HIV 1

Question 1

Describe strategies to prevent sexual and vertical transmission of HIV.

Answer 1

Sexual Transmission:

• CONDOMS! Abstinence, Be Faithful
• Antiretroviral Therapy!
• Pre Exposure Prophylaxis
• Post Exposure Prophylaxis

Vertical Transmission:

• Treat mother with CART during pregnancy!
• Antiretroviral therapy reduces risk of vertical transmission from 40% to <2%!!! Wahoo!!
• Caesarean section can reduce risk of transmission when there is no antiviral therapy.
• In developed countries HIV(+) mothers are advised to use formula
• Treat infant for 1 month after delivery!

Question 2

What to do if I’m a healthcare worker who taking blood from HIV patient and it pricks me?

Answer 2

Wash with soap and water! Cal occupational health immediately for risk assessment. Consider Antiretroviral therapy.

Question 3

Recall how HIV pathogenesis results in the immunologic dysfunction and clinical manifestations of HIV

Answer 3

• HIV infects CD4 cells resulting in progressive destruction of CD4 cell population. Since these help with LOTS of immunity.. huge immunologic consequences from this loss. Opportunitic infections then can come out since immune system drops below certain degree!! HIV has reverse transcriptase… to make it RNA to DNA.. which then integrates into DNA cells! People who don’t have CCR5 receptors.. are resistant to HIV infection! Bone marrow transplant with patient who had Bone marrow that did not have CCR5 .. HIV couldn’t infect him anymore…didn’t have that receptor!

Question 4

How does HIV kill… most morbidity and mortality is indirect due to opportunistic infections and immune dysfunction!

Answer 4

• HIV enters body through mucosa and infects dendritic cells.. which fuse with CD4 T cells. Infected CD4 cells spread to lymph nodes, plasma, and organs including intestinal mucosa. Immediate loss of CD4 function… Memory T cells are destroyed, Gut mucosal barrier is compromised can lead to chronic inflammation.
• below 200 CD4 T cells/uL count … you see constitutional symptoms, opportunistic diseases and death!

Question 5

Describe the main opportunistic infection risks at various CD4 levels

Answer 5

• 500cells/uL = HSV, pneumonia, candidiasis, diarrhea, shingles.
• less than 200… Pneumonia Pneomocytis, cryptococcal meningitis,
• less than 100… Candida esophagitis, toxoplasmosis, cryptococcosis
• Less than 50 … CMV.. progressive multifocal leucoencephalopathy