Aani Immuno: HIV & Vaccination COPY

Question 1

What is the genetic make up of HIV?

Answer 1

RNA retrovirus

Question 2

Which cells does HIV target as hosts?

Answer 2

CD4+ T Helper cells

CD4+ monocytes + dendritic cells

Question 3

How does HIV bind to the CD4 cells?

Answer 3

It binds via gp120

Question 4

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

Answer 4

Binds to gp41 for conformational change

Question 5

Which receptors of CD4 cells does HIV use?

Answer 5

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

Question 6

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

Answer 6

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

Question 7

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

Answer 7

Innate response: NK/complement/macrophages

Adaptive response:

1. Antibody dependent
2. Antibody mediated

Question 8

What happens in the antibody mediated immune response to HIV?

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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

Answer 10

CD8+ T cells release chemokines to target HIV

Question 11

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

Answer 11

MIP-1a, MIP-1b and RANTES

Question 12

Describe the structure of the HIV virus?

Answer 12

Diploid genome

Icosahedral (20 faces)

Question 13

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

Answer 13

8-10 years on average

Question 14

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

Answer 14

Below 200 cells/microlitre

Question 15

Which tests can you do to check for HIV?

Answer 15

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)

Question 16

What is seroconversion?

Answer 16

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

Question 17

When does HIV seroconversion take place?

Answer 17

Approx 10 weeks after infection

Question 18

When to treat a HIV patient with symptoms?

Answer 18

ASAP

Question 19

When to treat a HIV patient without symptoms?

Answer 19

<200 CD4 count

Start thinking about it at <350 CD4

Question 20

Name a common HAART regimen used?

Answer 20

Truvada: ETE

1. Emtricitabine
2. Tenofovir
3. Efavirenz

Question 21

What types of drugs make up a HAART regime?

Answer 21

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

Question 22

What are the disadvantages of HAART?

Answer 22

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

Question 23

Which HIV drug can you give in pregnancy ?

Answer 23

Zidovudine

Question 24

Side effect of Zidovudine?

Answer 24

Bone Marrow suppression
GI effects
Fever

Question 25

What kind of drug is Zidovudine?

Answer 25

Nucleoside Reverse Transcriptase Inhibitor

Question 26

What are the Anti-HIV drug types?

Answer 26

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

Question 27

Name an anti-HIV fusion inhibitor?

Answer 27

Enfuvirtide

Question 28

Name an anti-HIV attachment inhibitor?

Answer 28

Maraviroc

Question 29

Name some anti-HIV NRTIs?

Answer 29

``` Emtricitabine Zidovudine Zalcitabine Abacavir Stavudine ```

Question 30

Name the anti-HIV NNRTIs?

Answer 30

Efavirenz Delavirdine Nevirapine

Question 31

Name the anti-HIV anti-Nucleotide RTI?

Answer 31

Tenofovir

Question 32

Anti-HIV Integration inhibitor?

Answer 32

Raltegravir

Question 33

Which Anti-HIV drug causes hepatitis and rash?

Answer 33

Nevirapine (neva get a rash and hepatitis)

Question 34

Which Anti-HIV drug causes CNS effects?

Answer 34

Efavirenz

Question 35

Which Anti-HIV drug causes mitochondrial toxicity?

Answer 35

Stavudine

Question 36

Which Anti-HIV drug causes peripheral neuropathy?

Answer 36

Zalcitabine and Stavudine

Question 37

Which vaccines are given at 2 months?

Answer 37

5 in 1 (DTaP/IPV/HiB) | PCV

Question 38

Which vaccines are given at 3 months?

Answer 38

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

Question 39

Which vaccines are given at 4 months?

Answer 39

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

Question 40

Which vaccines are given at 12 months?

Answer 40

MenC | HiB

Question 41

Which vaccines are given at 13 months?

Answer 41

MMR | PCV

Question 42

Which vaccines are given at 3-4 years?

Answer 42

DTaP/IPV | MMR

Question 43

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

Answer 43

HPV

Question 44

Which vaccines are given at 13-18 years?

Answer 44

DT/IPV | MenACWY

Question 45

Which cells are T memory Cells?

Answer 45

CD45RO (memory has O in it)

Question 46

Which cells are T Naive Cells?

Answer 46

CD45RA (Naive has A in it)

Question 47

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

Answer 47

CD4

Question 48

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

Answer 48

CD8

Question 49

What type of memory cells last longest?

Answer 49

B memory cells that turn into plasma cells

Question 50

What are the T Helper 1 cytokines?

Answer 50

IL2 IFN gamma TNF

Question 51

What are the T Helper 2 cytokines?

Answer 51

IL4 IL5 IL6

Question 52

Which type of vaccine are easier to store?

Answer 52

Inactivated

Question 53

Give examples of Live Vaccines that are still used?

Answer 53

``` BCD (TB) Typhoid Varicella Zoster Yellow Fever MMR ```

Question 54

Give examples of Inactivated Vaccines?

Answer 54

``` IPV Hep A Cholera Rabies Pertussis ```

Question 55

Give examples of Toxoid vaccines?

Answer 55

Tetanus | Diphtheria

Question 56

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

Answer 56

MMR | But NOT BCG or yellow fever

Question 57

How do ALUM adjuvants work?

Answer 57

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

Question 58

How do CpG adjuvants work?

Answer 58

Activates TLRs on APCs

Question 59

Which Immunoglobulins are given passively?

Answer 59

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

Question 60

What is the Mantoux test for?

Answer 60

TB protection

Question 61

What do you do in the Mantoux test?

Answer 61

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