HIV & AIDS

Question 1

HIV clinical manifestations

Answer 1

• Initially asymptomatic (or nonspecific symptoms mimicking mono)
• Early stages when patients are unaware they are HIV-infected w/ high levels of virus (HIGH TRANSMISSION RISK!!!)
• All patients are life long carriers and continuously infectious

Question 2

What stage of HIV is AIDS diagnosed

Answer 2

Stage 3

Diagnosed when severe damage to immune system evident (CD4 <200)

Question 3

Diseases associated with AIDS

Answer 3

Opportunistic infections and cancers:

• Kaposi’s sarcoma
• Pneumocystis pneumonia
• MAC infection
• Severe CMV disease
• Cryptosporidiosis
• Candidiasis

Question 4

HIV Disease Course Classes

Answer 4

Fast - 3 years or less to AIDS
Intermediate - 8 to 10 years
Long term non-progressors - >10 years (<5% of cases)
Elite controllers - May be immune!

Question 5

Origins of HIV

Answer 5

Probable Zoonosis
Primates? - Bushmeat
Entry of HIV into human populations several times

Question 6

HIV Replication

Answer 6

• Infection of cells with CD4 and chemokine co-receptor molecule displayed at surface
• Reverse transcription of viral genome, integration into host chromosome (viral integrase); latency established
• Activation of latent virus

Question 7

Cytopathic effects of HIV

Answer 7

• Ultimately, HIV infection produces Th cell loss and profound immunosuppression
• Mechanism of viral killing is uncertain
• Formation of “swarms” (mutant forms of HIV-1)

***Able to mutate rapidly, complicating treatment. USE COMBO THERAPY

Question 8

HIV Transmission

Answer 8

Sexual contact
Parenteral
Perinatal
Other (organ transplants, occupational)

Question 9

Most common form of HIV

Answer 9

HIV-1

HIV-2 is primarily in West Africa

Question 10

HIV-2

Answer 10

Primarily in West Africa
Less easily transmitted
Slower progression to AIDS
Resistant to NNRTIs

Question 11

HIV infection pattern

Answer 11

Virus replicates feely (primary infection

Patients exhibit antibody response (Clinical latency)

Question 12

HIV Diagnosis

Answer 12

HIV Antibody:

1. EIA screen
2. Western blot for confirmation (3 bands for diagnosis)

Direct Tests:

• Reveal presence of virus RNA or protein antigens
• NAT to detect and QUANTIFY virus
• ANTIGEN P24 or RNA GENOME by PCR***

Question 13

Rapid HIV Tests

Answer 13

Rapid HIV-1/2 Antibody Test

Question 14

HIV Treatment

Answer 14

COMBINATION of antiviral agents (HAART)

Question 15

Viral Load

Answer 15

Amount of HIV in the blood

• Tests every 90 days
• Should remain low with effective treatment
• Watch the TREND of the counts

Question 16

HIV Impact on cognitive function

Answer 16

HIV-associated neurocognitive disorder

• Neurovascular function may be influenced by HIV and therapies
• May need to assess ability to take medications

Question 17

HIV Prevention

Answer 17

Education
Clean needle programs
Condoms
Screening of blood and organ donors

Question 18

U=U

Answer 18

Undetectable = Un-transmissible

Question 19

PrEP

Answer 19

Pre-exposure prophylaxis to those at risk (infected sexual partner)