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  #1  
Old 09-01-2012
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Virus High-Yield Facts about HIV

HIV is one of the tough topic and it is very high yield in the exam, so we can share the concept about HIV , and at the end we can cover this topic, so please add any important concept.
Diagnosis:
*Best initial test= ELISA test.
*Confirmatory test= western blot (considered +ve if patient demonstrated the presence of antibodies to at least 2 of 3 important HIV antigens which are gp120, gp41, and gp24).
*Early marker of infection is p24 Antigen.
* ELISA/Western blot are often falsely –ve in first 1-2 mths of HIV infection.
*Viral load testing (detected by RT PCR) useful to:
1- Measure response to therapy
2- Detect treatment failure
3- Diagnose HIV in babies
*Diagnosis in babies of HIV +ve mother:
• Test of choice is detect HIV-DNA by PCR
• Can culture HIV with antigens detection
• ELISA/Western blot are often falsely +ve in infant(anti-gp 120 cross the placenta)
• In children> 18 mths can use ELISA(IgG Ab) and Westren blot
*Best single prognostic indicator is plasma viral load
*Evaluate progression of disease: CD4:CD8 ratio by flow cytometery.


HIV- associated infections and CD4 count:
Normal CD4 count 600—1000
*CD4 >200: Increase risk of
VZ,TB, HSV, Oral and Vaginal Candidiasis, Bacterial pneumonia.
*CD4 < 200: Increase risk of
1- PCP: *Prophylaxis= TMP/SMX, and if patient allergy give Dapsone or Atorvoqine *treatment =TMP/SMX is best initial therapy, add steroids if PCP is sever.
2- Cryptosporidiosis: *treatment= by increase CD4 count
3- Disseminated Coccidioidomycosis: *treatment= Amphotericin B
*CD4 < 100: Increase risk of
1- Toxoplasmosis:* prophylaxis= TMP/SMX , Dapsone *treatmen=Primethamine/sulfadiazine
2- Candida esophagitis: *treatment= fluconazole
*CD4 < 50: Increase risk of
1- Mycobacterium avium*Prophylaxis = Azithromycin *treatment = clarithromycin + ethambutol+/-rifambutin
2- CMV:Prophylaxis and treatment by Valgancyclovir
3- Cryptococcal meningoencephalitis: treatment I.V amphotricin for 10-14 days followed by fluconazole as mentinance
4- PML= caused by JC virus= No effective treatment
5- NHL= associated with EBV
*HIV with any cell count:
1- If patient PPD >5mm= INH for 9 mths
2- Pneumococal vaccine, influenza vaccine, and Hep B vaccine, Hep A vaccine
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  #2  
Old 09-01-2012
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Old 09-02-2012
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Info

PML
NHL
INH
what do they mean ?
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Old 09-02-2012
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Old 09-06-2012
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Quote:
Originally Posted by dr amr View Post
PML
NHL
INH
what do they mean ?
PML= Progressive multifocal leukoencephalopathy
NHL= Non Hodgkin's lymphoma
INH= Isoniazid
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Old 09-06-2012
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General recommendation for treatment of PCP :
1-If the patient is already on antiretroviral therapy continue the therapy
2- If the patient is not on antiretroviral therapy defer antiretroviral therapy until has been treated because of possible drug interaction
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Old 09-23-2012
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Regarding Toxoplasmosis:
*lymphoma need to be rule out even T gonodii IgG antibody is +ve in case of:
(1)failure to show clinical and radiological improvement after therapy.
(2)CT brain demonstrated solitary lesion.

*Treatment: if the patient not tolerated sulfadiazine should be given combination of pyrimethamine and clindamycin.
Folinic acid should be added to the either regimen to prevent BM suppression caused by pyrimethamine.
Life long treatment with sulfadiazine and pyrimethamine after primary lesion respond to primary therapy
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Old 09-23-2012
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Regarding Cryptococcal meningoencephalitis :
Amphotericin is the drug of choice but if not in choices given Voriconazole will also cover cryptococcus.
AIDS Patient with Meningitis
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Old 10-01-2012
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you should add that if HIV patient has greater than 200 CD4 count the only exception to live vaccines that can be given is the MMR, this is because the measles component is extremely dangerous and can kill AIDS patients, so if the patient is well controlled you CAN give this vaccine.

Source: Usmleworld.
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Old 01-11-2015
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Arrow PML not only in CD4 <50 !

Uworld question 2277 describes an HIV patient with cerebral symptoms and CD4 count 70 and the answer is PML!. I guess in this particular case, even if CD4 count is not <50, the high viral load (90 000) together with typical picture on contrast CT scan (multiple, hypodense, non-enhancing lesions) make the diagnosis of PML.
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