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PSBIM 2023 - IDS > HIV/AIDS > Flashcards

HIV/AIDS Flashcards

1
Q

Classification based on HIV
infection stages

A

Stage O: negative HIV test within 6 months of the first HIV infection diagnosis,remain O until 6 months after diagnosis

Stage 3: Advanced HIV or AIDS,
if one or more opportunistic illness has been diagnosed

Stage U: Unknown, if none of the criteria apply

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2
Q

AIDS-defining opportunistic
illnesses in HIV infection

A
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3
Q

Characteristics of the etiologic
agent HIV and its antigenic determinants crucial for infection

A
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4
Q

Replication cycle of HIV

A

Note:
Binding: gp120 ->CD4 molecule
Co-receptors for HIV-1 : CCR5 and CXCR4
Fusion: gp41
Integrase - enzyme that integrates viral DNA into the host’s genome

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5
Q

Molecular heterogeneity of
HIV-1 and the four groups of
HIV-1

A
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6
Q

Predominant CRF in southeast
asia

A

CRFO1_AE

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7
Q

Mechanisms of viral
transmission in different
settings (sexual, transfusion,
occupational, maternal-fetal,
etc.)

A

HIV is transmitted primarily by sexual contact (both heterosexual and
male to male); by blood and blood products; and by infected mothers to infants intrapartum, perinatally, or via breast milk

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8
Q

Epidemiology of HIV infection
and AIDS in Asia and SE Asia

A
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9
Q

General hallmark of HIV disease

A

is a profound immunodeficiency resulting primarily from a progressive quantitative and qualitative deficiency of a subset of T lymphocytes referred to as helper T cells occurring in a setting of polyclonal immune activation

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10
Q

Mechanisms of CD4+ T cell
depletion or dysfunction

A
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11
Q

Course of Primary HIV infection, initial viremia, and viral dissemination

A
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12
Q

Role of co-receptors in HIV
pathogenesis

A
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13
Q

Mechanisms of establishing
chronic and persistent infection

A
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14
Q

Immune activation and inflammation in
HIV pathogenesis

A

VIral escape through mutation

Overwhelming immune activation d/t persistent viral replication ->”immune exhausion”

Downregulation of HLA class I molecules -> lack of CD8+ cells to recognize and kill infected target cells

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15
Q

Three mechanism of Immune Evasion

A
  1. Hypervariability in the primary sequence of the envelope
  2. Extensive glycosylation of the envelope
  3. Conformational masking of neutralizing epitopes
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16
Q

Reservoirs of HIV-infected cells

A

Lymphoid tissue
Peripheral blood
CNS (cells of monocyte/macrophage lineage)

*Resting CD4+ T cells- serves as one component of the persistent reservoir of virus

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17
Q

Features of advanced HIV
disease

A

HIV Stage 3 (AIDS)
- HIV-infected individuals >5 years with CD4+ T cell counts <200
- depletion of CD4+ T cells continues to be progressive and unrelenting in this phase
-may develop opportunistic infection abruptly without any prior symptoms

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18
Q

HIV infected individuals treated with ART

A

Longterm survivors

19
Q

Infected with HIV for a long period (>10 years) their CD4+ T cells counts were in the normal range, their plasma viremia remained relatively low, and they remained clinically stable over years without receiving ART

A

Longterm nonprogressors

20
Q

Individuals with extremely low levels of viremia that is often undetectable by standard assays and normal CD4+ T cell counts

A

Elite controller

21
Q

Diagnostic approach in HIV
infection

A

Diagnosis depends on the demonstration of antibodies to HIV and/or the direct detection of HIV or one of its components
(Ab appears 3-12 weeks following infection)

-CDC recommendations indicate that a positive 4th generation assay confirmed by a second HIV-1 and HIV-2 specific immunoassay or a plasma HIV RNA level is adequate for diagnosis

22
Q

False-positive in HIV infection

A

Antibodies to class II antigens (following pregnancy, blood transfusion, or transplant)
Autoantibodies
Hepatic diseases
Recent influenza vaccination
Acute viral infections
Administration of HIV vaccine

23
Q

Guidelines on serologic testing
in HIV-1 diagnosis

A
24
Q

Laboratory monitoring in HIV
infection

A
  1. CD4 count
    - best indicator of and correlates with the level of immunologic competence
    -measured at the time of diagnosis ->every 3-6 mo x 2 years of ART
  2. HIV RNA determination
    -used to monitor ART effectiveness
    -measure before initiation of ART
    -monitoring of viral load is done at 4-8 weeks until viral suppression is achieved then dec to 3-4 mo or 6 mo if stable for 2 years or more
  3. HIV resistance testing
    -should be performed if with failing treatment
25
Q

Clinical manifestations of acute
HIV infection

A
26
Q

Define clinical latency in HIV
infection

A

asymptomatic period while there is an ongoing and progressive HIV disease with active viral replication (median time: 10 years)

27
Q

Principles of therapy of HIV
infection

A
28
Q

HIV combination tx

A

see harrisons Table 197-21 for complete list of medications

29
Q

Nucleoside or Nucleotide reverse transcriptase inhibitors

A
30
Q

Non-nucleoside reverse transcriptase inhibitors

A
31
Q

Protease inhibitors

A
32
Q

Entry inhibitors

A
33
Q

Integrase inhibitor

A
34
Q

Initial Combination Regimens Recommended for Most Treatment-Naïve Patients Regardless of HIV RNA Level or CD4 Count

A
35
Q

Characteristics of Immune Reconstitution Inflammatory Syndrome (IRIS)

A
36
Q

IRIS related to a preexisting infection or neoplasm

A

Paradoxical IRIS

37
Q

IRIS associated with a previously undiagnosed condition

A

Unmasking IRIS

38
Q

Used to distinguish IRIS manifestations related to opportunistic diseases from IRIS manifestations related to autoimmune diseases

A

Immune reconstitution disease (IRD)

39
Q

Recommended prophylaxis in
against opportunistic infections
in patients with HIV infection

A
40
Q

Recommended Management of Common Opportunistic Diseases in HIV Infection

A

For patients diagnosed with an opportunistic infection and HIV infection at the same time and a CD4+ count >50 cells/μL, one may consider a 2- to 4-week delay in the initiation of antiretroviral therapy during which time treatment is focused on the
opportunistic infection

41
Q

HAART side effects

A
42
Q

Common opportunistic infections

A
43
Q

Common opportunistic infections

A
44
Q

AIDS defining illness

A

PSBIM 2023 - IDS (17 decks)

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