HIV Flashcards
Where do we find HIV1 and HIV 2 in the world?
America, Europe, central Africa
West Africa
Talk about the 3 main proteins of HIV?
P7 protein holds together the two positive single stranded RNA
Virus is enclosed bu the conical capsid viral protein P24
RNA genome consists of 9 genes, gag, pol and env are most important in making structural proteins for new virus particles.
Capsid contains 3 enzymes required for HIV replication, what are they and why are they important to us?
Reverse transcriptase, integrate and protease
We go after these with medicine
What cell does HIV infect and what are the 4 main outcomes because of infection of the cell?
CD 4 T cell Cell death Severe immunodeficiency Opportunist infections Malignancy
Big picture, explain how HIV gets distributed throughout the body?
CD4 T cell gets infected, goes to GALT in the gut, then gets sent to lymphoid organs throughout the body, massive immune/inflammatory response to the infection and rapid replication everywhere basically.
The hallmark pathogenesis of symptomatic HIV infection is what?
Immunodeficiency caused by continuing viral replication
What is the antigen HIV uses to attach to cells, which means what cells can it infect? What are the two fates of the virus once inside the cell?
Cd4
Once inside it can replicate and kill the cell
It can also cause a latent state and integrate itself into the host cell genome and not replicate right away.
Top 3 transmission risks of HIV?
Butt sex, needles and butt sex and anal sex
What is another high risk transmission for HIV we must always be cautious about?
Blood transfusions
Which race is more at risk for HIV?
Blacks, Hispanics and whites
3 main pathophysiology processes of HIV?
Immunodeficiency
Autoimmunity
allergic Hypersensitivity reactions
At about 250-500 cd4 count what infections/conditions are presenting in the HIV patient? 4
Bacterial infections Pneumococcal pneumonia Pulmonary TB Herpes zoster Oral candiasis
When we go less than 200 cd4 count, what infections is the HIV patient getting? 4
Pneumocystis jiroveci pneumonia
Histoplasmosis
Kaposi sarcoma
Extrapulmonary TB
At cd4 counts less than 100, 3 infections?
Cryptococcal meningitis
Esophageal candiasis
Toxoplasmosis
2 infections and 1 tumor that presents at less than 50 cd4 counts?
MAC and CMV
CNS lymphoma
3 specific physical exam findings for HIV and what is common in early infection?
Hairy leukoplakia of tongue
Kaposi sarcoma
cutaneous bacillary angiomatosis
generalized LAD
What is the first lab test to do when testing for HIV?
HIV 1/2 Ag/Ab combination assay (testing for HIV ab and HIV p24 antigen)
If that is positive, what do we do next?
If positive, test the sample with HIV 1/2 ab differtiaiton which will confirm the diagnosis.
What happens if the differentiation test is negative, what do you do next?
Do a HIV 1 NAAT and if positive, acute HIV is diagnosed.
What would be considered a false positive test result?
Positive combo test, negative differentiation test and negative HIV NAAT.
What prophylaxis measures do we take when cd 4 counts drop below 200 and 75?
Jiroveci
Mycobacterium Avium
What are 6 complicating symptoms of HIV?
Weight loss and muscle wasting Nausea Anorexia Depression Isolation Decrease in quality of life
What is the most common opportunist infection associated with AIDS and what are the symptoms?
Pneumonia from jiroveci
Pulmonary problems so cough, fever, SOB
What is the cornerstone of diagnosis of jiroveci pneumonia with these patients and what will we see most of the time?
Chest x ray
Diffuse or perihilar infiltrates
Pleural effusions uncommon
What technique can confirm the diagnosis of jiroveci pneumonia?
Bronchoalveolar lavage, so basically sputum
2 lab markers in helping diagnose pneumocystis?
Serum LDH and serum beta glucan
What is the most common cause of pulmonary disease in HIV infected persons?
Community acquired pneumonia
What is the most common space occupying lesion in HIV, what is the CD4 count typically in these patients, symptoms, what does CT can show, and what does MRI show?
Toxoplasmosis
Less than 100
HA, fever, neuro problems
Multiple subcortical lesions commonly in basal ganglia
Multiple ring enhancing lesions with surrounding areas of edema
3 GI conditions because of HIV?
Enterocolitis
Liver disease
Candidiasis in esophagus
What are the 5 major problems encountered with HIV patients infected by CMV in order of frequency?
Retinitis Colitis Esophageal ulceration Encephalitis Pneumonitis
How do we characterize kaposi sarcoma?
Low grade vascular tumor associated with HHV8
What part of the body is characteristically involved and what 3 areas of the body can it spread to?
Skin
Oral cavity, GI, and respiratory tract
The skin lesions typically show up in what 4 places?
Lower extremities, face (nose), oral mucosa, and genitalia
What are the symptoms usually in AIDS related KS?
Pulmonary
