HIV AIDS Immune Flashcards
What are the first two lab tests used for diagnosis of aids and what is used to track progression?
Review Chart
State how HIV/Aids is classifed and state two class C oppurtunistic infections
What is Natural Immunity?
- Natural born Defense
- Responds quickly and Broadly(body wide) if challanged
- Leads to inflamation
- Neutrophils, eosinophils, basophils, mast cells, monoctes, dendritc cells, macrophages, NATURAL KILLER CELLS
What is the difference between Natural Immunity and Acquired Immunity?
Natural Is born defense, Acquired is passive or active and can be defined as not made by the body itself.
What are passive Acquired Immunities?
- Maternal antibodies
- Injection of Antibodies from another persons
- immunoglobulin
- vaccinations
- monoclonal antibodies
What is the thought process of Herd Immunity
The many who are immune protect the few who are not.
When is herd immunity considered the best option
Herd immunity is best left for those who are unable to receive vacinations safely( ex. Immune dissorders, less than 6 months old, organ transplants, egg allergies
What are CD4-T Cells
They are the primary defenders that are young macrophages in our immune system. When they mature they become CD-8 Cytokins. They are the primary target of HIV virus.
List the 5 types of Immunoglobulins (Ig_)
IgA, IgD, IgE, IgG, and IgM
Which Type of Immunoglobulin(s) guard against Viral and bacterial Invasions
- IgA
- IgD
- IgE
- IgG
- IgM
- All of the Above
- 1 and 3
- 1,4,and 5
- 1,2, and 5
Answer 8
IgA, IgG, and IgM protect against Viral and bacterial invasion
Which Immunoglobulin Causes Allergic response
- IgA
- IgD
- IgE
- IgG
- IgM
Answer 3
IgE is the immunoglobulin responsible for allergic response
What is the Purpose of IgD?
- Prevent infection
- Acts as an antigen receptor of B cells
- Blocks protein synthesis
- Prevents Shock
Answer 2
IgD is the immunoglobulin responsible for the assistance of B cells acting as a receptor for the B cells
What types of cells are utilized in the Immune system
- RBC’s
- Macrophages
- Neutrophils
- Lmphocytes
- All of the above
- 2 & 3
- 2 & 4
- None of the above.
Answer 7.
The immune system consists of specialized blood cells (Lymphocytes and Macrophages). and Specialized structures including Lymph nodes, the spleen, thymus, bone marrow, tonsils, adenoids and appendix.
Name two specialized structures of the immune system_________________ & ___________________
The immune system consists of specialized blood cells (Lymphocytes and Macrophages). and Specialized structures including Lymph nodes, the spleen, thymus, bone marrow, tonsils, adenoids and appendix.
What are the Levels of CD+ T lymphocytes by category
- HIV Asymptomatic (CDC Category A: More Than500 CD4+ T Lymphocytes/mm3)
- HIV Symptomatic (CDC Category B: 200 to 499CD4 +T Lymphocytes/mm3)
- AIDS (CDC Category C: Fewer Than 200 CD4+T Lymphocytes/mm3)
What are the SELECTED LABORATORY TESTS FOR DIAGNOSING AND TRACKING HIV AND ASSESSING IMMUNE STATUS
See Picture
What are the Three Viral Enzymes that Most HIV and AIDS drugs are named after or similar too?
- Reverse Transcriptase
- intergrase
- protease
At what Stage of Exposure to HIV are you considered Infected.
After DNA Synthesis When Intergration begins you are now considered infected with HIV
What is the main reason HIV has not been able to have a vaccine provided
HIV is a retrovirus, Retroviruses mutate more rapidly, thus making it difficult to formulate a vaccine
What is a marker of HIV progression in patients and why
A decrease in CD4-T Cells is a marker of Disease progression. These falls result primarily from the shortened life span of CD4 -T cells
What are Two key Indicators of a progressing infection with HIV
The primary indicators for a progressing HIV infection are, A Decreasing CD4-T count and an INCREASE in viral Load.
What are the two types of HIV and which is more infectious
- HIV1 and HIV2 are the two main types of Infection
- HIV1 is more common in the US and 90% of the cases are caused by HIV1-Clade B
- HIV1 Is most infectious
- HIV2 Is more common in Africa and progression from infection to AIDS is longer
What is the primary Cause for transmission of HIV, and what effect does viral load have on infection
Close intimate contact with bodily fluids including:
- Blood
- Seminal Fluid
- amniotic fluid
- breast milk
Increased Viral Load increases the risk for infections
Geriatric Patients Get HIV too. 1 in 5 Do not know they are infected. What is a primary reason this is a problem in this age group
Disclosure of Sexual orientation is not considered acceptable, many elderly have new partners after long standing realationships due to a death of a spouse, they are often not utilizing condoms due to “percived no risk” especially with know fear of pregnancy,
True Or False
Viral Load is a better predictor of the risk of HIV progression to AIDS than CD4+T Count
True
The lower the viral load the longer to aids Diagnosis and the longer the pt will survive
What Does the ELISA/EIA test check for to establish if you are infected by HIV
Antibodies.
Why is an ELSIA not an effective diagnostic procedure for a person who was stuck by a needle
It takes 6-12 weeks for the body to develop antibodes, which is what the ELSIA tests for to confirm HIV
Which Test is preformed for validation of an ELISA
Western Blot Test
What is Seroconversion
Seroconversion is when the body produces antibodies to a specific antigen
Antigen test are what
Early diagnosis test for HIV and AIDS, check for the disease antigens itself, not antibodies, this results in a faster result than an ELISA, usually max 2-3 weeks but now almost instant
What Are some reasons to utilize a Quick antigen Test(Nucleic Acid-Based Tests{NAT}) (Select all that Apply)
- Blood and Tissue donation
- Saves money
- Treating Pregnant Women in labor who have not had prenatal care
- Funeral directors use to assist families in claiming special bennifits
- Emergency Departments( accidental exposure)
1.
- Correct, Allows for rapid harvest of organs
- False, These test are generally more expensive, but do allow for ease and cost savings in some cases of blood, donation
- Correct, Allows for rapid treatment of Infant and causal adjustments for delivery of fetus to reduce exposure to mothers bodily fluids
- False, Funeral homes, autopsie, MD offices, and ED use to protect staff, not claim bennifits
- True, assists in rapid treatment and profolaxis for accidental exposure.
How does a NAT test Find HIV
The test Detects Ammino acids that are specific to HIV
Define RT-PCR Test, and what it does
Real Time Polymerase Chain Reaction Test
RT-PCR Quantifies the virus by Detecting Viral Load thereby establishing disease progress.
It is used to monitor the progression of an HIV-1 Infection
Montior the effect of ART(antiviral, Drug Therapy)
Used along with CD4 counts to establish level of immune disfunction
True Or False:
VIral Load is a better predictor of the risk of HIV progression to AIDS than CD4+T count.
True
How does the Doctor Use the CD4+T count and Viral Load together.
The CD4+T count is used to determine when to start Drug therapy. Viral load is then utilized to monitor and establish drug effectivness.
Fusion Inhibitors (FI)
Name
S/E
Special Instructions
- maraviroc (Selzentry)- CC5R antagonist
- S/E Hepatotoxic
- Take with or without food
Protease Inhibitors
Name
S/E
Special Instructions
- darunavir (Prezista)
- HyperGlycemia, Lipodystrophy, Kidney Stones
- Take with food
- DO NOT GIVE TO DIABETICS
Don’t donate darunavir to diabebetics due to double doses of sugar making Kids HYPER(glycemic)
Non-Nucleoside Reverse Transcriptase Inhibitors
(NNRTI)
Name
S/E
Special Instructions
- efavirenz (sustiva)
- Rash Rare stevens Johson Syndrome
- CNS Disturbances
- DO NOT GIVE TO PSYCH PATIENTS
Sustiva, causes suspects to be subject to halucinations
Nucleoside Reverse Transcriptase Inhibitors
NRTIS
Name
S/E
Special Instructions
- zidovudine ZDV (Retrovir)
- Bone Marrow Depression
Only med that is given to pregnant women, this was the first med used with HIV treatment
RETROVIR FIGHTS THE RETROVIRUS from A to Z
Intergrase Stand Transfer Inhibitor
INSTI
Name
S/E
Special Instructions
raltegravier (isentress)
Prevents HIV from Replication
S/E Nausea, Vomiting Fever
Ratle Gravier Had a M(isentress). This prevent him and his wife from replication and made her sick with A fever and Stomach issues like nausea and vomiting.
What Is ART
ART Stands for Antiretroviral Therapy
When Should ART Be started
The General Rule followed by most Doctors is to start ART When the CD4+T count is at or around 500 cells/microliter
What Improves Adherence to ART
In ART many drugs are needed. Combinations of multiple drugs in one pill increases adherence
How is ART prescribed and was increases or is Optimal for effectiveness?
- ART Requires at least two medications to be combined. One must be and NRTI/NNRTI and the other can be any other type
- Optimal ART regimes include three drugs or more. This is sometimes refered to as HAART
- (Highly active antiretroviral threapy)
This is generally done with Two NRTIs and another drug from anyother class
NNRTI, PI boosted with ritonavir, or INSTI
Lucy is a 23 y/o sexually active women, who claims she is HIV positive. She comes to the clinic to have the effectiveness of her HIV treatment after ART has begun. What test would be most effective in determining Effectiveness of ART therapy
- CD4-T count
- Viral Load
- Western Blot test
- Vital Signs
- CD-4 Is usually more usefull after initiation of ART
- Viral load montitors Effectiveness of Therapy After the Initiation of ART
- Western Blot is not used to dertmine Theraputic effect, just to confirm infection after ELISA
- Vital Signs are done on all patients and do not show theraputic effect
What is Ritonavir and what is it used for?
Ritonavir is a PI (protease Inhibitor) which is frequently ordered as part of a HAART regime.
It in itself is not a protease inhibitor but it inhibits the enzyme that actually metabolizes the acting PI’s. When used with PI increases active PI levels in blood.
What are the goals of ART
- Decrease HIV-Associated Morbidity(illness)
- Preserve and Restore Immune function
- Supress plasma HIV viral Load
- Prevent HIV Transmissioin
- Reduce associated HIV Inflammation that effects oragns
What is CD4-T count used for with ART
In immunologic Naieve pts(never treated) CD4 counts are taken every 3-6 months
With all patients CD4 is used to determine the urgency to start ART
CD4 is also used to determine immunologic response to ART(how well the immunes system is doing)
And lastly but most IMPORTANT determines the need to initiate or discontinue prophylaxis of opportunistic Infections
Renee is being tested for CD4-T levels. At which point would she be diagnosed wtih AIDS
- 1000 cells/microlitter
- 800 cells/microlitter
- 500 cells/microlitter
- 250 cells/microlitter
- < 200 cells/microlitter
AIDS is Diagnosed at
- 1000 cells/microlitter
- > 800 cells/microlitter
- < 500 cells/microlitter
- 250 cells/microlitter
- <200 cells/microlitter
What is the CD4 to CD8 Ratio and what is it used for
The Ratio norm is 1-4. So if you have 800CD4 and 200CD8 and you divide them you get 4
cd4/cd8
AutoImmune diseases have increased CD4/CD8 Ratios
Viral Infections have Decreased CD4/CD8 Ratios
What Precent doesCD8 increase and CD4 decrease by after 6months of Seroconversion
- up 40% / down 30%
- up 50% / down 30%
- Up 30% / Down 20%
Answer 1
with ART may cause levels to increase to normal
How do you define stage one Accute HIV
Lab Evidence
Positive HIV Infection
CD4+T count . 500cells/uL
Must have lab testing
Clinical Evidence
none required, however no AIDS Defineing condition
NO OP INFECTIONS
Primary Infection Stage 1
Body develops HIV antibodies,
This is the window period when pts test negative but are highly infectious.
INCREASE IN VIRAL LOAD INCREASES INFECTION AVAILABILITY
WHAT IS VIRAL SET POINT AND WHAT CAN BE SURMISED FROM IT
Viral Set Point is the level in which the body after the initial immune response supbsides(flu like symptoms)
The Higher the Viral Set Point the Poorer the Prognosis
How do you define A stage 2 Chronic Infection
Laboratory Evidence
Positive HIV infection and CD4-T count 200-499 cells/uL
Clinical Evidence
None required no aids defining condition
(NO OP INFECTIONS)
