HIV Flashcards

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1
Q

HIV virology
Enzymes within capsid:
Major capsid protein (and significance)
envelope glycoproteins

Main Genes: structural, regulatory (replicative)

A

enveloped, 2x + sense ssRNA (a dimer)
Within capsid = protease, reverse transcriptase, integrase
Major capsid protein: p24, isolated in serum for early HIV infection
glycoproteins: gp120, gp 41

MAIN GENES
structural 3 -> (gag, pol, env)

replication/regulatory 6-> Important
–(tat, rev) are the required for replication (promoters)

MORE

  • -nef Downregulates MHC-I and CD4 receptors (remember CD4 helps TCR with signal cascade)
  • -Vif breaks down APOBEC (breaks down viral DNA)
    • Vpr nuclear import
    • vpu dowregulate CD4/MHC I receptors

**HIV makes it’s different mRNA/proteins by alternate splicing

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2
Q

HIV gag gene encodes?

A

nucleocapsid proteins p24 and p7
AND some matrix proteins
These are all somewhat antigenic

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3
Q

HIV pol gene encodes?

A

reverse transcriptase, integrase, and a protease that cleaves some viral proteins.

**reverse transcriptase gene has one of highest error rates described

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4
Q

HIV env gene encodes?

What is the V3 loop?

A

gp160 which is cleaved -> gp120 (head) and gp41 (stalk) -> bind CD4 receptor on T-cells

**env has hypervariable regions with common point mutations = V3 loop

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5
Q

Some phosphotyrosine linked receptors

A

Insulin, EGF, PDGF

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6
Q

Where do viral oncogenes come from in acute transforming viruses vs non-acute transforming viruses

A

ACUTE TRANSFORMING: Over time some viruses have mis-spliced an oncogene out of DNA from host such that they contain an oncogene within their RNA. Rous virus is the only one that still has its replication machinery. The rest require hosts and othere viruses to replicate them.

NON-ACUTE TRANSFORMING: retroviridae that integrate into DNA in key regulatory areas. They have room for replication instructions

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7
Q

HTLV-1?

A

Human T-cell leukemia virus 1

Retrovirus that Causes leukemia, especially caribbean and Japan

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8
Q

In HIV genome, what is LTR?

A

LTR = long terminal repeat (sequences), used as “sticky part that integrase recognizes to put into DNA. Also contains promotor/enhancer functions essential post incorporation into host DNA

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9
Q

HIV epidemiology

A

40million dead since 1981

#34million living with HIV/AIDS 2010
#2.7 infected/yr, 90% in dvlping world, 2/3 Africa
1.1 in USA
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10
Q

HIV transmission

A
Parenteral
#Sexual activity: Virus present in vaginal/cervical/seminal fluid
#Blood product transfusion
#IV drug use
#Rate of infection 30% incidence (transplacentally, DURING DELIVERY, nursing)
#Health care exposure
#NO EVIDENCE OF TRANSMISSION IN mosquitos/kissing, sharing food, saliva, urine, tears, sweat
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11
Q

HIV cell infection mechanism and brief cycle

A

gp120 + gp41 -> bind CD4 +CCR5 or CCR4 -> envelope fusion -> capsid entry

**Some ppl are resistant bc low lvls CCR5. Some drugs target/inhibit CCR5

viral RNA reverse transcribed cytoplasm -> dsDNA transported to nucleus/integrated ->->-> viral capsid and RNA bud through host cell membrane

**Also T-cell -> t-cell fusion with gp120 proteins to form syncytium

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12
Q

With no tx, what is median survival of patients after they dvlp AIDS?

A

2yrs after AIDS dvlps

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13
Q

AIDS definition

A

CD4 T-lymphocyte count <200, serologic evidence of HIV, and/or AIDS defining opportunistic infections

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14
Q

Usual HIV progression

A

1) Acute viral illness (mono-like)
- fever, malaise, lymphadenopathy, pharyngitis
2) Clinical (not viral) Latency… median 8yrs but can be widely variable. You have an HIV immune response but cannot get into all the T cells… steady destruction of CD4 T-lymphs.
3) AIDS

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15
Q

What cells do HIV infect?

A

MOST CD4 T-cells

but also
Monocytes, macrophages, CNS dendritic cells

because they have low lvls of CD4 receptors. But these cells do not die as the T cells do. BUT they do allow transport and dissemination (like to CNS)

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16
Q

Prognostic value of viral load (plasma HIV RNA) vs CD4 count

Opportunistic infections/symptoms at different CD4 counts

1000cells/microliter
400-200
<50

A

Viral load = speed of train heading for cliff
CD4 count = where the train is

1000cells/microliter
-normal; declines about 60/yr

400-200
-around 7yrs
Constitutional symptoms (fever, weight loss, night sweats, lymphadenopathy)
athletes foot
Candida (oral thrush)
herpes zoster
Tb, and other bacteria (staph/ H.flu/ PNEUMOCOCCUS)

meningitis

  • Toxoplasma gondii -> brain mass
  • pnuemocystis carinii -> pneumonia

<50

  • Mycobacterium avium-intracellulare
  • CMV (retinitis, esophagitis, disseminated)

**also B cell dysfunction with shitty hypergammaglobulinemia

17
Q

AZT therapy
MOA
Use
SE

A

rapid resistance if used alone

azidothymidine
1st HIV medication. Used throughout illness and in babies for 6 weeks

MOA: nucleoside reverse transcriptase inhibitor NRTI. Integrated into DNA and terminates transcription. Thymidine analog

SE anemia, neutropenia,
+ headache, insomnia, myalgia, nausea, CNS issues

18
Q

Lamivudine
MOA
USE
SE

A

NRTI, backbone of most HIV therapy. Also suppresses Hep B DNA replication

SE are notably mostly absent.

19
Q

NRTI class
MOA
SE’s

A

MOA: enters as prodrug -> phosphorylated -> competes for RT binding site.

SE: peripheral neuropathy, lactic acidosis, fat redistribution

20
Q

NNRTI MOA

Resistance

A

Rapid resistance alone; CROSS-RESISTANCE occurs heavily in this class

Non-nucleoside reverse transcriptase inhibitor, binds hydrophobic p66 pocket of RT

MOA: Binds noncompetitively to reverse transcriptase
#No need to be phosphorylated to become active, are not incorporated into DNA like NRTI's
21
Q

What HIV drug class ends in -navir?
MOA
USE and considerations
SE

A
Protease inhibitors (10 in market) 
MOA: binds directly to active site, is selective for viral enzyme vs human.

USE: in combination. P450 CYP3A4 metabolism, ritonavir is administered with a CYP3A4 inhibitor to increase lvls

SE: dyslipidemia, insulin resistance, central obesity (like cushingoid), hepatotoxicity

22
Q

Enfuvirtide
MOA
USE
SE

A

ONLY Fusion inhibitor binds gp41

Used in “salvage” regimen, requires injection bid

SE: neutropenia

23
Q

IL-2 infusion in HIV

A

Shown to increase/sustain CD4 count but without clinical benefit

24
Q

Maraviroc
MOA
USE
SE and considerations

A

ONLY CCR5 inhibitor
MOA: binds ccr5 to prevent fusion

SE generally not much. But don’t work if primary receptor is CCR4 (which is often the dominant coreceptor in advanced HIV). So you have to check if CCR5 or CCR4 is dominant.

“Viroc” thrown at CD4 to keep it away from temptress HIV

25
Q

Raltegravir and Elvitegravir
MOA
USE
SE

A

MOA Integrase inhibitor
USE: Often 1st line HAART
SE: diarrhea, nausea, fatigue, muscle ache

26
Q

HIV post exposure prophylaxis
Risk of seroconversion
Tx

A

0.3% risk from needle stick

Tx; 4wk triple therapy

27
Q

Antiretroviral therapy viral load goal

A

Durable suppression of HIV viral load (< 50 copies/ml)

28
Q

HAART therapy
Initial therapy
Considerations

A

Mainstay is 2NRTI + 1 of either protease/NNRTI/integrase inhibitor

Consider: Always test for resistances