Week 8 – HIV lecture 2

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what are the goals of HIV treatment? When do you start treatment?
Immediately; manage CD4 count. (worried you might not see the patient again). You don’t want to prescribe to a patient you may not see again, because those might be the patients that could be non-compliant and develop resistance.

What does HIV treatment “cascade” refer to?
there is a huge gap between diagnosed HIV + patients

How effective are pre-exposure and post-exposure prophylaxis

AI, AII, BIII, etc…what do these stand for, with reference to clincal recommendations?
these are grades of strength of recommendation, based on the number of randomized clinical trials. A is the strongest, B is medium, C is “smoke-filled room.”

Is prophylactic treatment effective?
very effective! PEP

What does PEP stand for?
Post exposure Prophylaxis.

what does PrEP stand for?
Pre Exposure Prophylaxis. reduces HIV spread even when inconsistently used.
2 doses/week

What are person-years
time x and #people taking medicine. e.g. 5ppl taking medication for one year = 5 person-years.

what is a discordant couple?
one partner +, one partner – for HIV.

What is PEPFAR?
President’s Emergency Plan For AIDS Relief. Bush era.

Results of PEPFAR?
treatment for 6.7 million patients
1 milion babies born HIV free from HIV+ mothers
Supported 17 million people with care including more than 5 million orphans and vulnerable children
provided HIV counseling for more than 57.7 million people

What does ABC stand for in the context of PEPFAR?
Abstinence, Be faithful, use a Condom.
used to be a funding requirement, but not anymore, since 2008.

What does IRIS stand for?
Immune Reconsitution Inflammatory Syndrome. (Immune system “wakes up,” and latent infections get attacked by body, leading to huge inflammatary response.)

What is the presentation of IRIS?
Lymphopenia induced proliferation

What are some common bacteria that get “unmasked”
Mycobacterial infection (typical or atypical): M. tuberculosis, M. avium, CMV retinitis, PJP, Cryptococcus

What HIV-related opportunistic infection might you expect to see at CD4 <200?
pneumocystis jiroveci (carinii)

What HIV-related opportunistic infection might you expect to see at CD4 <100?
Cryptococcal infections, M

what is DiGeorge Syndrome again?

Who else might get candidiasis, besides HIV+ patients?
Diabetic patients
Babies
people on antibiotics

What disease presents as painless lesions along the lateral edge of the tongue?
Oral hairy leukoplakia
caused by replication of EBV in epithelium of the mucosa

What do you use to treat herpes?
Acylovir (backup: famciclovir, valacyclovir)

What are some possible causes of oropharyngeal infections (oral ulcers)
HSV-1 & 2
CMV: large, shallow ulcers
aphthous stomatitis

What are you likely to think about as a diagnosis if you see genital lesions, whether distinct white shallow lesions, or one giant craterous ulcer
HSV (herpes)

What are you likely to think about as a diagnosis if you see a unilaterous, blistering, erythemetous rash?
VZV (varicella herpes zoster)

What are you likely to think of when you see a raised, black, papular lesion with purulent inflammation?
not Kaposis.
Bacillary agiomatosis.
caused by Bartonella henselae/quintano

small flesh-colored umbilicated lesions (or red)
mulluscum, with dip in the middle
caused by a poxvirus

retina is inflamed, surrounding hemorrhage, whitish stuff. has floaters in field of vision.
CMV retinitis

bilateral diffuse infiltrate, leading to chronic fever, leading to shortness of breath
pneumonia – walking pneumonia maybe, pneu
PCP – pneumocystis jiroveci (carinii)

How would you diagnose PJP?
Silver Stain, bronchoalveolar lavage, Diff-Quick

How would you treat PJP?
trimethoprim-sulfamethoaxazole (bactrim)

What other pathogen might you consider that causes chronic diarrhea, besides bacteria, ova, and parasites?
CMV (again!) this would be CMV colitis. common scenario to do all these cultures, and then have them come back negative.

Cryptosporidium is another cause.

What is acalculous cholecystis?

microspororidium
isospora
giardia uodenalis/lamblia
entamoeba histolytica

what is another cause of stroke-like symptoms in HIV+ patients?
PML: progressive multifocal leukoencephalopathy. seemingly random distribution of neurological effects. hemiparesis visual field defects

white is a ring-enhancing lesion in the brain caused by?
toxoplasma, or also lymphoma (not related to HIV)

how would you diagnosis toxoplasma gondii?
brain biopsy, worst-case scenario, can’t improve or gets worse with treatment.

what does MAC present as?
fever, sweats, weight loss, hepatosplenomegaly, adenopathy, anemia
focal disease with isolated adenitis

What is the best way to confirm a diagnosis of CMV in the
JC virus in the CSF (although MRI scan is also really good)

CMV can affect multiple organ systems in an HIV infected individual. What is the best way to diagnose CMV esophagitis?
biopsy ulcers, and send for EM

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