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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
How does HIV stimulate cells?
release NFkB which goes to the nucleus and increases HIV DNA transcription
26
How does T cell depletion occur in HIV?
direct cytopathic effects | kill CD4+ T cells -- for a while the immune system can replace them but eventually it can't keep up
27
Major abnormalities of Immune Function in AIDS (5)
``` Lymphopenia Decreased T cell Function in Vivo Altered T cell function in vitro Polyclonal B cell Activation Altered Monocyte or macrophage function ```
28
How does lymphopenia occur in AIDS
loss of CD4+ helper T cell
29
Polyclonal B cell activation in AIDS
poor responses to normal B cell activation signal
30
Altered monocyte or macrophage function in AIDS
``` decreased class II HLA expression can't present antigen to T cell ```
31
Altered T cell function in vitro in AIDS
decreased IL-2 and IFNy | decreased helper function for B cell antibody production
32
Macrophages in HIV
HIV-1 can infect and multiply in terminally differentiated non-dividing macrophages
33
Dendritic Cells in HIV
DCs pick up HIV and present it to the CD4+ cell which causes infection of that CD4+ cell
34
What receptor on DCs specifically binds HIV and displays it to T cells
lectin-like receptor
35
Follicular Dendritic cells in HIV
in Lymph nodes potential reservoirs for HIV trap HIV virion coated with anti-HIV antibodies but they retain ability to infect CD4+
36
B cells and HIV
B cell undergoes polyclonal activation | AIDS pts can't mount antibody response to new antigens
37
Results of Polyclonal Activation of B cells and HIV (4)
Germinal center B-cell hyperplasia Bone marrow plasmacytosis Hyperagammaglobulinemia Formation of circulating immune complexes
38
HIV and the brain
Nervous system is a main target for HIV | causes neurologic dysfunction
39
What does HIV infect in the brain
macrophages and microglial cells
40
When does Acute Retroviral Syndrome occur?
3-6 weeks after infection, resolves after 2-4 weeks | initial spread of the virus and host response
41
Symptoms of Acute Retroviral Syndrome (8)
sore throat, myalgias, fever, weight loss, fatigue | rash, diarrhea, vomitting
42
Where is there continual HIV replication and cell destruction?
lymph nodes and spleen during clinical latency period | number of circulating CD4+ T cells steadily declines
43
Clinical manifestations during the clinical latency period
oral candidiasis, vaginal candidiasis, herpes zoster, TB
44
How does HIV evade immune detection? (4)
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
What accounts for the more rapid decline in CD4+ T cell count?
The evolution from the virus using only CCR5 or CXCR4 to the using both
46
Typical progression time form HIV to AIDS
7-10 years
47
Clinical Features of AIDS (7)
``` Fever Weight loss Diarrhea Generalized Lymphadenopathy Neurologic disease Opportunistic infection Secondary neoplasms ```
48
Fungal infections associated with AIDS
pneumoncystis jiroveci, candidiasis, crytococcosis
49
Viral infections associated with AIDS
``` JC virus (progressie multifocal leukoencephalopathy) herpes varicella ```
50
Neoplasms associated with AIDS
Kaposi sarcoma (HHV8) EBV - primary lymphoma of brain HPV- invasive cancer of uterine cervix Anal Cancer
51
Highly Active Antiretroviral Therapy
Combination of 3-4 drugs that block different steps of HIV life cycle
52
Function of HAART (4)
alters HIV infection alters incidence of opportunistic infection (jiroveci and HHV8) suppress virus levels below detection reduce transmission of virus
53
How does suppressing virus levels in HAART help AIDS
stops loss of CD4+ T | over time slow increase in CD4+
54
Consequences of HAART
Immune reconstitution inflammatory syndrome | Side Effects
55
Side Effects of using HAART drug combination (6)
``` 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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