Acquired Immune Deficiency Syndrome

Question 1

HIV 1

Answer 1

More common type of HIV

Question 2

HIV 2

Answer 2

Mainly seen in Western Africa, one gene difference that makes HIV 2 less virulent than HIV 1 and less transmitted

Question 3

HIV transmission

Answer 3

Blood born pathogen
Transmitted via contact with blood
IVDU, blood or blood products (1 in 2 million chances now)
Sexual encounters and from Mother to baby

Question 4

HIV virus anatomy

Answer 4

HIV has a viral envelope with the gp120 surface protein (specific protein)
Has enzymes used for replication reverse transcriptase, integrase, and protease
All enzymes are in case in a capsid
Target CD4 cells of the immune system

Question 5

Pathogenesis

Answer 5

HIV gp120 protein binds to CD4 T-helper cells and use as host for replication

Binds to two receptors via CD4 receptor and CXCR4 or CCR5 receptors

After fusion CD4 cell is injected with viral RNA (reverse transcriptase) —> viral DNA
Viral DNA —integrase—> become part of host DNA and uses host for replication

After replication viral RNA buds out via protease and infects more cells

Overall decrease in CD4 cells

Question 6

CD4 cells

Answer 6

CD4 cells function (t-helper cells)
Main cell which recognizes antigens and triggers the immune response
Leave host susceptible to opportunistic infections

Question 7

Drug Classes

Answer 7

Nucleoside reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Protease inhibitors
CCR5 inhibitors
Fusion inhibitors
Integrase inhibitors

Question 8

HIV vs AIDS

Answer 8

HIV positive is total CD4 count is equal or above 200 and HAS NEVER DROPPED BELOW 200

AIDS is a CD4 count less than 200 at any point in time
-can also have signs of an OI or asymptomatic

Question 9

HIV screening test for…

Answer 9

HIV antibodies or the HIV p24 antigen

Question 10

3rd generation immunoassay (HIV EIA) or ELISA w/ western blot

Answer 10

OG test of choice
Assesses for presents of HIV antibodies
Can use urine, saliva or serum (serum most accurate result)
Takes 12 weeks to measure HIV antibodies

After 12 weeks —> very accurate

After EIA is positive a Western blot to confirm

If western blot is negative —> person not HIV positive

Question 11

Oraquick

Answer 11

EIA only test
Rapid HIV test that can be completed in 20 minutes on whole blood
Used as a screening tool
If positive —> additional testing to confirm DX

Question 12

4th generation combination immunoassay

Answer 12

Gold standard
Test designed to detect HIV antibodies and P24 antigen

P24 antigen can be detected as early as 10 days post-infection (faster than 3rd gen)

Dx acute HIV infection and minimize window period

If test is positive —> HIV 1/HIV 2 test should be done

If HIV 1/HIV 2 test is negative/indeterminate—> HIV viral load test

Question 13

Signs of HIV/OI

Answer 13

Thrush
Cervical dysplasia (+ Pap smear)
Cervical carcinoma in situ
Fever greater than 38.5 C (101.3 F)x 1 month
Oral hairy leukoplakia (Epstein-Barr virus) white patchy tongue
Herpes Zoster (shingles)
Immune thrombocytopenia purpura (ITP) red blood spots
Pelvic inflammatory disease (PID) bacterial infection in vagina —> uterus, ovaries etc.
Peripheral neuropathy
Frequent vaginal yeast infections
Kaposi Sarcoma (KS) soft tissue lesions (skin, mouth, lymph, internal organs, mucosa)
And OI

Question 14

Opportunistic Infections (OI)

Answer 14

Persons with HIV can be susceptible to OI
Usually when CD4 count is less than 200

-PCP pneumocystis jiroveci/carnii pneumonia
-MAC mycobacterium avium complex
-CMV cytomegalovirus

Question 15

Pneumocystis Jiroveci Pneumonia (PCP)

Answer 15

Organism is consider to be a fungi
PCP has a slow and progressive disease
CC: dyspnea and gradual onset that is progressive and slowly gets worse over weeks

SS: fatigued and will likely experience night sweats, wt loss and poor appetite

CXR: butterfly pattern of infiltrates that extend from the center of the chest

Treatment: Bactrim

Question 16

Disseminated Mycobacterium Avium Complex (MAC)

Answer 16

Acid fast bacillus and results in a system infection

SS: fevers, night sweats, wt loss, anorexia and lymphadenopathy

Treatment: Clarithromycin and Ethambutol for 6-12 months

Extended treatment because of nature of bacteria

AFB grows slowly because of the thick cell wall

Nutrients and medication have a hard time penetrating its cell wall

Question 17

Cytomegalovirus (CMV)

Answer 17

Herpes Virus

Person with HIV and low CD4 count typically infects the retina and causes CMV retinitis
—> blindness
Most at risk are people with a CD4 count less than 50

People with a CD4 count less than 50 —> must have regular eye exams

CMV is resistant against medications —> no prevention

Question 18

HIV complications

Answer 18

Multisystem disease
Affects many body organs over time
AA with HIV are at greatest risk of developing HIV related nephropathy must be monitored closely

Anemia, peripheral neuropathy, lymphoma, HIV dementia, Kaposi Sarcoma, diarrhea, pancytopenia, cardiomegaly and prone to many dermatologic issues.

Question 19

Pediatric HIV infection

Answer 19

Neonates infected via placenta from mothers
Incidence of infection low considering antiretroviral therapy
Without prenatal treatment neonate will show symptoms within 6 months of life
Life expectancy is typically no more than 3 years
Due to OI development usually within 1st year of life

DX of HIV during post-natal period —> HIV viral load test

Mother’s antibodies to HIV cross the placenta and makes it difficult to DX with regular testing methods

Baby HIV viral load testing

2 weeks and 4 weeks old —> presumptive uninfected
1 and 4 months —>definitive uninfected state

Antiretrovirals —> decrease infant mortality 76%

Antiretroviral therapy complications
—> insulin resistance and dyslipidemia

HIV causes chronic inflammation increased CV disease, CNS problems —> encephalopathy

Loss of developmental milestones, intellectual ability, impaired brain growth —> poor prognostic factor