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COM MOD > Chapter6- AIDS > Flashcards

Chapter6- AIDS Flashcards

1
Q

What does AIDS stand for?

A

Acquired Immunodeficiency Syndrome

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2
Q

Cause of AIDS

A

a retrovirus- human immunodeficiency virus

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3
Q

Characteristics of AIDS

A

profound immunosuppression leading to exposure to opportunistic infections, secondary neoplasms, and neurologic manifestations

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4
Q

Where is AIDS most globally found?

A

Africa and Asia

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5
Q

Modes of HIV transmission (3)

A
  1. Sexual transmission
  2. Parenteral transmission
  3. Mother-to-infant transmission
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6
Q

Sexual transmission of HIV

A

> 75% of cases

enhanced by coexisting STDs

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7
Q

Parenteral transmission of HIV

A

IV drug abusers
Hemophilias who received factor VIII and IX
Recipients of blood transfusion

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8
Q

How has HIV been eliminated from recipients of blood transfusions?

A

screening of donated blood and plasma for HIV
purity criteria for factor VIII and factor IX
screenings of donor history

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9
Q

Mother-to-infant transmission

A

In utero by transplacental spread
during delivery through infected birth canal
breast milk ingestion

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10
Q

How to eliminate risk of HIV in mother-to-infant transmission

A

antiretroviral therapy

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11
Q

Epidemiology of HIV/AIDS

A 
Men who have sex with men *largest group
Heterosexual contacts *globally most common
Intravenous drug abusers
Hemophiliacs
Recipients of blood and blood components
HIV infection of newborn
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12
Q

2 forms of HIV

A

HIV1- common in US Europe Central Africa

HIV2- West Africa and India

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13
Q

Contents of virus core of HIV

A

major capsid protein p24
2 copies of viral genomic RNA
3 viral enzymes

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14
Q

Major capsid protein p24

A

most abundant viral antigen

ELISA test used to diagnose HIV infection

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15
Q

3 viral enzymes in HIV viral core

A

protease
reverse transcriptase
integrase

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16
Q

What protein surrounds the viral core of HIV

A

matrix protein p17

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17
Q

What studs the viral envelope of HIV molecule

A

gp120 and gp41

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18
Q

First cells attacked by HIV infection

A

T cells, DCs, and macrophages to establish itself in lymphoid tissues
(all have CD4)

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19
Q

Process of HIV infection

A

Attack cells
Active viral replication
More infection of cells
Progression to AIDS

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20
Q

Chemokine Receptors of HIV

A

R5 strains use CCR5

X4 strains use CXCR4

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21
Q

R5 strains and CCR5 receptor

A

infect monocyte-macrophage lineage (M-tropic)
homozygous defective copies of CCR5 are resistant to HIV
heterozygous CCR5 causes delayed infection

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22
Q

X4 strain and CXCR4

A

infects T cells (T-tropic)

generated T cell depletion and impairment

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23
Q

What T cells are infected by HIV Infection?

A

memory and activated T cells

24
Q

Why does HIV not infect naive T cells?

A

naive T cells contain an active form of an enzyme that causes mutations in HIV genome
enzyme- APOBEC3G

25
Q

How does HIV stimulate cells?

A

release NFkB which goes to the nucleus and increases HIV DNA transcription

26
Q

How does T cell depletion occur in HIV?

A

direct cytopathic effects

kill CD4+ T cells – for a while the immune system can replace them but eventually it can’t keep up

27
Q

Major abnormalities of Immune Function in AIDS (5)

A 
Lymphopenia
Decreased T cell Function in Vivo
Altered T cell function in vitro
Polyclonal B cell Activation
Altered Monocyte or macrophage function
28
Q

How does lymphopenia occur in AIDS

A

loss of CD4+ helper T cell

29
Q

Polyclonal B cell activation in AIDS

A

poor responses to normal B cell activation signal

30
Q

Altered monocyte or macrophage function in AIDS

A 
decreased class II HLA expression
can't present antigen to T cell
31
Q

Altered T cell function in vitro in AIDS

A

decreased IL-2 and IFNy

decreased helper function for B cell antibody production

32
Q

Macrophages in HIV

A

HIV-1 can infect and multiply in terminally differentiated non-dividing macrophages

33
Q

Dendritic Cells in HIV

A

DCs pick up HIV and present it to the CD4+ cell which causes infection of that CD4+ cell

34
Q

What receptor on DCs specifically binds HIV and displays it to T cells

A

lectin-like receptor

35
Q

Follicular Dendritic cells in HIV

A

in Lymph nodes
potential reservoirs for HIV
trap HIV virion coated with anti-HIV antibodies but they retain ability to infect CD4+

36
Q

B cells and HIV

A

B cell undergoes polyclonal activation

AIDS pts can’t mount antibody response to new antigens

37
Q

Results of Polyclonal Activation of B cells and HIV (4)

A

Germinal center B-cell hyperplasia
Bone marrow plasmacytosis
Hyperagammaglobulinemia
Formation of circulating immune complexes

38
Q

HIV and the brain

A

Nervous system is a main target for HIV

causes neurologic dysfunction

39
Q

What does HIV infect in the brain

A

macrophages and microglial cells

40
Q

When does Acute Retroviral Syndrome occur?

A

3-6 weeks after infection, resolves after 2-4 weeks

initial spread of the virus and host response

41
Q

Symptoms of Acute Retroviral Syndrome (8)

A

sore throat, myalgias, fever, weight loss, fatigue

rash, diarrhea, vomitting

42
Q

Where is there continual HIV replication and cell destruction?

A

lymph nodes and spleen during clinical latency period

number of circulating CD4+ T cells steadily declines

43
Q

Clinical manifestations during the clinical latency period

A

oral candidiasis, vaginal candidiasis, herpes zoster, TB

44
Q

How does HIV evade immune detection? (4)

A
  1. Destroys CD4+ T cells
  2. Antigenic variation (virus is always changing)
  3. Down-modulation of Class I MHC (not recognized by CTLs)
  4. Evolve and involve both CCR5 and CXCR4
45
Q

What accounts for the more rapid decline in CD4+ T cell count?

A

The evolution from the virus using only CCR5 or CXCR4 to the using both

46
Q

Typical progression time form HIV to AIDS

A

7-10 years

47
Q

Clinical Features of AIDS (7)

A 
Fever
Weight loss
Diarrhea
Generalized Lymphadenopathy
Neurologic disease
Opportunistic infection
Secondary neoplasms
48
Q

Fungal infections associated with AIDS

A

pneumoncystis jiroveci, candidiasis, crytococcosis

49
Q

Viral infections associated with AIDS

A 
JC virus (progressie multifocal leukoencephalopathy)
herpes
varicella
50
Q

Neoplasms associated with AIDS

A

Kaposi sarcoma (HHV8)
EBV - primary lymphoma of brain
HPV- invasive cancer of uterine cervix
Anal Cancer

51
Q

Highly Active Antiretroviral Therapy

A

Combination of 3-4 drugs that block different steps of HIV life cycle

52
Q

Function of HAART (4)

A

alters HIV infection
alters incidence of opportunistic infection (jiroveci and HHV8)
suppress virus levels below detection
reduce transmission of virus

53
Q

How does suppressing virus levels in HAART help AIDS

A

stops loss of CD4+ T

over time slow increase in CD4+

54
Q

Consequences of HAART

A

Immune reconstitution inflammatory syndrome

Side Effects

55
Q

Side Effects of using HAART drug combination (6)

A 
Lipoatrophy (loss of facial fat)
Lipoaccumulation (excess fat centrally)
Elevated lipids
Insulin resistance
Peripheral neuropathy
Premature cardiovascular, kidney, and liver disease

COM MOD (21 decks)

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