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AANIYA PATH > Aani Immuno: HIV & Vaccination > Flashcards

Aani Immuno: HIV & Vaccination Flashcards

1
Q

What is the genetic make up of HIV?

A

RNA retrovirus

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2
Q

Which cells does HIV target as hosts?

A

CD4+ T Helper cells

CD4+ monocytes + dendritic cells

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3
Q

How does HIV bind to the CD4 cells?

A

It binds via gp120

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4
Q

How does HIV get inside the CD4 cells? (receptor)

A

Binds to gp41 for conformational change

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5
Q

Which receptors of CD4 cells does HIV use?

A

gp 120 initial bindind
gp41 conformational change
CCR5 and CXCR4 chemokine receptors

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6
Q

What are the stages of the HIV life cycle that can be targeting for anti-HIV drugs?

A
  1. Attachment/Fusion
  2. Reverse Transcription (DNA synthesis)
  3. Integration of viral DNA
  4. Viral transcription
  5. Viral protein replication/synthesis
  6. Viral assembly + release
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7
Q

What type of immune responses are initiated to an acute HIV-1 infection ?

A

Innate response: NK/complement/macrophages

Adaptive response:

  1. Antibody dependent
  2. Antibody mediated
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8
Q

What happens in the antibody mediated immune response to HIV?

A

Neutralising Abs (NtAb) block the T cell receptors: Anti-gp120 Ab and Anti-gp 41 Ab
AND Non-neutralising Abs are used too:
Anti-p24 gag IgG

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9
Q

Why is HIV’s target cell bad news for us?

A

Because CD4 cells (T cells) are needed for orchestration of immune response. They are needed for class recombination to develop Abs and they control B cell response. They also activate monocytes/dendritic cells

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10
Q

What else happens in the adaptive immune response to HIV apart from Abs?

A

CD8+ T cells release chemokines to target HIV

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11
Q

Which chemokines does CD8+ T cells release to tackle HIV?

A

MIP-1a, MIP-1b and RANTES

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12
Q

Describe the structure of the HIV virus?

A

Diploid genome

Icosahedral (20 faces)

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13
Q

How long does it take to develop AIDS once you have HIV?

A

8-10 years on average

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14
Q

What CD4 count would be considered a shift from HIV to AIDS?

A

Below 200 cells/microlitre

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15
Q

Which tests can you do to check for HIV?

A
  1. ELISA screening- checks for Anti-HIV Abs
  2. Western blot confirmation test - detects Anti-Abs
  3. PCR viral load detection (HIV RNA detected)
  4. Flow cytometry to detect CD4 count
  5. Genotypic assay testing for resistant strains (looking at mutations in HIV genome)
  6. Phenotypic assay testing for resistant strains (looking at HIV replication against increasing drug conc)
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16
Q

What is seroconversion?

A

The period of time during which Anti-HIV antibodies develop and become detectable

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17
Q

When does HIV seroconversion take place?

A

Approx 10 weeks after infection

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18
Q

When to treat a HIV patient with symptoms?

A

ASAP

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19
Q

When to treat a HIV patient without symptoms?

A

<200 CD4 count

Start thinking about it at <350 CD4

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20
Q

Name a common HAART regimen used?

A

Truvada: ETE

  1. Emtricitabine
  2. Tenofovir
  3. Efavirenz
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21
Q

What types of drugs make up a HAART regime?

A

Two Nucleoside Reverse Transcription Inhibitors (NRTIs) and One Protease Inhibitor (or a Non-NRTI)

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22
Q

What are the disadvantages of HAART?

A
  • Doesn’t remove latent HIV-1
  • Cost
  • Threat of drug resistance
  • High pill burden
  • S/Es e.g. toxicity
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23
Q

Which HIV drug can you give in pregnancy ?

A

Zidovudine

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24
Q

Side effect of Zidovudine?

A

Bone Marrow suppression
GI effects
Fever

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25
Q

What kind of drug is Zidovudine?

A

Nucleoside Reverse Transcriptase Inhibitor

26
Q

What are the Anti-HIV drug types?

A
  1. Fusion Inhibitors
  2. Attachment Inhibitors
  3. Nucleoside Reverse Transcriptase Inhibitors
  4. Non-nucleoside Reverse Transcriptase Inhibitors
  5. Nucleotide RT Inhibitors
  6. Integration Inhibitors
  7. Protease Inhibitors
27
Q

Name an anti-HIV fusion inhibitor?

A

Enfuvirtide

28
Q

Name an anti-HIV attachment inhibitor?

A

Maraviroc

29
Q

Name some anti-HIV NRTIs?

A 
Emtricitabine
Zidovudine
Zalcitabine
Abacavir
Stavudine
30
Q

Name the anti-HIV NNRTIs?

A

Efavirenz
Delavirdine
Nevirapine

31
Q

Name the anti-HIV anti-Nucleotide RTI?

A

Tenofovir

32
Q

Anti-HIV Integration inhibitor?

A

Raltegravir

33
Q

Which Anti-HIV drug causes hepatitis and rash?

A

Nevirapine (neva get a rash and hepatitis)

34
Q

Which Anti-HIV drug causes CNS effects?

A

Efavirenz

35
Q

Which Anti-HIV drug causes mitochondrial toxicity?

A

Stavudine

36
Q

Which Anti-HIV drug causes peripheral neuropathy?

A

Zalcitabine and Stavudine

37
Q

Which vaccines are given at 2 months?

A

5 in 1 (DTaP/IPV/HiB)

PCV

38
Q

Which vaccines are given at 3 months?

A

5 in 1 (DTaP/IPV/HiB)

Men C

39
Q

Which vaccines are given at 4 months?

A

5 in 1 (DTaP/IPV/HiB)
PCV
Men C

40
Q

Which vaccines are given at 12 months?

A

MenC

HiB

41
Q

Which vaccines are given at 13 months?

A

MMR

PCV

42
Q

Which vaccines are given at 3-4 years?

A

DTaP/IPV

MMR

43
Q

Which vaccines are given at 12-13 years (girls)

A

HPV

44
Q

Which vaccines are given at 13-18 years?

A

DT/IPV

MenACWY

45
Q

Which cells are T memory Cells?

A

CD45RO (memory has O in it)

46
Q

Which cells are T Naive Cells?

A

CD45RA (Naive has A in it)

47
Q

Which T cells are more likely to be Central Memory Cells?

A

CD4

48
Q

Which T cells are more likely to be Effector Memory Cells?

A

CD8

49
Q

What type of memory cells last longest?

A

B memory cells that turn into plasma cells

50
Q

What are the T Helper 1 cytokines?

A

IL2
IFN gamma
TNF

51
Q

What are the T Helper 2 cytokines?

A

IL4
IL5
IL6

52
Q

Which type of vaccine are easier to store?

A

Inactivated

53
Q

Give examples of Live Vaccines that are still used?

A 
BCD (TB)
Typhoid
Varicella Zoster
Yellow Fever
MMR
54
Q

Give examples of Inactivated Vaccines?

A 
IPV
Hep A
Cholera
Rabies
Pertussis
55
Q

Give examples of Toxoid vaccines?

A

Tetanus

Diphtheria

56
Q

Which LIVE vaccine is it okay to give to HIV patients?

A

MMR

But NOT BCG or yellow fever

57
Q

How do ALUM adjuvants work?

A

Activates Gr1+ cells to produce IL4 and this helps prime naive B Cells

58
Q

How do CpG adjuvants work?

A

Activates TLRs on APCs

59
Q

Which Immunoglobulins are given passively?

A 
HNIG (human normal IG) for Hep A and Measles
VZIG (varicella zoster IG)
HRIG (human rabies IG)
HBIG (Hep B IG)
Paviluzimab (RSV IG)
60
Q

What is the Mantoux test for?

A

TB protection

61
Q

What do you do in the Mantoux test?

A

Inject 0.1 ml of 5 Tuberculin units intradermally
Examine each arm 48-72 hours later
Positive result = red/swollen.
This indicates a potential previous BCG injection

AANIYA PATH (31 decks)

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