HIV/HAART

Question 1

HIV Origins

Answer 1

• originated in chimps (SIV)
• transfered to humans during eating/hunting
• mutated to HIV, spread through world

Question 2

HIV Spread

Answer 2

• sexually transmitted (receptive anal sex)
• blood borne (sharing needles, blood transfusions)
• vertical transmission (pregnancy, birth, breastfeeding)

Question 3

HIV Structure

Answer 3

• ssRNA genome
• integrase, protease, integrase, RT present in virion
• gp120 and gp41 found on envelope

Question 4

HIV Life Cycle

Answer 4

1. Attachment - virus binds CD4 and CCR5/CXCR4 on cell surface
2. Fusion and Penetration - viral envelope fuses with cellular membrane, RNA genome is inserted into cell
3. Reverse Transcription - RT turns ssRNA into dsDNA
4. Integration - integrase integrates viral genome into cellular genome
5. Transcription - when cell divides, viral genome is read and viral proteins are synthesized
6. Assembly - viral proteins assemble into visions
7. Budding - immature virion buds out and gets envelope, protease produces mature vision
8. Maturation - maturation completes once virion is out of the cell

Question 5

HIV Effect on Immune System

Answer 5

• infects CD4 T cells

- eventually kills CD4 cells, impairing immune system

Question 6

HIV Stages

Answer 6

1. Acute infection
2. Seroconversion (production of antibodies)
3. Asymptomatic stage
4. Symptomatic stage
5. AIDS

Question 7

HIV/AIDS Natural History

Answer 7

• initial spike in viral load, reduced to low levels after seroconversion
• initial drop in CD4 T cells, reduced to normal levels for years, begin to drop as viral load increases later

Question 8

Normal CD4 count

Answer 8

<400

Question 9

HIV Viral Load

Answer 9

• done by PCR
• measures number of copies of HIV RNA in blood
• copies/mL

Question 10

Devo of AIDS as train analogy

Answer 10

Viral Load = speed of train

CD4 count = length of track left

Question 11

HIV -> AIDS

Answer 11

• usually below 200 CD4 count
• opportunistic ix’s
• opportunistic cancers

Question 12

Opportunistic ix’s <200

Answer 12

• Pneumocystic jirovecii pneumonia
• Progressive multifocal leukoencephalopathy
• Oral thrush

Question 13

Opportunistic ix’s <100

Answer 13

• CMV retinitis
• Toxoplasmosis
• Cryptococcal meningitis

Question 14

Opportunistic ix’s < 50

Answer 14

-MAC

Question 15

Opportunistic ix’s at any CD4 count

Answer 15

-TB

Question 16

HIV related cancers

Answer 16

• lymphoma
• cervical cancer (HPV)
• Kaposi’s sarcoma

Question 17

Antiretrovirals

Answer 17

• drugs to treat HIV
• used in combo therapy
• monitored by CD4 counts and viral load
• goal: undetectable viral load, normal CD4 counts

Question 18

Types of Antiretrovirals (6)

Answer 18

NRTI's
NNRTI's
Integrase Inhibitors
Protease Inhibitors
Fusion Inhibitors
CCR5 Antagonist

Question 19

Common ART Regimens1

Answer 19

2 NRTI’s + 1 NNRTI
2 NRTI’s + 1 Protease Inhibitors
2 NRTI’s + 1 Integrase Inhibitor

Question 20

Primary Prophylaxis

Answer 20

-preventing a disease from occurring

Question 21

Secondary Prophylaxis

Answer 21

-preventing a disease from re occurring

Question 22

HIV Prophylaxis

Answer 22

• lifestyle changes
• medications (abx for various infectious diseases)
• vaccinations (pneumococcus, Hep A and B, HPV, influenza)

Question 23

HIV Management

Answer 23

• TB skin test
• eye exam if s
• pap test