% hispanic
Term
How many people in LA have HIV and AIDS?
Definition
17,555 and 54% have AIDS (9,283)
Term
How are Baton Rouge and New Orleans ranked among large metropolitan areas in US AIDS case rates?
Definition
baton rouge is 2nd; new orleans ranked 9th
Term
How can IVDU prevent getting HIV?
Definition
new needles, bleach kits, drug rehabilatation
Term
What retrovirals are given to pregnant women?
Definition
AZT to HIV + mothers during pregnancy and at delivery. AZT are given to their infants after delivery
Term
What is the HIV post exposure prophylaxis for healthcare workers?
Definition
AZT/3TC/lopinavir-ritonavir
Term
What is the risk of HIV transmission with needlestick injury?
Definition
1/300
Term
What do you do if you've been exposed to pt's bodily fluids as a healthcare worker?
Definition
wash site with soap and water, report incident, draw blood on patient (2 purple top tubes; oraquick, hep B and C) Go to urgent care center 5th floor UMOB or ED after hours
Term
What is clinical component A of HIV?
Definition
asymptomatic, acute HIV, persistent generalized lymphadenopathy (PGL)
Term
What is clinical component B of HIV?
Definition
symptomatic, AIDS-related complex (ARC)
Term
What is clinical component C of HIV infection?
Definition
AIDS-indicator conditions, including pulmonary TB, recurrent bacterial pneumonia, invasive cervical cancer
Term
What is immunlogic compnoent level 1?
Definition
more than or equal to 500 CD4 t cell count
Term
What is immunologic omponent level 2?
Definition
200-499 T cell count
Term
What is immunologic component 3?
Definition
<200 T cell=immunologic AIDS
Term
How do you define AIDS?
Definition
HIV + AIDS indicator condition OR HIV + CD4 <200
Term
What are the general manifestations of primary HIV infection?
Definition
fever, pharyngitis, LAD, arthralgia, myalgia, lethargy/malaise, anorexia/weight loss
Term
What are the neuropathic manifestations of HIV/AIDS?
Definition
headache/retro-orbital pain, meningoencephalitis, peripheral neuropathy, radiculopathy, brachial neuritis, guillain-barre syndrome, cognitive/affective impairment
Term
What are the dermatologic manifestations of primary HIV infection?
Definition
erythematous maculopapular rash, diffuse urticaria, desquamation, alopecia, mucocutaneous ulceration
Term
What are the GI manifestations of primary HIV infection?
Definition
oral/oropharyngeal candidiasis, N/V/D
Term
What is the differential diagnosis of primary HIV infection?
Definition
epstein-barr mononucleosis, CMV, toxoplasmosis, rubella, viral hepatitis, secondary syphilis, disseminated gonococcal infection, primary herpes simplex virus infection, other viral infection, drug reaction
Term
What are some examples of clinical category B HIV diseases?
Definition
bacillary angiomatosis, candidiasis, cervical dysplasia, or carcinoma in situ, constitutional symptoms (fever, diarrhea, for over a month), immune thrombocytopenic purpura, peripheral neuropathy
Term
CSF stained with india ink will show what pathogen?
Definition
crytococcus
Term
What is MAC?
Definition
disseminated mycobacterium avium complex
Term
What is the differential diagnosis of brain mases in HIV infected people?
Definition
toxoplasmosis (ring-enhancing, multiple, mass effect, IgG present), primary CNS lymphoma (ring enhancing or homongenous, single or multiple, mass effect), progressive multifocal leukoencephalopathy (nonenhancing, usually multiple, lesions confined to subcortical white matter, no mass effect)
Term
How do you clinically manage HIV+ patients?
Definition
pneumococcal vaccine every 6 years, TB skin test every year, Pap smear every 6 months, hep B and A if seronegative, flu vaccine very year, STD screening and tx
Term
WHen do you give prophylactic treatment for PCP?
Definition
CD4<200, thrush, or prior PCP
Term
When do you give prophylactic treatment for toxoplasmosis?
Definition
CD4<100
Term
When do you give prophylactic treatment for MAC?
Definition
CD4 <50
Term
When do you give prophylactic treatment for CMV?
Definition
CD4 < 100, screening eye exam
Term
Before starting ARV therapy, what labs do you get?
Definition
baseline CBC, CMP and lipid panel
hep A, B, and C serologies
CD4 T cell count, plasma HIVRNAviralload
genotypic resistance testing, viral tropism assay prior to initiating a CCR5 antagonist. HLA-B5701 testing prior to initiating Abacavir
Term
When do you start ARV therapy?
Definition
AIDS defining conditions. CD4 <350, or between 350 adn 500, pregnant women, HIV associated nephropathy (HIV AN), HBV coinfected treat for HBV.
Term
T/F Patients must commit to ARV for the rest of their life once they start.
Definition
true
Term
What combination therapy do you start with?
Definition
2 NRTIs plus 1 NNRTIs OR
2 NRTIS plus PIs OR
2 NRTIs plus INSTIs
Term
What is PIs?
Definition
protease inhibitors
Term
What is INSTIs?
Definition
integrase strand transfer inhibitors
Term
What is the single most important indicator of AIDS progression?
Definition
CD4 count
Term
How do you determine an adequate response to ART?
Definition
CD4 increase 100-150 cells/microliter/year
Term
How often do you monitor CD4s in HIV patient on therapy?
Definition
check at baseline x 2 and at least every 3-6 months
Term
How do you determine response to ART usuing HIV RNA?
Definition
HIV RNA below limit of detection <40 to <80 copies/mL
Term
How often do you monitor viral load on HIV patients on ARV?
Definition
check at baseline x2, immediately before starting ART, 2-8 weeks after start or change of ART, every 3-4 months with stable patients
Term
What is Maraviroc/selzentry?
Definition
CCR-5 co receptor antagonist for those infected with CCR5 tropic HIV-1
Term
What is raltegrair (isentress)?
Definition
HIV integrase strand transfer inhibitors (integrase inhibitors)
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