HIV

Question 1

What is HIV?

Answer 1

It is an RNA single stranded virus that uses human hosts to replicate. It is a retrovirus.

Question 2

What is a retrovirus?

Answer 2

It is a virus that contains reverse transcriptase. It converts

Question 3

How many types of HIV viruses are there?

Answer 3

hiv 2 and hiv 2. hiv 2 is mainly in south african, and parts of india. they are the same symptomatically, but 2 has a slower rate of progression.

Question 4

What are the primary targets of HIV cells?

Answer 4

CD4 cells.

Question 5

How does HIV get into cells?

Answer 5

viral enveloped protein (gp120) binds to cells with cd4 receptor

Question 6

What are ways that HIV can be transmitted?

Answer 6

through sexual contact, mother to child, body fluids, tissue transplantation.

Question 7

How is HIV NOT transmitted?

Answer 7

saliva, respiratory droplets, insects, or close personal contact.

Question 8

Describe the early disease progression for HIV

Answer 8

lasts about 2-4 weeks. HIV localizes to lymphoid tissues. Virus rapidly spreads at first. You see acute retroviral syndrome.

Question 9

What is acute retroviral syndrome:

Answer 9

fever, fatigue, rash, headache, lymphadnoapathy, sore throat, myalgia, nausea, vomit, diarrhea, night sweats.

Question 10

When can you detect the HIV antibody?

Answer 10

usually at 3-8 weeks after infection. Time between infection and detectable levels is called the window period. Patient is usually asymptomatic during this period. HIV IS STILL REPLICATING.

Question 11

What is the severity of the illness determined by?

Answer 11

Amount of virus in the body, degree of immune suppression: CD4 lymphocyte counts decrease. When CD4 lymphocytes decreased to less than 500, you typically start to develop opportunistic infections.

Question 12

What additional lab tests might give you clues that an HIV infection is present?

Answer 12

anemia, lymphopenia, throboyctopenia.

Question 13

What are some common HIV associated complications:

Answer 13

wasting, pneumocytits jiroveci, kaposi’s sarcoma, thrush. PE may show adenopathy. Risks include: IDU, MSM, HIV infected partner.

Question 14

What is the final stage associated with HIV infection?

Answer 14

AIDS (acquired immunodeficiency syndrome). CD4 count <200 or AIDS defining condition (opportunistic infection or cancer).

Question 15

Describe the typical course of an HIV infected individual:

Answer 15

1. primary infection
2. Acute HIV syndrome
3. clinical latency
4. Constitutional symptoms
5. Opportunistic disease
6. death

Question 16

What are the reasons for testing of HIV?

Answer 16

ID those with infection so antiviral therapy can be initiated. ID carrier who may transmit infection to other. Monitor disease progression. Eval treatment efficacy.

Question 17

What is the most common type of HIV testing?

Answer 17

Serology for antibody, Detect HIV Antibody, or Nucleic Acid testing. It is less common to due a culture because it is so dangerous.

Question 18

What is Opt-Out testing?

Answer 18

Testing will be performed unless patient says otherwise. Research indicates more patients will consent to testing if they perceive it as part of routine.

Question 19

What is the testing algorithm?

Answer 19

1. perform screening test: EIA (if 2/3 positive…then..)
2. confirmatory test – Western Blot
   3.

Question 20

What is the screening test for HIV?

Answer 20

Enzyme immunoassay that will detect HIV antibodies in the serum. sensitivity and specificity is 99%. If positive, then EIA is REPEATED. 2/3 tests are positive then confirmatory testing is automatically performed.

Question 21

What is the western blot test?

Answer 21

It is the confirmatory test. Viral components are separated via electrophoresis. sensitivity and specificity is >99%

Question 22

How would you know if a patient is positive with the WB test?

Answer 22

p24 and p120/160 bands are present. It is positive if 2/3 antigen-antibodies are present.

Question 23

How is a patient confirmed HIV positive?

Answer 23

if they have 2/3 screening tests are positive and confirmatory western blot is also positive.

Question 24

What is the screens are positive but confirmatory is negative

Answer 24

then patient is considered negative. follow up in 4 weeks.

Question 25

What could cause false negative results?

Answer 25

1. window period
2. seroreversion
3. atypical host response
4. agammaglobulinemia
5. HIV-2 infection
6. techincal clerical

Question 26

What could cause false positives?

Answer 26

1. autoantibodies
2. HIV vaccines
3. technical or clerical error

Question 27

HIV POCT

Answer 27

Public health needs for rapid HIV test:

1. high rates of non return for test results
2. need for immediate info or referral for treatment choices
3. screening in high-volume, high prevalence.

Question 28

What is the only FDA approved assays used in the health care setting?

Answer 28

HIV POCT. It is considered a screen test. It has 99% S/S. specimens include: saliva, blood, and urine.

Question 29

What does determining the patient’s viral load do?

Answer 29

helps monitor the disease progression, and monitor therapeutic response.

Question 30

What are the CD4 counts used for? normal is 500-1000

Answer 30

help to stage the disease. Make therapeutic decisions: such as when o start therapy, and when to start prophylaxis for opportunistic infections. Indicator of prognosis. Monitor every 6-12 months.

Question 31

What diseases do you see at 200-500 Cd4 count?

Answer 31

Bacterial pnuemonia, pulmonary TB, herpes zoster, thrush, cryptosporidosis, Kaposi’s sarcoma

Question 32

less than 200

Answer 32

Pneumocystits jiroveci, disseminated histoplasmosis,

Question 33

less than 100

Answer 33

Herpes simplex virus, toxoplosmosis, cryptococcosis, candida esophagitis

Question 34

less than 50

Answer 34

CMV, mycobacterium avium

Question 35

What testing should be used for perinatal HIV infections in infants?

Answer 35

Nucleic acid testing. can’t use mother’s IgG HIV antibody will cross the placenta. Infant is positive if they have two HIV NATS positive at two different times. Early antiviral therapy is recommended.

Question 36

What are the goals of ART?

Answer 36

prolong life and improve quality of life.
undectable viral load
immune reconstitution
reduce HIV transmission

Question 37

What is treatment failure?

Answer 37

viral load>200, patient not taking meds, cd4 count fails to increase to 100, >3 months treatment and still having symptoms.

Question 38

When do you perform resistance testing?

Answer 38

when patient is first diagnosed and as part of starting ART or when you switch drugs.

Question 39

Are opportunistic infections ever cured in HIV patients?

Answer 39

no

Question 40

REMEMBER TO LOOK OVER

Answer 40

OPPORTUNISTIC INFECTION PAGE!