HIV

Question 1

Acute HIV Syndrome; Wide dissemination of virus seeding of lymphoid organs

Answer 1

6 weeks

Question 2

Alpharetrovirus

Answer 2

-Rous sarcoma virus
-Contains src oncogene

Question 3

Betaretrovirus

Answer 3

-Mouse mammary virus
-Exogenous or endogenous

Question 4

Gammaretrovirus

Answer 4

-Abelson murine leukemia virus
-Contains abloncogene

Question 5

Gammaretrovirus

Answer 5

-Abelson murine leukemia virus
-Contains abloncogene

Question 6

Deltavirus

Answer 6

-HTLV-1
-Causes T-cell lymphoma and neurologic disease

Question 7

Deltavirus

Answer 7

-HTLV-1
-Causes T-cell lymphoma and neurologic disease

Question 8

Epsilonretrovirus

Answer 8

-Walleye dermal sarcoma virus
-Not known to be pathogenic in humans

Question 9

Epsilonretrovirus

Answer 9

-Walleye dermal sarcoma virus
-Not known to be pathogenic in humans

Question 10

Lentrivirus

Answer 10

-HIV-1,HIV-2
-Causes AIDS

Question 11

Lentrivirus

Answer 11

-HIV-1,HIV-2
-Causes AIDS

Question 12

Spumavirus

Answer 12

-Simian foamy virus
-Not known to be pathogenic in humans

Question 13

Primary cause of AIDS pandemic

Answer 13

Group M

Question 14

caused localized epidemics

Answer 14

Group O and HIV-2

Question 15

caused localized epidemics

Answer 15

Group O and HIV-2

Question 16

confined almost entirely to residents of Cameroon

Answer 16

Groups N and P

Question 17

HIV Structure

Answer 17

● 70-130 nm in diameter
● Lipid-containing envelope
● Icosahedral capsid
● Dense inner core
● Two ssRNA w/ reverse transcriptase and tRNA
● Proteins: Integrase, protease

Question 18

First Phase HIV (Life Cycle)

Answer 18

Adsorption, Penetration and Integration

Question 19

Second phase (HIV Life cycle)

Answer 19

Transcription, Translation and Budding

Question 20

plays an important role in the transmission of HIV at mucosal surfaces such as the genital tract and gut and contributes somewhat to the pathogenesis of HIV disease

Answer 20

INTEGRIN a4a7

Question 21

Stage 1 HIV

Answer 21

<1 Year- >1500
1-5 Years- >1000
6 Years through Adult- >500

Question 22

Stage 2 HIV

Answer 22

<1 Year- 750-1499
1-5 Years- 500-999
6 Years through Adult- 200-499

Question 23

Stage 3 HIV

Answer 23

<1 Year- <750
1-5 Years- <500
6 Years through Adult- <200

Question 24

Transmission of HIV

Answer 24

● Sexual contact
- Developed countries: Homosexual
- Developing countries: Heterosexual
● Injection drug use
● Transfused blood and blood products
● Occupational transmission
● Mother to child

Question 25

HIV pathophysiology

Answer 25

-Direct infection and destruction of these cells by HIV -Indirect effects such as immune clearance of infected cells -Cell Death associated with aberrant immune activation and inflammation - Immune exhaustion due to persistent cellular activation with resulting cellular dysfunction

Question 26

HIV Structure

Answer 26

Is an RNA retrovirus with a lipid envelope containing glycoproteins (gp120 and gp41). The gp120 protein binds to the CD4 receptor on T cells, macrophages, and dendritic cells, facilitating entry into the host cell.

Question 27

HIV requires a co-receptor for successful entry into the cell

Answer 27

CCR5 and CXCR4 are the most common co-receptors involved in this process.

Question 28

HIV-infected individuals also have an increased risk of malignancies such as

Answer 28

Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer, due to impaired immune surveillance

Question 29

HIV-infected individuals also have an increased risk of malignancies such as

Answer 29

Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer, due to impaired immune surveillance

Question 30

Cellular target of HIV

Answer 30

-CD4+ T lymphocytes -CD4+ cells on myeloid lineage -Dendritic cells - with restriction factors (SAMHD1 and plasmacytoid) -Epidermal langerhans cells - with restriction factors (Langerin)

Question 31

Primary infection and initial dissemination

Answer 31

● Viral entry: langerhans cell transport or microscopic rents in the mucosa ● Infection of target cells (CD4+ T cells) ● Viral replication: reticuloendothelial tissues ● Eclipse phase ● Acute burst of viremia and wide dissemination ● Acute HIV syndrome

Question 32

Lymphoid organs

Answer 32

● Major anatomic site for viral propagation ● Trapped virus serve as viral reservoir

Question 33

The average rate of CD4+ T-cell decline is

Answer 33

~50/uL per year in an untreated patient

Question 34

The average rate of CD4+ T-cell decline is

Answer 34

~50/uL per year in an untreated patient

Question 35

Elite controllers

Answer 35

-Extremely low levels of plasma viremia that is often undetectable by standard assays -Normal CD4+ T-cell counts

Question 36

Clinical Findings in the Acute HIV Syndrome

Answer 36

General -Fever -Pharyngitis -Lymphadenopathy -Headache/Retroorbital pain -Arthralgias/Myalgias -Lethargy/Malaise -Anorexia/Weight loss -Nausea/Vomiting/Diarrhea Neurologic -Meningitis -Encephalitis -Peripheral neuropathy -Myelopathy Dermatologic -Erythematous maculopapular rash -Mucocutaneous ulceration

Question 37

Acute HIV Infection Manifestation

Answer 37

- 3-6 weeks after primary infection - Occur along with a burst of plasma viremia

Question 38

Immune activation and Inflammation

Answer 38

1. The replication of HIV 2. The induction of immune dysfunction 3. The increased incidence of chronic conditions such as premature cardiovascular disease

Question 39

Condition associate with Persistent Immune Activation and Inflammation in Patients with HIV Infection

Answer 39

- Accelerated aging syndrome - Bone fragility - Cancers - Cardiovascular DIsease (Carditis) - Diabetes (DM) - Kidney disease - Liver disease - Neurocognitive dysfunction

Question 40

Autoimmune phenomena

Answer 40

● Chronic immune activation and the dysregulation of B and T Cells ● Psoriasis, idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia, Graves disease, antiphospholipid syndrome, and primary biliary cirrhosis ● Immune reconstitution inflammatory syndrome (IRIS)

Question 41

IRIS stands for

Answer 41

Immune Reconstitution inflammatory Syndrome

Question 42

Characteristics of IRIS

Answer 42

- Paradoxical worsening of an existing clinical conditions or abrupt apperance of a new clinical findings (unmasking) is seen following the initation of antiretroviral therapy -Occurs weeks to months following the initation of antiretroviral therapy -Is most common in patients starting therapy with CD4+ T-cell count <50/uL who experience a precipitous drop in viral load -Is frequently seen in the setting of TB, particularly when cART is starting soon after initation of anti-TB therapy -Can be fatal

Question 43

When to Start ART In IRIS patients

Answer 43

-Manifested for patient once Antiretrovirals started - Can occur 2 weeks to 2 years Consider CD4 count <50 ->start antiretrovirals ( if >50 wait 2-4 weeks before retroviral start) not immediately

Question 44

HIV Diagnosis

Answer 44

● Antibodies to HIV and direct detection of HIV or one of its components ● ELISA - detection of antibodies to HIV andor the p24 antigen (standard blood screening test) ● Resulls: positive (highly reactive), negative (non reactive), or indeterminate (partially reactive) ● Western blot- HIV-1- or HIV-2-specific antibody immunoassay ● Plasma HIV RNA level

Question 45

HIV Gold standard in diagnosing

Answer 45

The gold standard for diagnosing HIV is a combination of HIV antigen/antibody tests followed by a confirmatory test, typically a nucleic acid test (NAT) or a Western blot/immunoblot test.

Question 46

HIV RNA Determinations

Answer 46

● RT-PCR assay ● At the time of HIV diagnosis and every 3-6 months thereafter in the untreated patient 7 ● Monitored approximately every 4 weeks until the effectiveness of the therapeutic regimen is determined ● During therapy, monitor every 3-6 months to evaluate the continuing effectiveness of therapy

Question 47

HIV Resisctance Testing Recommendation

Answer 47

- At the time of initial diagnosis - If therapy is not initiated at that time - At the time of initiation of ART - Virologic failure