HIV II Flashcards
Immune Cell Responses to HIV
Loss of CD4, CD8 (later)
Polyclonal Activation of B cells, inability to mount Ab response
Autoimmune destruction
What is the Window in HIV patients
The period before seroconversion
6-12 weeks following infection
How to diagnose HIV
Ab to HIV antigens (gp120,160 + 41/24)
Serology + Western Blot
A positive rapid test for HIV should be followed by…
a western blot
What antibody is typically used as a primary diagnostic for HIV
Anti-p24
What are HIV RNA levels monitored for
Diagnosis of Acute infection
Follow effectiveness of therapy
Indicated breakthrough of virus
Prognosis Prediction (w/CD4 level)
What does it mean when I call HIV RNA levels an independent prognostic factor?
Increases in RNA levels indicate progression of the disease
Three classifications of CD4 counts
Above 500
200-499
Less than 200
Strongest indicator of disease progression?
CD4 counts
Lymphoid pathology in earlier HIV patients
loss of T cells (esp in Peyer’s Patches)
Expansion of B cell areas
Lymphadenopathy
Lymphoid pathology in later HIV patients
Burned out pattern
Loss of most lymphoid elements
Cell Loss, Fibrosis
CNS pathology in HIV/AIDS patients
Subacute meningoencephalitis
Microglial nodules + Giant Cells
Why do all the opportunistic infections in AIDS present so weirdly in pathology
A lot of normal pathology is immune response to an organism.
Why is serology typically useless in diagnosing oportunistic infections?
IC patients can’t mount an antibody respnse
At time of transmission, what symptoms tend to occur
Acute Retroviral Syndrome
High levels of replicaton, viremia, and seeding
Lasts for 2-4 weeks
Role of concurrent infections in AIDS disease progress
Concurrent infections appear to accelerate the disease process by activating the immune system and increasing virus proliferation
Cause of CNS dementia in AIDS patients?
HIV infection of microglial cells
AIDS associated neoplastic conditions
Kaposi’s
Hodgkin’s
Lymphoma
Three common fungal opportunistic infections
Candidiasis
Pneumocystis Pneumonia
Cryptococcus
Presentation os Candidiasis in an AIDS patient
Mouth, esophagus
Appearance of thrush is an indicator of diminishing fxn
Significance of Pneumocystis Pneumonia
Nearly universal
Hallmark of the original epidemic
Cryptococcus infection is associated with what symptoms
Lung, Meningitis
GI infections associated with AIDS
Giardia
Entamoeba
Cryptosporidiosis (More severe)
Viral infections especially associated with AIDS
CMV, Herpes, Zoster
Tell me the story of Kaposi’s Sarcoma.
HHV8 infection causes a cancer of skin, mucous membranes, and GI. Proliferation of endothelial cells, smooth muscle cells, and pericytes. Causes inefficient vascular formation with blood filled channels.
Who gets Kaposi’s
MSM
Non-Hodgkin’s lymphoma is…
Cancer of B cell origin
Polyclonal B cell activation in extranodal sites/brain
Assoc. w/ EBV
AIDS carcinoma of cervix is associated with
HPV
WHy is vaccination for AIDS so ineffective
More antibodies –> More macrophage eating –> more disease process
Need a vaccine to stimulate specifically Cell-mediated responses
Complications of HAART therapy
Lipoatrophy, lipoaccumulation, elevated lipids Insulin resistance Periph. neuropathy Premature CV disease Renal/Hepatic Dysfxn
HAART stands for
Highly Aggressive Anti-retroviral therapy
Why does HAART therapy have so many complications? (Maybe?)
Persistent inflammation/T cell dysfxn
Beats AIDS I guess…
What tends to coinfect with cryptococus?
Pneumocystis
