Chapter 12

Question 1

Hallmark of AIDS and HIV

Answer 1

• decrease in CD4+ (t-helper/introducer) lymphocytes

Question 2

Epidemiology of AIDS

Answer 2

• primary immunodeficiency caused by the retroviruses HIV type 1 and type 2
• virus has continued to mutate and spread globally
• increasingly becoming a disease of poor, uneducated, or undereducated people of color

Question 3

HIV type 1

Answer 3

• thought to have originated in central africa
• cause of most AIDS cases found in central africa, US, Europe, Australia
• has at least 10 subtypes

Question 4

HIV type 2

Answer 4

• thought to have originated in west africa
• found primarily in west africa
• characterized by a longer latency/asymptomatic periosd, a milder form of the disease and lower mortality rates, can progress to AIDS

Question 5

Transmission of AIDS

Answer 5

3 types

• sexual (most common)
• parenteral
• perinatal

Question 6

Parenteral

Answer 6

transmission via blood, blood products, or blood contaminated needles or syringes

Question 7

HIV (Human immunodeficiency Virus)

Answer 7

RNA retrovirus that causes defect in cell-mediated immunity that may progress to AIDS

Question 8

Chemokine Coreceptors

Answer 8

must be present for the virus to gain entry into cells in order for the virion to fuse with the host cell

• CCR5 must be present for HIV particles to bind to CD4+
• CXCR4 must be present in later infection

Question 9

Antiretroviral Therapy

Answer 9

This polydrug therapy approach
involves the administration of multiple antiretroviral agents. It provides
better viral suppression, thereby decreasing viral load, increasing
CD4+ counts, and decreasing resistance for a longer period.

Question 10

AIDS B cell changes

Answer 10

overproduction of nonessential anitbodies
antibodies are ineffective against diseases
increased apoptosis

Question 11

HIV disguises itself

Answer 11

with large amount of carbohydrate on surface of gp120

Question 12

Acute Infection oh HIV

Answer 12

HIV is widespread throughout body, with viremia and viral seeding of lymph tissures

Question 13

Progression to asymptomatic phase

Answer 13

seeded HIV replicates in lymph nodes; graduly destroy’s lymph tissues

Question 14

Verimia

Answer 14

virus enters the blood stream; recurs after lymph tissues are destroyed

Question 15

AIDS

Answer 15

is syndrome, the virus can express itself in multiple ways

Question 16

HIV virion

Answer 16

• enters body and quickly repllicates
• present in the blood and cerebrospinal fluid
• not detected by usual laboratory tests
• usually asymptomatic

Question 17

Seroconversion

Answer 17

the time in which enough HIV antibodies develop and become detectable in the blood
- occurs between 3 weeks to 6 months after exposure

Question 18

Symptoms of primary HIV infection

Answer 18

• flu or mono like symptoms
• CD4+ t cell count greater thatn 400cells/ul
• ## elevated ESR

Question 19

ESR

Answer 19

erythrocyte sedimentation rate - a measurement of sedimentation

Question 20

CRP

Answer 20

C reactive protein - preferred test for inflammation

Question 21

Clinical latency period after seroconversion

Answer 21

ranges from 3 to 12 years

• CD4+ cell count greater that 400/ul
• virus is extremely active, producing up to 2 mil per day

Question 22

Rapid virus production after latency period

Answer 22

persistent and continuing drop in CD4+ T-cell count to less than 400/ul

Question 23

Symptomatic stage/chronic HIV infection

Answer 23

• complete anergy, no response to skin testing
• development of skin/membrane infections/problems
• in children there are growth delays and they are frequently sick

Question 24

AIDS Diagnosis

Answer 24

• CD4+ t cell count is less than 200/ul
• one or more opportunistic infections
• one or more tumors or cancers
• most common symptoms are night sweats, fever, and nausea

Question 25

Steps of HIV

Answer 25

infection of mucous tissue -> death of mucosal cd4+ cells -> Infection establishes in lymph tissues -> infection spreads throughout body -> immune response -> clinical latency -> AIDS

Question 26

CD4+ T cell categories

Answer 26

Category A = count >or= 500ul Categoty B= count ranges from 200 to 499 Category C= count < 200

Question 27

Clinical Category A

Answer 27

variety of clinical conditions, asymptomatic persistent generalized lymphadenopathy, history of or current acute HIV infection

Question 28

Clinical Category B

Answer 28

conditions secondary to impaired cell mediated immunity

Question 29

Clinical Category C

Answer 29

Conditions listed in AIDS surveillance case condition

Question 30

ELISA (enzyme - linked immunosorbent assay)

Answer 30

- positive for HIV antibodies if blood or oral mucosal transudate of an infected person reacts with the surface antigen of killed HIV virus - highly sensitive and specific - must be performed with both HIV 1 and 2 viral antigens

Question 31

Western Blot

Answer 31

- used when ELISA test is positive - used to confirm the presence of HIV - uses electrophoresis - identifies specific antibodies against the HIV protein antigen - specificity (combo'd with ELISA) > 99.9% - patient must wait 1-2 wks for confirmation

Question 32

Absolute CD4+ cell count

Answer 32

- specific indicator of disease progression of HIV to AIDS

Question 33

CD4+ lymphocyte percentage

Answer 33

<20% risk of AIDS development is higher

Question 34

Plasma Viral Load

Answer 34

- indicates the amount of viral replication and the effectiveness of therapy - helps to predict disease progression - goal: to reduce viral load

Question 35

Genotypic Resistance Testing

Answer 35

- identifies gene mutations | - very expensive

Question 36

HAART Therapy

Answer 36

Highly Active Antiretroviral Therapy

Question 37

Anergy/delayed hypersensitivity (type IV) test

Answer 37

- tests for M. tuberculosis, mumps, or measles viruses | - Early HIV: Skin test results normal

Question 38

Megestrol acetate

Answer 38

a progestational agent; patients are at risk for blood clots in the legs

Question 39

Dronabinol

Answer 39

antiemetic: decrease nausea and increase appetite

Question 40

Systemic Manifestations of HIV/AIDS

Answer 40

-Malnutrition/wasting syndrome

Question 41

Gastrointestinal Manifestations

Answer 41

- nearly universal in HIV infected people - chronic diarrhea is a Major GI complication (common cause is protozoa cryptosporidum) - candida albiacans infections

Question 42

GI Symptoms

Answer 42

- chronic diarrhea - oral candidiasis - anorexia - nausea/vomiting - mucous membrane ulcers - retrosternal pain on swallowing - abdominal pain - low serum vitamin B12

Question 43

Pulmonary Manifestations

Answer 43

- major source of morbidity/mortality in AIDS patients - opportunistic pneumonias - parenchymal lung diseases

Question 44

Mucocutaneous Manifestations

Answer 44

- occur early and late in HIV - HIV viral exanthem is usually the first symptom - can have allergic, infectious, or neoplastic origin

Question 45

Types of Mucocutaneuous manifestations

Answer 45

``` herpes zoster oral hairy leukoplakia Herpes simplex 1 & 2 S aureus Fungal skin infections Kaposi Sarcoma ```

Question 46

Gynecologic manifestations

Answer 46

persistent monilial vaginitis, cervual dysplasia, cervical neoplasia, PID

Question 47

Neurologic Manifestations

Answer 47

- neurologic system is invaded early | - primarily HIV encephalopathy

Question 48

Ocular Manifestations

Answer 48

CMV retinitis | HIV associated retinopathy

Question 49

Cardiovascular Manifestations

Answer 49

hypertriglyceridemia | lipidemia

Question 50

Manifestations in other systems

Answer 50

renal impairment hematologic impairment liver dysfunction endocrine dysfunction

Question 51

Major classes of Antiretroviral Therapt

Answer 51

nucleotide reverse transcriptase inhibitors (NRTIs) Nonnucleoside reverse transcriptase inhibitors (NNRTIs) Protease Inhibitors (PIs) fusion inhibitors Integrase strand transfer inhibitors (INSTIs) CCR5 antagonists

Question 52

NRTIs

Answer 52

prevent HIV replication by preventing DNA synthesis

Question 53

NNRTIs

Answer 53

inhibit reverse transcriptase do not need to be converted intracellularly potent antiretrovirals only given in combination with other antiretrovirals

Question 54

Protease Inhibitors

Answer 54

inhibits protease that clips the viral protein precursors to the appropriate size extremely expnsive names typically end in "vir"

Question 55

Fusion inhibitors

Answer 55

blocks fusion between viral and target cell membranes

Question 56

CCR5 antagonists

Answer 56

blocks infection by blocking CCR5 and preventing HIV binding to cell membrane

Question 57

Integrase transfer inhibitors

Answer 57

target and inhibit integrase encoded by the viral pol gene