HIV/AIDS Flashcards
The ___________ was first
isolated in 1983 and was retrospectively identified as
the cause of acquired immunodeficiency syndrome
(AIDS; reported 1981).
• It is a non-transforming retrovirus (Retroviridae
family) of the lentivirus subfamily.
human immunodeficiency virus (HIV)
HIV-__ being more common (overall) particularly in
sub-Saharan Africa, while HIV-__ is more prevalent in
West Africa and associated with slower disease course.
HIV-1; HIV-2
What gender is more commonly infected with HIV?
Males
What is the largest single risk factor for getting HIV?
male-to-male sexual contact remains the
largest single risk factor
Transmission of HIV is by exchange of infected bodily fluids predominantly
through ______ and ________ .(Sharing needles and
blood transfusions, organ transplants etc.)
intimate sexual contact and by parenteral means.
The most common method of sexual transmission of HIV in the United States is ________?
anal
intercourse in men who have sex with men (MSM), in whom the risk of HIV
infection is 40 times higher than in other men and in women.
___________ is the second most
common form of transmission of HIV in the United States but accounts for 80% of the
world’s HIV infections.
Heterosexual transmission (male to female or female to male)
• Transmission of HIV from _______ is the third largest group affected in the
United States
sharing needles
T/F: The presence of erosions, ulcerations, and hemorrhagic inflammatory pathoses
(e.g., gingivitis, periodontitis) may predispose an individual to oral transmission of HIV
True
What does Gag produce in the HIV virus?
Nucleocapsid
Matrix
Caspid
What does pol produce in the HIV virus?
Enzymes
What does Env produce in the HIV virus?
Envelope
HIV primarily infects cells with _________ molecules at the site of HIV entry.
CD4 cell-surface
receptor molecules (CD4+ T helper lymphocytes
mainly)
The HIV virus uses CD4+ cells to gain entry by _____ or ______
fusion
with a susceptible cell membrane or by
endocytosis
The probability of HIV infection depends on both the
_______ and _______
number of infective HIV virions in the body fluid
which contacts the host and the number of cells
with appropriate CD4 receptors available at the
site of contact.
The enzyme product of the pol gene, a \_\_\_\_\_\_\_\_\_ that is bound to the HIV RNA, synthesizes linear double-stranded cDNA that is the template for \_\_\_\_\_\_\_\_.
reverse transcriptase; HIV integrase
_____ protein
interacts with the RNA within
the capsid
Nucleocapsid (NC)
______ protein surrounds
the RNA of HIV
Capsid (CA)
______ protein surrounds
the capsid and lies just beneath
the viral envelope.
Matrix (MA)
Just before the budding process, \_\_\_\_\_\_\_ cleaves Gag proteins into their functional form which get assembled at the inner part of the host cell membrane, and virions then begin to bud off.
HIV protease
________ is the transition from the point of viral infection to when antibodies
of the virus become present in the blood (circulating antibodies).
Seroconversion
Stage ___ of HIV infection
Laboratory confirmation of HIV infection, no AIDS defining conditions and CD4+ T
lymphocyte count of ≥500 cells/μL or CD4+ T lymphocyte percentage of total lymphocytes of
≥29***.
Stage 1 (Immediately after HIV exposure and may last for years)
Stage ____ of HIV infection
Laboratory confirmation of HIV infection, no AIDS defining condition, and laboratory
confirmation of HIV infection and CD4+ T lymphocyte count of 200–499 cells/μL or CD4+ T
lymphocyte percentage of total lymphocytes of 14–28***.
Stage 2 (Progressive immunosuppression and early symptomatic disease*)
Stage ____ of HIV infection
Laboratory confirmation of HIV infection and CD4+ T lymphocyte count is <200 cells/μL or
CD4+ T lymphocyte percentage of total lymphocytes is <14 or documentation of an AIDS-
defining condition. Documentation of an AIDS-defining condition supersedes a CD4+ T
lymphocyte count of ≥200 cells/μL and a CD4+ T lymphocyte percentage of total lymphocytes
of ≥14***.
Stage 3 (AIDS; variety of immunosuppression-related diseases**)
Stage ____
• During the first 2 to 6 weeks after initial infection with HIV, ~70% of patients develop an acute
flulike syndrome marked by viremia (acute seroconversion syndrome) that may last 10 to 14 days
(sometimes up to 4 weeks). Others may not manifest this symptom complex.
• Symptomatic persons often develop mononucleosis-like symptoms: lymphadenopathy, fever,
pharyngitis, weakness, diarrhea, nausea, vomiting, myalgia, headache, weight loss, and a skin rash
(roseola-like or urticarial). Only an estimated 20% of symptomatic persons seek medical attention.
• A concomitant transient fall in CD4+ cells occurs along with high titers of plasma HIV, but patients
do not develop evidence of immunosuppression (>500 cell/ml; CD4+ cell count tend to return
toward normal levels after acute symptoms.
• This is usually followed by developing antibodies (anti-gag, anti-gp120, anti-p24) between weeks 6
and 12. A few may take 6 months or longer to achieve seroconversion particularly in patients
without acute symptoms. (6 weeks –6 months, 97% within the first 3 months of infection)
• The severity of the initial acute infection with HIV (i.e., level of viremia) is predictive of the course
the infection will follow. Generally, the longer the acute infection lasts the earlier patients develop
AIDS.
• Can last up to 8–10 years.
• The virus disseminates throughout lymphoid tissue, incubates, replicates (several
thousand copies), and alters many physiologic processes, resulting in hyperimmune
activation, persistent inflammation, and impaired gut function and flora.
• Evolution of the virus within its host to generate closely related yet distinct mutant
viruses that serve to evade the surveying immune response and circulating
antibodies.
• There is a progressive decline in immune function evident as progressive depletion
of CD4+ cell count (CD4+ lymphocytes >500 cells/μL) & slow but usually
progressive increase in viral load.
• <1% are non-progressors and maintain a low viral load.
• Silent clinically except for persistent generalized lymphadenopathy (Up to 70% of
patients).
Stage 1
Stage ___
Early symptomatic period
• Can last 1–3 years.
• Signs and symptoms increase as the CD4+ count drops below 500 cells/μL and
approaches 200 cells/μL(often between 200 and 300/μL)
• Viral load continues to increase.
• Platelet count may decrease in about 10% of patients.
Any or a combination of the following:
• Persistent generalized lymphadenopathy
• Fungal infections
• Vaginal yeast and trichomonal infections
• Oral hairy leukoplakia (OHL)
• Herpes Simplex Viruses (HSV-1 & HSV-2)
• Herpes Zoster (VZV)
• HIV-related retinopathy
• Constitutional symptoms: fever, night sweats, fatigue, diarrhea, weight loss,
weakness.
Stage 2
Stage ___
• When the CD4+ count drops to below 200 cells/μL (also
high viral load) or documentation of an AIDS-defining
condition, the person has AIDS and is susceptible to
opportunistic infections and maliganacies.
• Opportunistic infection(s): Pneumocystis jiroveci
pneumonia, cryptococcosis, tuberculosis, toxoplasmosis,
histoplasmosis, others
• Platelet count may be low.
• Neutrophil count may be low.
• CD4+ cell count <50/μL at high risk for lymphoma and
death.
• Malignancies: Kaposi sarcoma, Burkitt lymphoma, non-
Hodgkin lymphoma, primary CNS lymphoma, invasive
cervical cancer, carcinoma of rectum, slim (wasting)
disease
• Death usually occurs because of wasting, opportunistic
infection, or malignancies.
Stage 3 (AIDS)
In stage 1 HIV, what is the CD4+ cell count?
> 500 CD4+
In stage 2 HIV, what is the CD4+ cell count?
200-499
In stage 3 HIV, what is the CD4+ cell count?
< 200
What is the best test to show HIV infection?
Nucleic acid test
_____ tests
• Detect the actual virus in the blood.
• Polymerase chain reaction (PCR)–based assays of the viral RNA is performed to
determine if a person has HIV or the viral load in the blood (i.e., degree of viremia)
and monitor response to therapy.
• Detect HIV sooner (superior) than other types of tests.
• More expensive and not routinely used.
• Detection ranges are from 40 copies/mL to more than 750,000 copies/mL. The
greatest viral load is found during the first 3 months after initial infection and during
late stages of the disease.
Nucleic acid tests
_____ tests
• Detect both HIV antibodies and antigens in blood
samples.
• In HIV-infected individuals, p24 is produced even
before antibodies develop.
• Antigen/antibody tests are recommended for testing
done in labs and are now common in the United
States.
• This lab test involves drawing blood from a vein.
There is also a rapid antigen/antibody test available
that is done with a finger prick.
• E.g., Abbott has developed a combination assay, the ARCHITECT HIV Ag/Ab
Combo assay (Abbott Laboratories, Abbott Park, IL), that can simultaneously detect
the combined presence of HIV antigens (p24 antigen) and antibodies to HIV. This test
is important for diagnosing HIV infection in the acute phase of the disease when
antibodies are not yet present and for ongoing monitoring of patients.
Antigen/antibody tests
What test is the most commonly used test for HIV?
Antigen/Antibody test
_____ tests
• Only detect antibodies to HIV in blood or oral fluid.
• In general, antibody tests that use blood from a vein can
detect HIV sooner after infection than tests done with blood
from a finger prick or with oral fluid.
• Most rapid tests and the only currently approved HIV self-
test (OraQuick) are antibody tests.
• Enzyme-linked immunosorbent assay (ELISA) testing for
HIV in saliva is 98% sensitive in detecting antibodies to
HIV.
Antibody tests
• Current practice in medical setting is to screen first _____. If the results are
positive, a second _____ is performed (due to high rate of false positive). All
positive results are then confirmed with __________. This combination
of tests is accurate more than 99% of the time and the patients are considered
potentially infectious.
ELISA; ELISA; Western blot
Guidelines developed for effective drug therapy to treat HIV/AIDS in most patients living
with HIV/AIDS incorporate a _____ regimen as a standard for long-term therapeutic
effectiveness against the virus.
three-drug ART regimen
__________
• A way for people who do not have HIV but who are at very high risk of getting
HIV to prevent HIV infection by taking a pill every day.
• The pill (brand name Truvada) contains two medicines (tenofovir and
emtricitabine) that are used in combination with other medicines to treat HIV.
• When someone is exposed to HIV through sex or injection drug use, these
medicines can work to keep the virus from establishing a permanent infection.
Pre-exposure prophylaxis
In the United States, __% of individuals who have
acquired HIV are unaware of their status,
contributing to as high as __% of continuous HIV
spread.
15%; 40%
T/F: The risk of HIV transmission from infected patients to
health care workers is very low, reportedly about 3 of
every 1000 cases (0.3%) through a needlestick or other
sharp instrument contaminated with the virus.
Tru
The CDC recommends ________ as soon as possible after
exposure to HIV-infected blood, regimen recommended is based on the severity
of the exposure and the HIV status of the source patient (two- vs three- drug
regimen of antiretroviral medication).
postexposure prophylaxis (PEP)
Tests for seroconversion should be performed at __, ____, and __ months after being exposed to HIV
3, 6, and 12
Can you turn a pt away bc they have AIDS?
No
Two major consideration in dental treatment for patients living with HIV/AIDS
- Current CD4+ lymphocyte count.
2. Level of viral load.
The level of viral load can be measured by what protein?
p24
At what point do you prescribe pre-tx abx?
<200 CD4+ cells
What is the most common oral manifestation of HIV?
Candidiasis
• After seroconversion, HIV disease often
remains silent except for PGL.
• The prevalence of this early clinical sign
varies; however, in several studies it
approaches 70%.
• PGL consists of lymphadenopathy that
has been present for > 3 months and
involves two or more extrainguinal sites.
• The most frequently involved sites are the
posterior and anterior cervical,
submandibular, occipital, and axillary
nodes.
• Nodal enlargement usually is larger than 1 cm, and varies from 0.5 to 5.0 cm.
• Because lymphoma is known to occur in this population, a lymph node biopsy may be indicated
for localized or bulky adenopathy, when cytopenia or an elevated ESR is present, or when
requested for patient reassurance.
• PGL does warn of progression to AIDS; almost one-third of affected and untreated patients will
have diagnostic features of AIDS within 5 years.
Persistent generalized lymphadenopathy
Which candida is seen <200 CD4+ cells?
Pseudomembranous
Which candida is seen with <400 CD4+ cells
Erythematous
What is the Tx for oral candidiasis from HIV?
Azoles or Amphotericin B
What is the 2nd most common oral manifestation of HIV
Oral hairy leukoplakia
Mucosal, cutaneous, and/or nail(s) ______may be induced by:
1. A variety of drugs taken by HIV/AIDS patients such as zidovudine and emtricitabine-based HIV
regimens.
2. Drugs used to control microbial infections in these patients such as ketoconazole (fungal-
infections), clofazimine (leprosy and some TB), and pyrimethamine (toxoplasmosis/anti-
parasitic).
3. Destruction of the adrenal cortex by disseminated infections (e.g. deep fungal infections) in this
immunocompromised population is another possible cause of the observed hyperpigmentation.
4. Pigmentation with no apparent cause has arisen in HIV-infected patients, and some investigators
have theorized that this may be a direct result of HIV infection.
hyperpigmentation
______ appears with a distinctive linear band of erythema that involves the free gingival margin and
extends 2 to 3 mm apically.
• The alveolar mucosa and gingiva may demonstrate punctate or diffuse erythema in a significant percentage of
cases.
• This diagnosis should be reserved for gingivitis that does not respond to improved plaque control and exhibits a
greater degree of erythema than would be expected for the amount of plaque present
• Results from an abnormal host immune response to subgingival bacteria or may represent an unusual pattern of
candidiasis.
Linear gingivitis
________ appears as ulceration and necrosis of one or more
interdental papillae with no periodontal attachment loss.
• Patients with this have interproximal gingival necrosis, bleeding, pain, and halitosis.
Necrotizing ulcerative gingivitis (NUG)
________ is characterized by gingival ulceration and necrosis associated with
rapidly progressing loss of periodontal attachment. (Attachment loss of more than 6 mm within a 6-month period
is not unusual)
• Although severe cases can affect all teeth, multiple isolated defects often are seen and contrast with the diffuse
pattern associated with typical chronic periodontitis.
• Edema, severe pain, and spontaneous hemorrhage are common.
• Deep pocketing usually is not seen because extensive gingival necrosis typically coincides with loss of the adjacent
alveolar bone.
• Necrotizing ulcerative periodontitis (NUP)
_______ may be seen as an extension of NUP or may involve oral mucosa separate from the
gingiva. (biopsy in this case is indicated)
• Involves predominantly soft tissue or extend into the underlying bone, resulting in extensive sequestration.
Necrotizing stomatitis
The prevalence of oral recurrent HSV infection among HIV-infected individuals increases significantly
once the CD4+ cell count
< 50/mm 3.
Persistence of active HSV infection for more than ___ months in a patient infected with HIV is one
accepted definition of AIDS.
1 month
• Most lesions are of the more uncommon forms—major
and herpetiform.
• With more severe reduction of CD4+ cell count, major
lesions become more prevalent.
• Lesions that are chronic or atypical or that do not
respond to treatment should be biopsied.
• Treatment of persistent lesions involves potent topical or
intralesional corticosteroids. Systemic steroids generally
are avoided to prevent further immunosuppression.
Recurrent aphthous stomatitis (RAS)
• The EC-Clearinghouse-WHO cohorts (1993) defined oral
ulceration in the context of HIV as a distinct entity not
corresponding to any pattern (minor, major, or
herpetiform) of recurrent aphthous stomatitis (RAS) nor
caused by fungal, bacterial, or viral organisms.
HIV-related (non-specific) oral ulceration
Can • Electrocautery and laser ablation be used to treat HPV when combined with HIV infection?
No
_______ currently represents the most common malignancy among the AIDS
population in the United States.
Non-Hodgkin lymphoma (NHL)
If CD4+ cells get below 50, what is the pt at risk of?
Lymphoma or death
Oral lesions are seen in approximately 4% of patients with
AIDS-related NHL and most frequently involve the ____, ____, ______
gingiva,
palate, and tongue.
_______ currently represents the
second most common malignancy
among people with AIDS in the United
States.
Kaposi sarcoma
The lesion most likely arises from endothelial cells, which may express markers for both lymphatic and
blood vessel differentiation and is caused by _______
human herpesvirus 8 (HHV-8).
