Question 1

Acute HIV syndrome may be mistaken for:

Accepted Answer

Acute HIV infection syndrome is a highly nonspecific illness that may be easily mistaken for the flu, mononucleosis, or the common cold. It arises weeks to months after infection with HIV. Acute HIV infection manifests as fever, sore throat, headache, muscle aches, rash, and enlarged lymph nodes. Without a high level of suspicion, it can easily be missed by clinicians. Patients with nonspecific symptoms should be asked about behaviors, which may increase their risk for acquiring HIV.

Question 2

Each year in the United States, there are approximately how many new cases of HIV?

Accepted Answer

According to Centers for Disease Control and Prevention (CDC) estimates based on reporting data, approximately 50,000 new cases of HIV are diagnosed each year. This has been relatively steady in recent years.

Question 3

Which of the following statements best summarizes the relationship between periodontal disease and HIV?

Accepted Answer

While some conflicting data exist, the burden of conventional periodontal disease (not necrotizing ulcerative periodontitis or linear gingival erythema) is similar in HIV-positive and HIV-negative patients. It is unclear whether periodontal disease is accelerated in more advanced HIV/AIDS. Necrotizing ulcerative gingivitis (NUG) can be seen in patients who are HIV-negative.

Question 4

Which of the following is an example of vertical transmission of HIV?

Accepted Answer

Vertical transmission refers to the passage of HIV infection from mother to offspring. An HIV-infected mother may transmit the virus to the fetus during pregnancy, at birth, or when breast-feeding the infant.

Question 5

Which of the following best describes the role of CD4+ T cells in HIV?

Accepted Answer

Unlike CD8+ T cells, CD4+ T cells do not have cytotoxic immune functions. CD4+ T cells are also called "helper T cells" because they assist in activating the immune system so that coordinated killing of invading microorganisms is possible. HIV infects these helper T cells via their CD4+ extracellular receptor. When CD4+ T cells are depleted by HIV, the infected host is left susceptible to a multitude of opportunistic infections.

Question 6

Which of the following best describes the rationale for HAART?

Accepted Answer

HAART is prescribed to reduce the likelihood that drug-resistant HIV strains will emerge. By blocking viral replication in various points in the lifecycle, viruses with mutations allowing them to evade one drug are less likely to continue propagation because of the presence of at least two other drugs. Using HAART does not reduce drug-related side effects, dosages, dosing intervals, or the cost of prescription drug regimens.

Question 7

An HIV-positive man whose last CD4+ cell count was 244 is noted to have a single painless raised, cauliflower-like lesion on the lateral tongue. This lesion most likely represents:

Accepted Answer

Oral warts, caused by human papillomavirus, may be common in HIV-positive patients with low CD4+ cell counts. Oral warts present as cauliflower-like raised lesions, and are usually painless unless they have been traumatized. Aphthous stomatitis, cancrum oris, and oral herpes lesions would all be very painful. Kaposi's sarcoma lesions are usually described as darkly pigmented.

Question 8

Based on the CDC's most recent HIV incidence estimates, which of the following groups has the highest risk for contracting HIV?

Accepted Answer

Men who have sex with men (MSM) have the highest risk for contracting HIV. In particular, black MSM have the highest rate of any group, comprising more than a quarter of all new infections in 2009. In young black men who have sex with men, the rates have rapidly increased in recent years. While minority black and Hispanic women are disproportionately affected compared with white and Asian women, the overall risk of contracting HIV is still lower compared to the MSM group.

Question 9

The risk of contracting HIV following percutaneous exposure is most approximately one in:

Accepted Answer

The estimated HIV seroconversion rate following percutaneous exposure is approximately 0.3%. This is most similar to a risk of one in a thousand. In contrast, hepatitis B percutaneous exposure results in seroconversion in approximately 30% of individuals. Hepatitis C seroconversion following needlesticks is approximately 3%.

Question 10

Reverse transcriptase is best characterized as converting:

Accepted Answer

Reverse transcriptase is best characterized as converting RNA into DNA, which is the reverse of what typically occurs in a human cell.

Question 11

In advanced HIV/AIDS, one would expect to find _____ HIV viral load and a _____ CD4+ cell count.

Accepted Answer

In advanced cases of HIV/AIDS, viral replication in CD4+ cells results in high viral loads and low CD4+ cell counts. CD4+ T-cell counts and RNA viral loads are typically followed to assess whether a patient with HIV has responded appropriately to antiretroviral therapy.

Question 12

Standard precautions refers to:

Accepted Answer

"Standard precautions" refers to a set of infection control guidelines used by all healthcare providers to reduce the likelihood of cross-contamination. Standard precautions protect both the patient and the healthcare provider. Hand washing with alcohol-based hand sanitizer or soap and water should be performed before and after patient contact. If contact with bodily fluids is anticipated, barrier precautions-such as gloves, eye shields, and gowns-may be appropriate. Sharps should be handled carefully and discarded in appropriate hard-plastic biohazard bins.

Question 13

A known HIV-positive patient is noted to have painless bleeding of the gingiva with minimal manipulation, as well as halitosis and gingival inflammation. Which of the following treatments will likely be helpful?

Accepted Answer

This patient likely has necrotizing ulcerative gingivitis. Of course, NUP should be suspected if rapid attachment loss is noted, especially with substantial pain that could signify bone necrosis. Of the choices listed, twice daily chlorhexidine rinses are most likely to help, in conjunction with meticulous oral care (brushing 3x daily, flossing at least daily), smoking cessation, and a nutritious diet. H₂O₂ mouthrinses are contraindicated in immunocompromised individuals, and nystatin rinse is indicated for elimination of oral candidiasis.

Question 14

A dental hygiene practitioner experiences a percutaneous exposure with a large-bore hollow needle while performing irrigation on a patient. Before undergoing care, the patient had stated that he had never been tested for HIV, but that he had used injection drugs in the distant past. What is the best course of action?

Accepted Answer

This scenario illustrates a possible bloodborne exposure. Because this patient has risk factors for HIV, anyone with blood exposure should be considered candidates for HIV prophylaxis. The healthcare provider should be counseled about the risks of PEP toxicity and of HIV seroconversion. While it may be appropriate to delay PEP while HIV testing is obtained, and therefore avoid possible PEP-related toxicity, most would likely error towards preventing HIV especially in high-risk cases. Therefore, two-agent PEP should be considered while HIV tests are being obtained.

Question 15

An HIV-positive woman presents for oral care. She has white patches on her lingual surfaces, which do not easily scrape off. This is most likely to represent:

Accepted Answer

Oral hairy leukoplakia (OHL) is a painless white plaque, which does not scrape off easily (in contrast to candidiasis). OHL typically presents on the lateral borders of the tongue, and occurs in between 20% to 80% of patients with HIV/AIDS.

Question 16

Since 1992, the number of documented cases of HIV following occupational exposure in the dental or dental hygiene care setting is:

Accepted Answer

Prospective studies of healthcare workers have estimated the risk of acquiring HIV infection from occupational exposure to be approximately 0.3%; in other words, the vast majority of exposures do not result in HIV infection.10 The risk of transmission by other routes (e.g., exposure through the eye, nose, or mouth) is even lower at approximately 0.1%.

Question 17

Which best describes the most recent trends in the incidence and prevalence rates of HIV infections globally?

Accepted Answer

Incidence refers to the rate of new infections of a disease. Prevalence is the number of people currently infected with a disease. Based on the most recent United Nations' AIDS estimates, HIV incidence has decreased in recent years, whereas prevalence has continued to increase, largely as a result of longer average life expectancy in HIV/AIDS.

Question 18

Which of the following exposure scenarios is least likely to transmit HIV?

Accepted Answer

While multiple factors are thought to affect the probability of infection in these different exposure scenarios, on average, the risk of HIV seroconversion due to unprotected sex, needlestick, ingestion of infected breast milk, and human bites is much higher than due to blood transfusion. Because of antibody screening and appropriate blood banking practices, the most recent estimates suggest that less than one new HIV infection may occur in a million units of transfused blood products.

Question 19

Highly active antiretroviral therapy (HAART) refers to:

Accepted Answer

HAART refers to the use of at least three antiviral medications in concert. HAART has been shown to be superior to monotherapy (the use of a single drug) for improving survival and prognosis. In some cases, patients on HAART may have "undetectable" HIV viral loads, meaning that viral replication is being properly inhibited.

Question 20

A middle-aged man of Mediterranean ancestry presenting for professional oral care is noted to have purple, papular lesions on the hard palate. He states that he has not noticed the lesions before, and that he has not received routine medical care for over a decade. What is the next most appropriate step in oral care management?

Accepted Answer

This patient is presenting with a probable case of oral Kaposi's sarcoma (KS), a disease of vascular proliferation caused by human herpes virus-8 (HHV-8). Oral KS is more common in HIV/AIDS, but may also be seen in non-HIV/AIDS related types of KS, such as "classic" KS seen in middle-age and elderly men of Mediterranean and Eastern European ancestry, or "iatrogenic" KS seen in patients receiving immunosuppressive drug therapy. To determine the diagnosis, he should be referred nonemergently to a primary care doctor for examination and likely the need for HIV testing and biopsy confirmation of the KS diagnosis.

Quiz 46: Human Immunodeficiency Virus Infection