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BDS2 BAMS > Epidemiology, pathogenesis, diagnosis and dental relevance HIV > Flashcards

Epidemiology, pathogenesis, diagnosis and dental relevance HIV Flashcards

1
Q

what infection occurred in individuals before HIV was known?

A

Pneumocystis pneumonia

Oct 1980-June 1981, LA

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2
Q

what individuals did Pneumocystis pneumonia infect?

A

young, active homosexual men

all had previous or current CMV and oral mucosal candidosis

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3
Q

what rare cancer was seen in 41 homosexuals?

A

Kaposi’s sarcoma

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4
Q

what was associated with Kaposi’s sarcoma and Pneumocystis pneumonia?

A

massive decrease in T cells

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5
Q

what are T cells important in?

A

immune system protection for infections and cancers

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6
Q

what are the 2 main groups of T cells

A

Killer

Helper

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7
Q

what do killer T cells do

A

circulate the body, scan for abnormal cells and destroy

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8
Q

what do helper T cells do

A

messengers, imitate activity other immune cell and generate antibodies

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9
Q

Kaposi’s sarcoma

A

Previously rare - associated with elderly (immunocompromised) and generally non-aggressive

The most frequent opportunistic tumour observed in 20% of patients with AIDS (mostly homosexuals).

Now associated with a human herpes virus

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10
Q

what was the first mode of transmission of the virus identified?

A

sexual transmission

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11
Q

what other groups were affected by the virus?

A

groups typically associated with immunosuppression

  • women (associated with injecting drug use or sexual contact with men who had AIDS)
  • Haitians residing in the US (all young and denied homosexual activity)
  • Heterosexual men with haemophilia – all received factor VIII
    groups of people affected spread beyond MSM
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12
Q

when was the name AIDS acquired and what does it stand for?

A

1982

Acquired Immunodeficiency Syndrome

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13
Q

what is the causative agent of AIDS

A

Human Immunodeficiency virus (1984)

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14
Q

what is AIDS

A

is a syndrome or range of symptoms, that may develop in time in a person with HIV

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15
Q

when was the first test for HIV-1 approved?

A

1985 in America

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16
Q

what was the first HIV-1 test like

A

Very sensitive but high false positive rate (low specificity)
- Give a wrong diagnosis to someone and no way of confirming either way

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17
Q

what was the first HIV-1 test used for

A
  • routine diagnosis
  • screening blood donations

Screening tests were augmented with confirmatory tests allowing expansion of testing to wider populations for diagnostic purposes

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18
Q

when was testing and ‘clear’ status of US blood banks

A

April 1985, clear by July

6-month period before blood testing in UK
- Unclear why
(Logistics? One company licensed to produce test – not sufficient capacity to assess all countries)

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19
Q

what is the confirmatory test for HIV

A

ELISA positive results all checked again – disregard false positives so give correct diagnosis

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20
Q

what was a process that helped build a stigma around HIV

A

Pre-test counselling:

- knew what test was for and consequences of those tests

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21
Q

mistakes by the UK surrounding HIV/AIDS stigma

A

late action

Iceberg advert (shock and shame) – shock people into changing their behaviour

  • Hindsight wrong thing to do. Made a lasting stigma
  • Now Hope for adverts
  • National HIV Testing Week starts Saturday 16 November
  • There is no shame in knowing your status
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22
Q

what is the new style of HIV care

A

Test and Treat approach
- Due to very good drugs, prevent them from suffering from opportunistic infections
Know most infections come from an unaware host – reduce their infectivity by testing and treating – reduce spread

More positive view

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23
Q

how is HIV transmitted (5)

A
  • Unprotected sex
  • Drug addicts
  • Blood transfusion
  • Pregnancy
  • Non-sterile instruments
24
Q

how is HIV not transmitted (5)

A
  • Touching
  • Through food
  • Kissing
  • Insect bites
  • In the pool
25
Q

what is HIV PrEP

A

Anticipatory treatment
- Available on NHS in Scotland since July 2017 for HIV negative individuals who are at risk (consistent high risk sexual encounters)

Take daily, build up protective levels in build steam, HIV cannot take hold when exposed

26
Q

where did HIV come from

A

Xenosis – derived from animals, jump to humans (e.g. avian flu)
- From chimp, via ingestion and/or blood exposure

1970s move from Congo to Haiti, then America, then Global
1980s peak

27
Q

what is the global impact of HIV/AIDS

A

37.9 million people living with HIV globally, 21% don’t know their status

28
Q

what is happening to the number of new HIV diagnoses

A

decreasing in most part

  1. 8 million people newly infected in 2017 globally
    - 26% decrease in number of new infections across the global population since 2010

New infections still increasing for some places
Battle not won concern
- Women more new infections than males now (social context – vulnerable to sexual violence)

29
Q

what is happening in relation to number dying compared to number living with HIV infection

A

Less dying of infection but more living with infection

- As the number of people receiving treatment in increasing

30
Q

HIV WHO targets for 2020

A

90% aware of infectious state
90% on HIV treatment
90% have undetectable viral levels

31
Q

how is Scotland doing in HIV levels

A

300-250 new transmissions a year
- 91% aware of status,
- 87% (less) on treatment (not all getting specialist care – 96%),
- nearly 100% (97%) virally supressed
(low enough level in blood very unlikely to pass on infection)

Deaths in Scotland
- 40-50 per year

32
Q

how many main viruses are there of HIV

A

2

33
Q

what type of virus is HIV

A

small retrovirus

34
Q

structure of HIV

A 
Main structural (core) protein p24 encases
- P9 and P7
- Single stranded RNA
- Reverse transcriptase
Then there’s matrix protein p17

With a lipid membrane envelope (host-derived) with host proteins and envelope glycoproteins (gp41, gp120)

  • Since lipid virus hard to survive out with host

2 glycoporteins: important in replication, facilitate entry into body’s CD4 cell

Once in release Viral RNA, enzymes of virus convert into DNA and then inserted into body’s DNA

35
Q

what are the glycoporteins role in HIV virus

A

important in replication, facilitate entry into body’s CD4 cell

36
Q

how does being a lipid virus impact on how HIV can live

A

hard to survive out with hosts

37
Q

how does HIV replicate in host

A

Body replicating CD4 cells replicate virus

- Small infection causes billions of infected virus cells in small time span

38
Q

what type of HIV causes pandemics

A

HIV 1 causes pandemic
- Multiple strains

3 groups: major, new and other

  • New and other in West Africa
  • Main seen distributed globally
39
Q

how many groups of HIV 1 are there

A

3 groups: major, new and other

  • New and other in West Africa
  • Main seen distributed globally
40
Q

5 key stages in HIV life cycle

A
  1. HIV releases genetic material into CD4 cell
  2. Reverse transcriptase copies RNA – DNA
  3. Viral DNA inserted in cell DNA
  4. Many copies of the viral RNA and proteins made
  5. New viral particles assemble and bud from cell

Small minority of T4 cells are infected

41
Q

virus half life of HIV

A

5.7 hours

42
Q

how many HIV virons per ml of blood

A

100 - 10 million

43
Q

course of HIV disease

A

Start of infection: huge number of virus circulating in body

  • Asymptomatic period (if do flu like)
  • Non-specific, unaware

Then between 2-15 years (variable) extended period, virus multiplies in body and body can no longer keep on top of it CD4 drops and virus in circulation increases
- No therapy = death

44
Q

AIDS definition

A

the presence of one of 25 conditions indicative of severe immunosuppression or HIV infection in an individual with a CD4+ cell count of <200 cells per cubic mm of blood

therefore, is end point of long-established infection (continuous, progressive or pathogenic)

45
Q

clinical features of AIDS

A

Lymphadenopathy and fever

  • Insidious onset
  • May be accompanied by weight loss and malaise

Opportunistic Infections

  • Pneumocystis carinii pneumonia
  • Cerebral toxoplasmosis
  • Cryptococcal meningitis
  • Candidosis
  • Herpes virus infections
  • Diarrhoeal disease

Malignancies

  • Kaposi’s Sarcoma
  • Non-Hodgkins lymphoma

Wasting
- Common in Africa

AIDS-related dementia
- Disease in cognitive and/or motor function

46
Q

4 alternative tests for HIV/AIDS

A

Rapid tests

Oral fluid tests

Dried blood spot (DBS)
- easy to obtain – good for research

At home kits (2014) - sampling and testing
- All positive results must be confirmed

Big change from 80s with pre-test counselling

47
Q

improved diagnosing of HIV infection

A

Antibody tests:
- sensitive but only pick up 6-12 weeks post infection (many misses

2nd generation assays, 3rd – closer

Viral antigen detection better than antibodies (2 weeks and detects virus)
PCR (1-2 weeks)

48
Q

dental relevance of HIV

A

HIV infected individuals have poorer oral health and greater dental care needs than the general population

BUT Experience high levels of HIV-related stigma and discrimination when attending dental services
- double-gloving, end of day appointments etc

Standard Infection Control Procedures mean no risk

Need HIV positive to come into practice – oral lesions they have can cause pain and affect mental health

49
Q

3 groups of oral lesions related to HIV

A

Group 1

  • Key
  • Lesions strongly associated with HIV infection
  • Candidosis, Hairy Leukoplakia, Kaposi’s sarcoma, Non-Hodgkin’s lymphoma, Periodontal disease

Group 2
- Lesions less commonly associated with HIV infection

Group 3
- Lesions seen in HIV infection

50
Q

HIV screening in dental setting

A

Key prevention strategy is to improve the availability and access to HIV screening

Early diagnosis improves health outcomes and provides opportunities to prevent further transmission events

Several key HIV indicator that are encountered by the dental professional

Rapid point of care HIV tests could be used to offer chairside HIV screening to patient during dental appointments
Individuals advised recommended to get diagnosis if present dental

51
Q

infection control in the dental setting

A

Both patients and dental professionals can be exposed to pathogens

Contact with blood, oral and respiratory secretions and contaminated equipment occurs

Proper procedures can prevent transmission of infections to patients and dental professionals

(Follow controls = no risk
All are exposed to pathogens)

52
Q

what is a famous case that causes fear in the general public in failure of infection control procedures

A

the Florida Dentist

  • First incident of clinical transmission of HIV
  • Investigation strongly suggests that five patients (patients A, B, C, E, and G) became infected with HIV while receiving care from a dentist with AIDS
  • Numerous patient notifications exercises associated with the dental setting – no further cases of transmission since
53
Q

what is regularly monitored in health care workers?

A

viral load

54
Q

what is the duty of candor legislation

A

requires health care professionals to notify patients if they have been put at risk of infection

55
Q

what is important to remember about needletstick injuries

A

they are common

hard to acquire infection (prevalence and risk of transmission in population)

risk is further reduced by
- source on cART with undetectable viral load
- follow up and management with PEP
Risk of transmission reduced when undetectable viral load – means HIV untransmissible

56
Q

how is risk of infection by needle stick injury further reduced

A
  • source on cART with undetectable viral load
  • follow up and management with PEP
    Risk of transmission reduced when undetectable viral load – means HIV untransmissible
57
Q

dental professionals should

A
  • possess adequate knowledge about HIV infection and the significance of oral lesions associated with HIV which may help identify those who would benefit from HIV testing
  • provide HIV patients with oral healthcare of the highest standards. A focus on routine and preventative care will maintain and improve the quality of life for patients with HIV
  • Infection control measures should be strictly followed
  • Dental professionals have a legislative duty to report all sharps injuries and seek appropriate follow up and management as per local policies.

BDS2 BAMS (54 decks)

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