HIV Flashcards
gag gene encodes for
p24 capsid protein
env gene encodes for
gp120, gp41 envelope proteins, which allow HIV to bind CD4 receptor, and CCR5/CXCR4 respectively
pol gene encodes for
reverse transcriptase
integrase
diagnose AIDS
CD4
pneumocystis jirovecii pneumonia (PCP)
interstitial infiltrates on CXR with CD4
TB, mycobacterium avium complex (MAC, MAI)
CD4
histoplasma capsulatum (immunocompetent)
mild pulmonary disease
associated with bird and bat droppings in OH and MS river valleys
in AIDS patients, systemic disease with HSM, fever, cough
CD4
cryptococcal meningitis
most common meningitis in AIDS patients
ring-enhancing lesions on MRI
toxoplasmosis, or primary CNS lymphoma (more likely to have solid lesions)
CMV retinitis
CS4
progressive multifocal leukoencephalopathy (PML)
reactivation of latent JC virus
cryptosporidiosis
chronic, watery diarrhea
CD4
oral thrush
later, esophageal candidiasis
candida albicans
esophageal candidiasis with CD4
oral hairy leukoplakia
EBV, CD4
oral infections
HSV (herpes), CMV
Kaposi sarcoma
HHV8, increased blood vessels
CD4
bartonella henselae
bacillary angiomatosis
CD4
Non Hodgkin lymphoma
primary CNS lymphoma
large B cell lymphoma
EBV coninfection for both of the above
malignancy associated with HPV in AIDS
squamous cell carcinoma of cervix/anus. HPV types 16 and 18
PPX CD4
TMP-SMX for PCP
dapsone if sulfa all
pentamidine (aero)
ppx cd4
TMP-SMX for toxoplasmosis ppx if positive IgG titer for toxo
dapsone+pentamidine+leucovorin
ppx CD4
MAC prophylaxis
azithrymycin
ppx cd4
histoplasmosis (endemic area) itraconazole
HAART
combination of at least 3 different HIV medications
goal is to treat infection and prevent resistance (attach HIV at different points in its replication/infection cycle in order to control the infection and avoid resistance)
combine 2 NRTIs + 1 from a different class
Consider initiating in everyone with HIV, regardless of CD4 count
should be initiatied in anyone with CD4
protease inhibitors
The viral protease clips viral polypeptide into their functional parts. Without a protease, new viruses cannot mature.
saquinavir ritonavir indinavir nelfinavir fosamprinavir lopinavir tipranavir atazanavir darunavir
side effects: GI intolerance inhibit CYP450 (esp ritonavir) hyperlipidemia/hypertriglyceridemia lipodystrophy pancreatitis nephrolithiasis-indinavir, atazanavir increased bilirubin- atazinavir
ritonavir side effects
pancreatitis, inhibits CYP450
protease inhibitor that causes nephrolithiasis
indinavir, atazanavir
Atazanavir side effects
increased bilirubin, nephrolithiasis
Nucleoside reverse transcription inhibitor
competitively inhibits HIV reverse transcriptase, keeps the virus from replicating
nucleoside analogs (guanosine or cytosine)
must be phosphorylated or activated by thymidine kinase
zidovudine didanosine lamivudine abacavir emtricitabine
nucleoTide reverse transcription inhibitor
tenofovir
competitively inhibits HIV reverse transcriptase, keeps the virus from replicating
nucleotide analog
zidovudine (AZT)
used in newborns born to HIV+ mothers
can be given to mom at time of delivery if she hasn’t been on a regular regimen already during her pregnancy (otherwise stay on course)
how to treat occupational exposures
3 drug regimen for 4 weeks
for anyone who has been exposed
NRTI zidovudine side effect
bone marrow suppression
NRTIs that cause pancreatitis and peripheral neuropathy
didanosine, zalcitabine, stavudine
didanosine, stavudine side effects
hepatic steatosis, pancreatitis, peripheral neuropathy
Abacavir side effect
hypersensitivity reaction
NNRTIs
Non-competitively inhibit HIV reverse transcriptase at a different site than NRTIs
Do not require phosphorylation to be active
Nevirapine Delavirdine Efavirenz Etravirine Rilpivirine
NNRTI general side effect
rash
Efavirenz side effects
neuropsychiatric symptoms (nightmares, vivid dreams, dizziness, worsening depression)
false- positive drug test to cannabinoids
teratogenic
enfuvertide
binds gp41, inhibiting viral fusion and entry.
expensive
given by injection
indicated in patient with a lot of drug resistance
side effects: injection site reactions, and increased risk of bacterial pneumonia
raltegravir, elvitegravir
integrase (from the pol gene) inhibitor
side effects: nausea, rash, myopathy
maraviroc
CCR5 (cofactor, typically seen on macrophages) antagonist
inhibits gp120 conformational change so virus cannot bind host cell effectively
tropism test before therapy to make sure the virus is not X4
only patients with all R5 virus qualify for treatment
ritonavir
protease inhibitor
didanosine
NRTI
delavirdine
NNRTI
zidovudine
NRTI
abacavir
NRTI
lamivudine
NRTI
nelfinavir
protease inhibitor
efavirenz
NNRTI
what drug blocks gp41
enfuvertide
what drug blocks gp120
maraviroc
side effect: lactic acidosis
NRTIs
side effect: GI intolerance
protease inhibitors
side effect: peripheral neuropathy
didanosine, stavudine, zalcitabine
side effect: megaloblastic anemia
zidovudine (AZT)
side effect: rash
NNRTIs
side effect: hyperglycemia, diabetes mellitus, lipid abnormalities
protease inhibitors
side effect: bone marrow suppression
zidovudine
given to pregnant women with HIV
zidovudine, if the woman is not already on a regimen
