HIV Epidemiology and Dental Relevance

Question 1

What is the causative agent of AIDS?

Answer 1

HIV - human immunodeficiency virus

Question 2

How is HIV transmitted?

Answer 2

unprotected sex
drug addicts
blood transfusion
pregnancy (intrauterine)
breast milk
non-sterile instruments

Question 3

What bodily fluids transmit HIV?

Answer 3

blood
semen
vaginal fluid
anal mucus
breast milk

Question 4

At what day of transmission does the HIV antibody appear?

Answer 4

roughly 20 days

Question 5

What is ART?

what are examples?

Answer 5

• Long term medical treatment (not cure) to suppress the virus

NRTIs (nucleoside reverse transcriptase inhibitors),
NNRTIs (non-nucleoside reverse transcriptase inhibitors)
PIs (protease inhibitors) and fusion inhibitors.

Question 6

What is PrEP?

Answer 6

a pill that stops the person from getting HIV
used for high-risk people

Question 7

What are the 3 exposure categories of HIV and what one is the highest?

Answer 7

gay, bisexual men - highest
sex between men/women
drug injectors

Question 8

What are the stages of the HIV life cycle?

Answer 8

1. HIV releases genetic material into CD4 cell
2. Reverse transcriptase copies RNA into DNA
3. Viral DNA inserted in cell DNA
4. Many copies of the viral RNA and proteins made
5. New viral particles assemble and exit cell

Question 9

What cells decrease as time passes with the infection?

Answer 9

CD4 immune cells

Question 10

When is the apparent clinical latency?

Answer 10

from 9 weeks to 8 years

Question 11

When do HIV symptoms mostly occur?

Answer 11

8 years

Question 12

When do opportunistic diseases take control?

Answer 12

9 years

Question 13

What are the two definitions of AIDS?

Answer 13

AIDS is currently defined as the presence of one of 25 conditions indicative of severe immunosuppression

HIV infection in an individual with a CD4+ cell count of <200 cells per cubic mm of blood

AIDS is therefore the end point of an infection that is continuous, progressive and pathogenic

Question 14

What are the 4 stages of HIV/AIDS?

Answer 14

stage 1 - asymptomatic
stage 2 - mild disease
stage 3 - moderate disease
stage 4 - severe disease (AIDS)

Question 15

What are the 3 groups of oral lesions associated with HIV?

what are examples of each

Answer 15

Group 1 - lesions strongly associated with HIV infection
Oral candidiasis (thrush)
Hairy leukoplakia (white patches on tongue)
Kaposi’s sarcoma (cancer of the blood vessel walls)
Non-Hodgkin’s lymphoma

Group 2 - lesions less commonly associated with HIV infection
PD disease

Group 3 - lesions seen in HIV infection
Various other lesions

Question 16

What can dentists use during chairside dental appointments if patient has key indicators of HIV?

Answer 16

rapid point of care HIV tests
early diagnosis improves health outcomes

Question 17

What is legally required after a sharps accident?

Answer 17

report all sharps injuries and follow post-exposure management protocols, including testing and potential post-exposure prophylaxis (PEP).

Question 18

What should be followed to prevent spread of disease?

Answer 18

infection control measures
* Use of personal protective equipment (PPE)
* Proper handling and disposal of sharps (needles, instruments)
* Sterilization and disinfection of dental equipment
* Adherence to standard precautions for all patients

Question 19

What is the structure of HIV?

Answer 19

• HIV contains a single stranded RNA, has an envelope composed of lipid and viral proteins.

Question 20

How does HIV mutate and why is this advantageous for the virus?

Answer 20

• Each time an HIV-1 RNA genome is reverse transcribed to DNA a number of mutations are introduced.
• This helps HIV-1 to escape the host immune system and/or acquire resistance to antiviral compounds.

Question 21

What kills HIV?

Answer 21

• Quite easily killed by heat
• HIV does not survive long outside the human body (such as on surfaces), and it cannot reproduce outside a human host.

Question 22

What is the clinical course of HIV?

Answer 22

• HIV destroys CD4 T cells, which are crucial for immune function.
• Around 60% experience an acute flu-like illness 1 month after infection.
• Disease progression typically has 3 phases:
  Primary infection
  Long asymptomatic period (median 10 years)
  AIDS - defined by opportunistic infections/cancers due to severe immunodeficiency.
• The virus gradually depletes CD4 cells, leading to AIDS when the immune system is severely compromised.

Question 23

How is HIV tested for?

Answer 23

• Antibody detection with an ELISA test.
• Positive results = Further blood sample for the same patient using a range of different test formats such as radioimmunoassay or immunofluorescence, this ensures no false positives are reported.

Question 24

What does combinations of ART drugs cause?

Answer 24

have a dramatic and positive effect on those with HIV infection resulting in rapid falls in plasma HIV load and rises in CD4 cell counts.

Question 25

What is the combination treatment called (ART)?

Answer 25

called HAART (highly active anti-retroviral therapy).