HIV and AIDS Flashcards
HIV origin
Chimpanzees [1] and sooty mangabeys [2]
- Bushmeat caused cross species transmission
Transfer to humans [xenosis]
- Esp. central and west Africa
Transfer of HIV from Africa to west
Congo workers introduced it to Haiti= breakout
US transfer [1969-72]
Further spread
- International travel
- Blood transfusion
- IVDU
- Gay community
- Haemophiliac blood contamination (Factor VIII)
Discovery of HIV
Around 1983-84
Increasing pneumocystis
AZT
Zidovudine
- Anti-viral mono therapy for HIV
- Ineffective when monotherapy, even when added with dDD
AIDS clinical trial groups
1994
Antenatal and intrapartum AZT
Post-partum AZT to neonate
- Decreased transmission
Specific opportunistic infections in HIV
Pneumocystis carnii pneumonia
Mycobacteria avium
Cytomegalovirus retinitis
Toxoplasmosis
old HAART
Highly active anti-retroviral therapy
- At least 3 anti-retroviral drugs (ARVs)
Aims
- Reduces viral load to undetectable levels, allowing immune system to recover
Consider
- Food restrictions
- Drug interactions
- Taking the ALL drugs on time
Protease inhibitors
- Example
- Administration directions
Indiavir
- Must be taken without food but with water for max absorption
- 1 hour or 2 hours after a meal
- 3 x a day
old ART side effects [9]
Lipodystrophy
Hyperlipidaemia, CVD
Diabetes/ glucose intolerance
Decreased bone mineral density
GI
Peripheral neuropathy/ CNS effects
Hepatotoxicity
Renal stuff
Skin rash
Simple HAART regime
1 pill (x9) - TDF/FTC.EFV
Viral dynamics and resistance
10 Billion produced in a day
- large viral genome–> mutations every 10K bases
One mutation can cause resistance
Measurement of viral load
Measure viral replication
- Marker for treatment success (<40= undetectable)
Higher= more rapid disease progression
- Very high seen in early disease >10million/ml
CD4 count
Measures the function of the immune system
Decreasing level= increase risk of disease progression
Normal= >500
<200= risk of significant morbidity
Consequences of untreated HIV
Earlier stages
- TB
- Kaposi
- Shingles
- Oral thrush
- Seborrhoeic dermatitis
Mid
- Pneumocystis pneumonia
- Toxoplasmosis
- Lymphoma
Late
- Cytomegalovirus
- Myobacterium avium
- CNS lymphoma
Age distribution of HIV
Most common in 40-49 age group, closely is 50-59
- Smallest in <30
