Study
Review All
Quiz!
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HIV attaches to the ___ on a ___ cell and inserts ___ into the cell. |
CD4 locus, T-helper, RNA |
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HIV works by transcribing ___ into ___ by _____. |
RNA, DNA, reverse transcriptase |
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What kind of cell does HIV attack? HIV attaches to what receptor? |
T-helper, CD4 receptor |
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Name the antiretroviral drug classes mentioned. |
1) Nucleoside reverse transcriptase inhibitors (NRTIs) |
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How does HAART affect the immune system? |
Incr number of "memory cells" and "naive cells" - seen as an increase in pt's CD4 count |
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Conjunctival microvasculopathy involves... |
capillary dilation, isolated vascular fragments, BV segments of irreg caliber, microaneurysms ("berry aneurysms"), granual appearance to blood column within BVs, decr flow rate w/ "sludging" |
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Conjunctival microvasculopathy occurs in... |
AIDS pts, esp if CD4 count low |
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Conjunctival microvasculopathy most apparent in... |
peri-limbal area of bulbar conj |
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Conjunctival microvasculopathy is assoc w/ elevated ___ levels. |
fibrogen |
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T/F - HZO in AIDS is similar to HZO in immunocompetent indiv. |
False - more severe in AIDS |
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HZO in a young pt should raise suspicion of... |
HIV infection since most HZO is in older pts |
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HZO is more common in what CD4 count levels? |
More freq in <100>300-400 (less freq in 100-300!) |
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Tx HZO in AIDS? |
Oral acyclovir, famciclovir, valciclovir IV Acyclovir for advanced immunodef. or disseminated zoster AVOID oral steroids unless progressive proptosis w/ opthalmoplegia or optic neuritis induced by HZV Mild analgesics (acetaminophen) first, but if not use Tylenol 3 w/ codeine, Vicodin |
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When Tx HZO for AIDS, you should avoid... |
oral steroids unless progressive proptosis w/ opthalmoplegia or optic neuritis induced by HZV |
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Rose bengal stains the (inside/outside) of HSV and (inside/outside) of HZV. |
outside, inside |
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T/F - HSV occurs more often in HIV pts vs non-HIV pts |
False - Not to a greater degree in HIV vs seronegative |
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T/F - Recurrence rate of HSV in HIV pts is greater vs non-HIV pts. |
True - 2.5x more |
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T/F - HIV pts take longer to recover from HSV vs non-HIV. |
False - time to resolution not sig different |
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T/F - Fungal keratitis can spontaneously occur in HIV pts |
True |
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What kind of stain identifies the hyphae of fungal keratitis? What growth medium is used? |
Gram stain, Sabouraud's agar |
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Tx fungal keratitis in HIV pts? |
Topical amphotericin (for Aspergillus), Natamycin (for Candida), Miconazole or Clotrimazole (for resistant strains) |
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What is Molluscum Contagiosum? |
Lesions of skin caused by infections of poxvirus |
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In HIV, Molluscum Contagiosum appears as... |
pearly white, gray, or flesh-colored w/ centrally umbilicated papules ("belly button") Or granulomatous lesions, can be 10 mm or larger in dia, and numerous (as many as 100) |
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In HIV, Molluscum Contagiosum occurs in CD4 count of... |
<100 |
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T/F - Toxic conjunctivitis or keratitis from Molluscum Contagiosum occurs frequently in AIDS pts. |
False - much less toxic rxn in AIDS pts prob b/c poor imm response to viral toxins |
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#1 ocular complication in AIDS pts? Why? |
Dry eye, due to HAART #1 ocular complication of AIDS due to the dz itself = CWS in retina |
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T/F - Kaposi's sarcoma is a disease of AIDS that occurs only on the skin. |
False - can occur viscerally (lungs, GI tract), which can be more severe and life-threatening |
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T/F - The causative agent of Kaposi's sarcoma is HZV. |
False - HSV (type 8) |
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2 ocular presentations of Kaposi's sarcoma? |
1) Pyogenic granuloma appearance on conj - looks like subconj heme |
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Conjunctival Kaposi's sarcoma occurs more frequently where specifically in the eye? |
inferior fornix |
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What would cause a pt to have Sx in Kaposi's sarcoma? |
cosmetic disfigurement or trichiasis and local irritation or recurrent subconj heme |
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Most important ocular manifestation of Kaposi's sarcoma that needs to be treated? |
Eyelid KS causing trichiasis |
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T/F - Kaposi's sarcoma can be Tx'd with radiation. |
True - but can recur; ocular structures hold up well to radiation Tx |
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Non-Hodgkin's Lymphoma in HIV is assoc w/ CD4 count of ___. |
<100 |
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Non-Hodgkin's Lymphoma often involves these structures... |
CNS, GI tract, liver, bone marrow Rarely orbital involvement |
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Non-Hodgkin's Lymphoma ocular signs/Sx? |
Proptosis, pain, eyelid edema, purple discoloration (ecchymosis) |
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What is Immune Reconstituted Uveitis in AIDS? |
Due to change in Tx, see an incr CD4 count thus incr imm system, thus incr imm response |
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What kind of anterior seg findings is found with CMV retinitis? |
mild AC rxn, no PAS, few to no KPs |
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T/F - You must dilate all AIDS patients due to high likelihood of retinitis. |
True |
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Most common retinitis in HIV? |
AIDS (HIV) retinopathy |
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Most frequently encountered ocular complication in AIDS itself (not the Tx)? |
CWS in retina |
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T/F - AIDS retinopathy occurs more often in higher CD4 count levels. |
False - occurs more with decr CD4 count |
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About half of AIDS pts w/ CD4 <50 have this ocular sign... |
AIDS retinopathy |
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In AIDS retinopathy, the CWS typically present near... |
large vessels in post pole |
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AIDS retinopathy mechanism? |
Rheologic abnormality (incr fibrinogen and viscosity, w/ focal retinal vessel infarction) |
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How do you DDx CMV retinitis vs AIDS retinopathy? |
AIDS retinopathy - CWS tends to fade or appear elsewhere; CMV lesions will smolder, enlarge, and advance |
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CMV retinitis occurs w/ CD4 count at ___. |
<50 |
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Most common cause of infectious retinitis in AIDS pts... |
CMV retinitis |
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T/F - CMV retinitis is less prevalent in AIDS pts in recent years. |
True - due to HAART |
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How does CMV retinitis affect the retina? |
Spreads thru ant or post blood supply of retina, results in full thickness destruction of retina (necrosis) Can also spread into eye via optic nerve |
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Sx of CMV retinitis? |
Gradual onset of floaters, photopsias, scotomas (more likely w/ post pole involvement) No pain, redness, photophobia |
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"pizza pie", "cottage cheese", "ketchup retinitis" describes this AIDS related retinitis... |
CMV retinitis |
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Describe how hemorrhagic/fulminant CMV retinitis looks like. |
White, necrotic retina; early = grainy, later = opaque; multiple hemes, spreads along arcades, may mimic BRVO "pizza pie", "cottage cheese", "ketchup retinitis" |
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Describe how granular/indolent CMV retinitis looks like. |
fewer hemes, grainy leading edge, small satellites or foci at or beyond (ahead of) the leading edge, mostly seen in periphery |
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What does the "brushfire" nomenclature refer to in CMV retinitis? |
leading edge of retinitis which is yellow/white and grainy, w/ atrophic retina left behind w/ ghost BVs, mild RPE loss, and gliosis |
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CMV involvement of optic nerve head appears as... |
yellow/white disc w/ small hemes surrounding margins |
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Greater risk of RD in CMV retinitis if... |
larger amts of retina involved, esp periphery |
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Tx CMV retinitis RD? |
Vitrectomy + silicone oil, but post-op VA poor and silicone oil causes marked hyperopic shift (permanent) |
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Ganciclovir is used in the Tx of this AIDS ocular complication. What is the concern w/ this drug? |
CMV retinitis. Concern = granulocytopenia, neutropenia(?), thrombocytopenia |
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Foscarnet is used to Tx this AIDS ocular complication. What is the concern w/ this drug? |
CMV retinitis. Concern = kidney (nephrotoxicity) therefore must pre-hydrate w/ saline |
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Cidofovir is used to Tx this AIDS ocular complication. What is the concern w/ this drug? |
CMV retinitis. Concern = toxic to kidney (must use w/ probenecid), can cause iritis |
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Fomivirsen is used to Tx this AIDS ocular complication. What is the concern w/ this drug? |
CMV retinitis. Concern = vitritis, RPE stippling |
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Criteria for stopping CMV retinitis maintenance? |
CD4 >100, viral load reduction of 2.0 logs for at least 6 mos, 6 mos or more of healed inactive retinitis |
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T/F - RPHRN involves granular borders. |
False - no granular borders unlike CMV retinitis |
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T/F - RPHRN involves massive hemes at the posterior pole |
False - no hemes (vs CMV retinitis) |
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How long can RPHRN take to destroy the retina? |
2 weeks |
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Tx RPHRN? |
Acyclovir IV + foscarnet or ganciclovir |
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T/F - Toxoplasmic retinitis in HIV usually occurs next to a previous toxo scar |
False - rarely occurs |
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CD4 count for Toxoplasmic retinitis = |
<100 |
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What life-threatening complication is assoc w/ Toxoplasmic retinitis in AIDS pts? |
Encephalitis (50%) |
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Toxoplasmic retinitis vs CMVR... |
Toxoplasmic retinitis is more opacified vs CMVR and has no granular borders. Also hemes are infrequent in Toxoplasmic retinitis in AIDS |
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DDx Syphyillitic retinitis vs CMVR... |
Syphillitic eyes are markedly inflamed vs CMVR, rarely inflamed at all. Retinas in both can appear as dry and grainy. |
