- About how many current individuals are there with HIV in the US? - What % are unaware? - HIV has a higher prevalence in which individuals?

- 1.2 million - 14% - African-americans, hispanic men, MSM

- HIV 2 tends to have (...) transmissibility rates than HIV 1? - HIV 2 tends to be less likely to progress to (...), but if it does, it follows the same course as those patients with HIV 1? - Patients with HIV-2 are more likely to maintain a "fight against" loss of (...) cells? - What is this termed? - Patients with HIV-2 tend to also have (...) viral load than persons with HIV-1?

- lower transmissibility rates - AIDS - immune CD4 cells - long-term non-progressors - lower viral load

- 70-80% of HIV infections occur with (...) contact (Africa) - The highest sexual transmission risk is (...) - Risk with (...) has been shown to be very low, but not impossible

- heterosexual contact - receptive anal intercourse with HIV + individual - oral sex

- If a needle stick/fluid contact occurs and the person is HIV+, what is the risk of transmission if not treated with antiretroviral medication within 24 hours? - Which is more concerning for risk of HIV transmission, percutaneous puncture or mucocutaneous exposure? - Who should you call to report any contact, even if HIV status of patient is unknown? - You should contact your infection control person STAT for (...); the goal is to start medication within (...) hours of exposure - HIV testing of HCW is performed periodically over (...)

- 0.3% - percutaneous puncture - infection control - PEP (post-exposure prophylaxis) - 1-2 hours - 6 months; @ 6 weeks, 12 weeks, 6 months

- What helps B-cells generate strong antibody responses to pathogens? - What do these secrete? - What does this aid in? - What aids immune memory when a viral pathogen is encountered a second time?

- CD4 T-lymphocytes (CD4 helper cells) - cytokines - killing pathogen (virus in this case); eliminating virally infected cells - memory CD4 cells

- An infection with HIV disrupts or destroys (...) - (...) cells are directly infected and destroyed - (...) attempts to clear infected cells - (...) dies due to erroneous immune activation - (...) becomes exhausted and depleted - This results in profound destruction of (...)

- CD4 T-lymphocytes - CD4 cells - immune system - CD4 cells - immune system - CD4 lymphocyte count

- Upon initial HIV infection (in the first few days), the virus cannot be detected in (...) - This is called the (...) phase - Eventually, what happens to the virus? - As this specific process is occurring, some patients will detect (...) - The viral increase at this time may cause (...) - 90% of patients will have (...) - These patients will rarely seek care for these symptoms so it is not diagnosed

- plasma - eclipse phase - disseminates to lymphatic tissue, infects/destroys more CD4 cells, releases more viral progeny - their first symptoms - acute HIV infection - at least one symptom, usually mild

- What is the first sign of HIV infection? - Onset of symptoms usually is (...) weeks after exposure, and resolves with time - The average duration of these symptoms is (...) days

- acute HIV infection - 2-4 weeks - 18 days

HIV Flashcards by Brittany Christmas

About how many current individuals are there with HIV in the US?
What % are unaware?
HIV has a higher prevalence in which individuals?

1.2 million
14%
African-americans, hispanic men, MSM

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HIV belongs to the family of (…)
What are the 2 subtypes of HIV?

retroviruses
HIV1, HIV2

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Which HIV type is distributed worldwide and likely originated in chimpanzees?

HIV 1

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Which HIV type more predominant in the West Africa origin and likely originated in soot mangabeys?

HIV 2

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What are the subtypes of HIV 1?
Which subtype is the major number of cases?

M, N, O, P
M

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HIV 2 tends to have (…) transmissibility rates than HIV 1?
HIV 2 tends to be less likely to progress to (…), but if it does, it follows the same course as those patients with HIV 1?
Patients with HIV-2 are more likely to maintain a “fight against” loss of (…) cells?
What is this termed?
Patients with HIV-2 tend to also have (…) viral load than persons with HIV-1?

lower transmissibility rates
AIDS
immune CD4 cells
long-term non-progressors
lower viral load

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How is HIV transmitted?

sexual contact
contaminated blood products
breastfreeding
intrapartum and perinatally
IV drug abusers

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70-80% of HIV infections occur with (…) contact (Africa)
The highest sexual transmission risk is (…)
Risk with (…) has been shown to be very low, but not impossible

heterosexual contact
receptive anal intercourse with HIV + individual
oral sex

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What should be started as soon as possible in pregnancy to reduce the risk of transmission of HIV to the baby?

ART

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What factors increase the risk of HIV transmission?

higher viral titers (more likely to transmit)
presence of any other STIs or ulcerations increases risk (HSV, syphilis): allows HIV port of entry
oral contraceptive use: progesterone effect of thinning out vaginal lining

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What factors reduce the risk of HIV transmission?

circumcision reduces risk of transmission

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What is HIV not spread by?

touching a person with HIV
insect bites
salive, urine, nasal secretions, sputum, sweat, tears, vomit (unless bloody)

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If a needle stick/fluid contact occurs and the person is HIV+, what is the risk of transmission if not treated with antiretroviral medication within 24 hours?
Which is more concerning for risk of HIV transmission, percutaneous puncture or mucocutaneous exposure?
Who should you call to report any contact, even if HIV status of patient is unknown?
You should contact your infection control person STAT for (…); the goal is to start medication within (…) hours of exposure
HIV testing of HCW is performed periodically over (…)

0.3%
percutaneous puncture
infection control
PEP (post-exposure prophylaxis)
1-2 hours
6 months; @ 6 weeks, 12 weeks, 6 months

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What are some risk factors for HIV acquisition?

unprotected sex
MSM
sex workers
IV drug use
incarceration
gender-diverse or transgender
maternal-fetal transmission
unsafe medical practices

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After a positive test for HIV, what should you assess (what should the work-up consist of)?

take a thorough history and perform a full physicial
- sexual contacts (partners)
- social history (support that can help with stigma, support and adherence)
- complications (current drug use/chronic health issues)
- immunizations

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What immunizations should patients with HIV receive?

streptococcus pneumoniae
hepatitis B (high risk of hepatocellular carcinoma)

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HIV uses (…) to transform RNA into DNA so it can become compatible with human (…) cells

reverse transcriptase
human CD4 cells

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What helps B-cells generate strong antibody responses to pathogens?
What do these secrete?
What does this aid in?
What aids immune memory when a viral pathogen is encountered a second time?

CD4 T-lymphocytes (“CD4 helper cells”)
cytokines
killing pathogen (virus in this case); eliminating virally infected cells
memory CD4 cells

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An infection with HIV disrupts or destroys (…)
(…) cells are directly infected and destroyed
(…) attempts to clear infected cells
(…) dies due to erroneous immune activation
(…) becomes exhausted and depleted
This results in profound destruction of (…)

CD4 T-lymphocytes
CD4 cells
immune system
CD4 cells
immune system
CD4 lymphocyte count

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What is the course of HIV?

virus transmission and dissemination
acute HIV infection
chronic HIV infection

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Upon initial HIV infection (in the first few days), the virus cannot be detected in (…)
This is called the (…) phase
Eventually, what happens to the virus?
As this specific process is occurring, some patients will detect (…)
The viral increase at this time may cause (…)
90% of patients will have (…)
These patients will rarely seek care for these symptoms so it is not diagnosed

plasma
eclipse phase
disseminates to lymphatic tissue, infects/destroys more CD4 cells, releases more viral progeny
their first symptoms
acute HIV infection
at least one symptom, usually mild

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What is the first sign of HIV infection?
Onset of symptoms usually is (…) weeks after exposure, and resolves with time
The average duration of these symptoms is (…) days

acute HIV infection
2-4 weeks
18 days

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Acute HIV infection manifests with (…) symptoms
What do these symptoms include?

mono-like symptoms
- fever
- sore throat (tonsillitis, mucocutaneous ulcers in mouth)
- HA
- lymphadenopathy
- myalgias, arthralgias
- N/V
- night sweats
- generalized maculopapular rash

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What symptoms in an acute HIV infection are unique to HIV?

mucocutaneous ulcers in mouth
generalized maculopapular rash

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What is the name of this rash? What is this associated with?

- maculopapular rash - HIV (acute HIV infection)

Mucocutaneous ulcers can occur in which locations?

- oral cavity - esophagus - anus - penis

You should consider acute HIV infections in patients who display what symptoms? | (Consider acute HIV infection especially if symptoms are (...))

- fever, fatigue, rash, pharyngitis in pt who has risk factors - mucocutaneous ulcers | (prolonged)

What is the normal CD4 count?

500-1500 cells/mm^3

How long can the transition of chronic HIV infection to advanced HIV take in the total absence of antiretroviral therapy?

10 years

What are the stages (phases) of HIV transitioning from chronic HIV infection to advanced HIV? | (this is the quieter phase)

- chronic HIV infection - asymptomatic - early symptomatic - presence of AIDS defining conditions or CD4 < 200 - advanced HIV CD4 < 50

- Over time, HIV establishes a (...) - What mitigates the viral load and prevents further declines in the CD4 count? - As viremia continues/increases, (...) continues to decline during this latent period of infection - Don't confuse latency as (...) as during HIV latency, the virus is (...) and (...) - What is the AIDS definition of CD4 levels?

- chronic infection - cytotoxic CD8 cells - CD4 count - no activity; active and replicating - CD4 level < 200

As CD4 decreases, (...) and (...) increase

symptoms and opportunistic disease

- In the earliest phases of HIV infection, most patients are (...) - Many will have generalized (...) - These will generally present in two areas that are (...) - This usually includes the (...) nodes, persists over (...) months, is not explained by other (...), and is generally (...) - This asymptomatic period can start in the (...) period

- asymptomatic - lymphadenopathy - noncontiguous - inguinal nodes, 3 months, other illnesses, symmetric - acute HIV period

Regarding the symptomatic period of HIV: - The decline of CD4 cells is (...) as the body achieves a balance between cell death and replacement - As CD4 levels continue to decline slowly over time, HIV+ patients may develop more (...) - They can become more symptomatic even with CD4 counts above (...), but are more common as CD4 levels decline - Symptomatic HIV usually related to infections with (...)

- slow - symptoms - 200 - opportunistic pathogens

What infections are patients with HIV in the symptomatic period relate to?

- oral/vaginal candidiasis (thrush) - oral hairy leukoplakia caused by EBV (white plaque on side of tongue) - MRSA - hepatitis A, B, C - streptococcus pneumoniae - syphilis

What is this showing?

oral hairy leukoplakia caused by EBV

What are some consequences of HIV?

- HPV and cervical cancer risk increase - HIV-polyneuropathy - cardiac disease - HIV-related encephalitis or dementia

Describe HIV-polyneuropathy and what symptoms are associated with it?

developed distal and symmetric polyneuropathy: - numbness or pain in hands/feet - paresthesias - progresses to weakness

- Patients with HIV have a higher risk of (...) and (...) - What should patients do to decrease heart complication risks? - (...) medications can negatively affect cardiac function, but not as severe as HIV itself

- myocardial infarction and heart failure - smoking cessation (crucial), control of BP and lipids - ART medications

What is HIV-related encephalitis or dementia managed with?

ART and dementia specific treatments

What is the definition of AIDS?

1. CD4 < 200 cells/microL 2. presence of an AIDS-defining condition in an HIV + individual | (pt w/ AIDS-defining condition who is already HIV+, CD4 doesn't matter)

What AIDS-defining conditions should we know?

- repeated bacterial infections - candida in the bronchi, lungs, esophagus - pneumocystic pneumonia (pneumocystic jirovecii pneumonia) - fungal - wasting syndrome - Kaposi's sarcoma

- What type of tumor is Kaposi sarcoma? - What is the cause of Kaposi sarcoma? - How is Kaposi sarcoma transmitted?

- vascular tumor - kaposi sarcoma herpes virus - sexual, maternal, infant

- What type of patients in kaposi sarcoma rare in? - How many times more common is kaposi sarcoma in AIDS pts? - What % of AIDS patients are affected by kaposi sarcoma?

- immunocompetent - 20,000x - 35%

Kaposi sarcoma can occur in other immunosuppressed conditions but is highly associated with (...)

AIDS

If patients are not being treated for HIV, (...) is more likely to be seen

kaposi sarcoma

What is the appearance of kaposi sarcoma and how it grows over time?

- lesions are red/purple - become more nodular over time - can start to coalesce; borders grow together

What parts of the body can Kaposi sarcoma affect?

- skin - mucocutaneous sites - organs (respiratory tract, GI tract)

How is Kaposi sarcoma confirmed?

biopsy

- What may also be present in patients with Kaposi sarcoma? - When (...) is initiated, these lesions can stabilize or resolve - What are some other treatments that can be used to get rid of lesions from KS? - What can be used in severe or widespread cases?

- generalized lymphadenopathy - antiretroviral therapy - surgical excision (cosmetic relief); liquid nitrogen - chemotherapy agents: doxorubicin/paclitaxel

What AIDS-defining condition is this describing: - weight loss of at least 10% in the presence of diarrhea or chronic weakness and documented fever for at least 30 days that is not attributable to a concurrent condition other than HIV itself

wasting syndrome

What are the causes of wasting syndrome?

- cytokine release - hypogonadism (low testosterone) associated with HIV - metabolic and malabsorptive mechanisms

What is the treatment for wasting syndrome?

- nutritional supplement - nutritional consultation - appetite stimulators (megestrol acetate/dronabinol)

- What was the survival length with AIDS after the appearance of opportunistic infections initially? - However, (...) has changed this - Now, a 20 y/o infected with HIV on medication can live another (...) years

- 6 months - antiretroviral therapy - 30 years

Describe what long term non-progressors are and what % of HIV patients they make up?

- 5-15% - do not follow typical progression to AIDS - may not develop AIDS for > 20 years - genetic influences result in better immune response/lower virus levels

Describe what elite controllers are and what % of HIV patients they make up?

- 0.003% - do not show detectable viral levels and maintain CD4 counts for many years

How can you diagnose HIV?

- viral load (10-12 days after infection) - HIV p24 antigen - 4th gen tests: combo test detect p24 antigen and antibodies IgG and IgM (virologic and serologic)

What are some initial tests that should be conducted after a positive HIV result?

- CD4 lymphocyte levels - HIV viral load - CBC, CMP, UA, lipid panel - Hep A, B, C testing - STI testing - HLAb5701 allele test if abacavir is being prescribed - genetic drug resistance testing

Monitoring of HIV typically consists of getting what levels/tests?

- CD4 and viral load counts - eval of side effects/toxicities of medications

Describe the 95/95/95 goal of the WHO?

- 95% of HIV+ pts have diagnosis - 95% of those diagnosed are one ART - 95% of those on ART are considered suppressed

There have been a few people cured of HIV, what has this treatment consisted of?

- stem cell transplant after chemotherapy/radiation - donor stem cells has a unique genetic alteration allowing for better immune clearance | (these patients had also been diagnosed with cancer)

mucocutaneous ulcers