IM - HIV & AIDS

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TerryZ
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251335
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IM - HIV & AIDS
Updated:
2013-12-07 09:24:36
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internal medicine IM human immunodeficiency virus HIV acquired syndrome AIDS
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IM
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Internal medicine - HIV and AIDS
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  1. HIV & AIDS - facts
    • MC virus: HIV type I human retrovirus
    • Path: CD4+ T-cell, reverse transcriptase
    • Xmit: via semen, blood, milk, vag fluid
    • C-sect: if CD4<500 or viral load>1000
    • Mort: 2/2 opport inf, wasting, CA
  2. HIV & AIDS - Xmit risk
    • Needle:   1/300
    • Vag M}F: 1/1000
    • Vag F}M: 1/3000
    • Anal:       1/1000
    • Moth}Ch: 1/3; w/meds <1/50
  3. HIV & AIDS - high risk
    • Blood Xfuse <1985
    • .
  4. HIV & AIDS - S/Sx 1)Prim
    • Prim: mono-like at 2-4w for 3d-2w
    • S/Sx: F, Sw, mal, leth, HA,arth/myalg,
    •          D, ST, LAD, truncal macpap rash
  5. HIV & AIDS - S/Sx 2)Asymp
    • Def: seropositive, no clinical evidence
    • CD4 cnt: >500 (nml)
    • Dur: 4-7 yrs untreated
  6. HIV & AIDS - S/Sx 3)Sympt
    • Pre-AIDS: 1st evidence immun dysfn
    • Dur: 1-3 yrs untreated
    • LN: persist gen LAD
    • Fung: local fungal inf (nails, mouth)
    • F: recalc vag yeast/trichomonal inf
    • Tongue: hairy leukoplakia
    • Skin: SebDerm, psor, mollusc, warts
    • Const: nt sw, \wt, D
  7. HIV & AIDS - S/Sx 4)AIDS
    • //immun supr: dissem oppor inf/malig
    • CD4 cnt: <200
    • Sxs: pulm, GI, neuro, cutaneous, syst
  8. AIDS - pulmonary
    • CAP: 2+/yr; 20x if CD4<200
    • PCP: 70%,MC death, CD4<200
    •        F, dry cough, SOB; CXR (80%)
    •        TMP-SMX x 3w, steroid if hypox
    •        PPx: TMP-SMX daily
    • TB: (-)PPD test 2/2 immunosuppr
    • CMV/MAC: /risk CD4<50
    • Cryptococcus neoformans, Histoplasma capsulatum, Kaposi's sarcoma
  9. AIDS - nervous system
    • dement: 33%,\ST mem,cog defects->
    •                     AMS,aphasia,motor abnl
    • Toxo: mass(deficits,HA); enceph(F,AMS)
    •   CT/MRI: 4+}basal g, subcortWhMatter
    • Crypto mening: in CSF (India Ink)
    •   Tx: amphoB 10-14d,PO flucon 8-10w
    • Oth inf: bact mening, histo, CMV, PML,
    •            HSV, neurosyph, TB
    • ~inf: CNS lymphoma,CVA,metab enceph
  10. AIDS - GI
    • D: MC{ab tx; E.coli,shig,salm,camp,CMV,
    •          giard, crypto, Isospera beli, MAC
    • Oral: thrush, HSV/CMV ulcers, EBV OHL,
    •         Kaposi's sarcoma
    • Esoph: dysph{cand,CMV,HSV; CD4<100
    • Anorec: proct,N.gono,Chlam,syph,HSV
  11. AIDS - derm
    • Kaposi: gay, ~P,raised,Br/Blk/Purp pap
    •            face,chest,genit,mouth;widespr
    • Inf: HSV, mollus contag, 2ndary syph,
    •       warts, shingles, etc.
  12. AIDS - CMV infection
    • serious opportun viral dz
    • dissem involves GI/pulm
    • retinitis - unilat vision loss (5-10%)
    • Colitis, esophagitis
    • Tx: gang, foscar
  13. AIDS - MAC
    • aka: Mycobacterium Avium Complex
    • MC: opportun bact inf; 50%, CD4<50
    • Sx: D, wasting(\wt,F), LAD, anemia
  14. AIDS - HIV-1 wasting syndr
    \\wt: 10% + ([c-D or F+wk]>1mo)
  15. AIDS - Malignancies
    • Kaposi's syndrome
    • NHL - rapidly growing CNS mass lesions
    • Primary CNS lymphoma
  16. HIV & AIDS - Dx
    • PCR RNA: viral load test
    • p24 ag assay: \cost, \sens
    • seroconv: 3-7w, confirms dx
    •   ELIZA: enz-lnked immunosorbent assay
    •      (+) in 1-12w}Wst blot, (-) 99% sens
    •   Western Blot: confirm (+)ELIZA
    • AIDS: Indic cond in HIV-1(+), CD4<200
  17. AIDS - indicator dzs
    • cand,cervCA,coccidomycosis,crypto>1m,
    • CMV,enceph,HSV>1m,@salm,histo,
    • isos>1m,Kapos,lymphoma,mycobact,
    • TB,PCP,PNA>1/y,PML,toxo,wasting
  18. HIV & AIDS - Tx, ~retroviral
    • Indic: sympt -or- CD4 cnt <500
    • HAART: x replic, 2NRTI+(NNRTI or PI)
    • NRTI: Zido(AZT),lami,abac,tenof,emtric
    • NNRTI: efavirenz,rilpivirine
    • PI: ritonavir, atazan, darun, lopin/riton
    • Mon: HIV RNA load (->undetectable)
    • Preg: continue HAART
    • Compliance!!: .
  19. HIV & AIDS - Prophylaxis
    • PCP: pneumocystic PNA; carinii/jirovecii
    •   Occ: CD4<200
    •   Sx: dyspnea, dry cough, F
    •   Test: CXR (B infilt), /LDL, ABG(hypox),
    •           sputum(spec),bronchoscop+BAL
    •   Tx: TMP/SMX, /dose
    • TB: PPD/yr, +} isoniazid+pyridoxine
    • Atyp mycobac: MAC,CD4<100,clarit,azith
    • Toxo: CD4<100 } TMP/SMX
  20. HIV & AIDS - Vaccinations
    • NO LIVE VIRUS!
    • Pneumo/5-6y
    • Flu/1 yr
    • HepB if not ab+

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