HIV Infection and AIDS Flashcards
Describe the course of HIV infection
- Acute retroviral HIV infection
- Clinical Latency (HIV Inactivity or Dormancy)
- Acquired Immunodeficiency Syndrome (AIDS)
- Living with HIV
What are the 4 critical areas of focus for ongoing HIV prevention, care and research for the NHAS?
- Widespread testing and linkage to care
- Support for PLWH to remain engaged in comprehensive treatment
- Universal viral suppression
- Full access to comprehensive pre-exposure prophylaxis (PrEP) services
What are the 4 critical areas of focus for ongoing HIV prevention, care and research for the NHAS?
- Widespread testing and linkage to care
- Support for PLWH to remain engaged in comprehensive treatment
- Universal viral suppression
- Full access to comprehensive pre-exposure prophylaxis (PrEP) services
What is HIV?
Human Immunodeficiency Virus
- Can lead to AIDS if not treated
- Unlike some other viruses, the human body cannot get rid of HIV completely, even with treatment. Once you get HIV, you have it for life.
HIV attacks the body’s immune system, specifically the CD4 cells (T cells), which help the immune system fight off infections.
Untreated, HIV reduces the number of CD4 cells (T Cells) in the body, making the person more likely to get other infections or infection-related cancers.
With proper medical care, HIV can be controlled.
Define Retrovirus
HIV belongs to a group of unusual viruses called retroviruses.
Retroviruses reverse the way nucleic acid is made during replication by using an enzyme (transcriptase). As the virus attaches to a healthy cells, it injects its viral RNA into the cell.
Reverse Transcription
Through a process called reverse transcription, and using the reverse transcriptase enzyme, the viral RNA produces a DNA copy of itself which is duplicated into a double-stranded DNA structure.
The viral DNA copy is then transported to the nucleus of the healthy cell, where it integrates into chromosomal DNA.
What makes developing a cure for HIV difficult?
The ability of HIV to integrate its DNA into human cell DNA makes the development of a cure challenging because proviral HIV DNA needs to be eliminated without damaging human DNA.
How fast does HIV replicate?
Very rapidly - about every 2 days
The typical infected person who is not taking Antiretroviral therapy (ART) has about one billion replications per day.
How fast does HIV replicate?
Very rapidly - about every 2 days
The typical infected person who is not taking Antiretroviral therapy (ART) has about one billion replications per day.
How fast does HIV replicate?
Very rapidly - about every 2 days
The typical infected person who is not taking Antiretroviral therapy (ART) has about one billion replications per day.
What are the primary organs of the immune system?
“lymphoid” organs
- Spleen
- Tonsils
- Adenoids
- Gut
- Appendix
- Lymph Nodes
What are the two major classes of lymphocytes?
B Cells and T Cells
B Cells -
Produce antibody to foreign antigens (such as those on the surfaces of bacteria or viruses). They either destroy the cells or mark them for destruction by other immune cells.
T Cells -
Carry most of the burden of fighting viral infections. Attack and destroy cells recognized as being foreign
Can also orchestrated, regulate, and coordinate the overall immune response.
How does an HIV infection work?
HIV does not infect all cells of the body - only cells with specific receptors to which it can attach.
After infecting the immune system, HIV often destroys the very system designed to protect the body from foreign invaders. if successful, HIV and other organisms can then replicate and cause disease with little or no effective response by the immune system.
The cells that HIV infects have a surface receptor called:
CD4+
T-helper cells in the immune system have this receptor. HIV can attack and destroy these cells faster than the body can make new ones.
What happens when enough T-helper cells are destroyed?
The immune system deteriorates. Functions like the ability to develop antibodies to new antigens, normal macrophage function to engulf and destroy microorganisms, and production of chemical messengers like interferon and interleukin which aid the immune response, are impaired.
What happens when enough T-helper cells are destroyed?
The immune system deteriorates. Functions like the ability to develop antibodies to new antigens, normal macrophage function to engulf and destroy microorganisms, and production of chemical messengers like interferon and interleukin which aid the immune response, are impaired.
What bodily fluids can transmit HIV?
- Blood
- Semen
- Pre-seminal Fluid
- Rectal Fluids
- Vaginal Fluids
- Breast Milk
Virus has been found in urine, but transmission after contact has not been reported.
What are the common ways HIV is transmitted?
- Condomless sex (vaginal or anal)
- Sharing of needles and syringes
- Mother to child during pregnancy or the birth process
- Breast feeding
- Transfusion of blood or blood products
- Transplantation of tissues and organs
What is the riskiest type of sex for getting or transmitting HIV?
Anal sex. Bottoming more risky than topping.
Lining of the rectum is thin and may allow HIV to enter the body during anal sex
What increases your risk of contracting or transmitting HIV?
Having an STD, urethritis,a genital ulcer, or having a sore or break in the skin from an STD.
What increases your risk of contracting or transmitting HIV?
Having an STD, urethritis,a genital ulcer, or having a sore or break in the skin from an STD.
How long can HIV live in a used needle?
Up to 42 days depending on temperatures and other factors
What are some ways HIV is NOT spread?
Casual contact with HIV-infected persons shaking hands sharing bathrooms working with an HIV-infected individual Food, water, and biting insects such as mosquitoes are not vehicles for HIV infection
What is the estimated percentage of people that don’t know they have HIV?
Of the estimated million + people with HIV in the United States, 1 in 7 (15%) do not know they are infected
Statistically, who is most affected by HIV?
Gay and bisexual men of all races, African Americans, Hispanics / Latinos.
In 2014, gay and bisexual men accounted for 70% of all new HIV infections.
Heterosexual sex made up less than 25%
Injection drugs made up less than 5%
44% African Americans, 26% whites, 25% Hispanics / Latinos
Stage 1:
Acute retroviral HIV infection
Within 2 to 4 weeks after infection, people may experience a flu-like illness, which may last for a few weeks. This is the body’s natural response to the infection
People are very contagious when they are in stage 1.
To know whether someone has acute infection, either a foureth-generation antibody/antigen test or a nucleic acid (NAT) test is necessary
Stage 1:
Acute retroviral HIV infection
Within 2 to 4 weeks after infection, people may experience a flu-like illness, which may last for a few weeks. This is the body’s natural response to the infection
People are very contagious when they are in stage 1.
To know whether someone has acute infection, either a fourth-generation antibody/antigen test or a nucleic acid (NAT) test is necessary
Stage 3:
AIDS
Acquired Immunodeficiency Syndrome
The most sever phase of HIV infection. Immune system is so severely damaged that they get an increased number of severe and opportunistic illnesses.
Without treatment, people at this stage live about 3 years
ART
Antiretroviral Therapy
Can taking ART reduce a person’s chance of transmitting HIV through sex?
Yes, by as much as 96%
What are CDC HIV Testing Recommendations?
Everyone between the ages of 13 and 64 should get tested for HIV at least once in their lifetime as part of routine health care.
Persons with specific risk factors should be screened at least annually:
- Diagnosed with or treated for hepatitis or TB
- Diagnosed with or sought treatment for another STD
- Exchanged sex for drugs or money
- Inject drugs and share needles or works with others
- Have had more than one sex partner since last HIV test
- Have had sex - anal or vaginal - with an HIV-positive partner
- If you are a man who has sex with another man
Sexually active gay and bisexual men may benefit from more frequent testing (every 3 to 6 months)
If a person is pregnant, they should be tested for HIV by their medical provider.
NATs and HIV
Nucleic Acid Tests look for the actual virus in the blood. The test result can be either positive / negative or an amount of virus present in the blood (known as an HIV viral load test).
This test is very expensive and not routinely used for screening individuals unless they recently had a high-risk exposure or a possible exposure with early sy mptoms of HIV infection
antigen / Antibody Tests and HIV
Antigen / Antibody tests look for both H IV antibodies and antigens.
Antibodies are produced by your immune system when you are exposed to bacteria or viruses like HIV.
Antigens are foreign substances that cause your immune system to activate.
If you are infected with HIV, an antigen called p24 is produced even before antibodies develop.
Rapid antigen / antibody tests are available
Antibody HIV Tests
Antibody tests detected the presence of antibodies in your blood or saliva. These tests do not test for HIV itself.
Most rapid tests and home tests are antibody tests.
In general, antiibody tests that use blood from a vein can detect HIV sooner after infection than tests done with blood from a finger prick or oral fluid.
Rapid tests can be ready in 30 minutes or less.
HIV Home Tests
Home Access HIV-1 Test System
- involves pricking your finger to collect a blood sample, sending the sample to a licensed lab, then calling for results. Confirmation followup should be done if test is positive
OraQuick in-home HIV Test
- Rapid test that uses saliva. Results generally available within 20 minutes. Followup should be done if test is positive. Oral fluid tests find infection later after exposure than do blood tests. 1 in 12 infected people may test false-negative with this test.
What are some behavioral strategies for preventing HIV?
- Abstinence
- Limiting the number of sexual partners
- Never sharing needles
- Using condoms the right way every time you have sex
What are some HIV prevention medicines?
Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) can prevent people who are HIV negative from getting HIV.
Pre-exposure Prophylaxis
A daily pill containing two antiretroviral drugs (tenofovir and emtricitabine) reduces the risk of getting HIV from sex by more than 90%. For drug users, reduces the risk by more than 70%
Can be used for people in an ongoing relationship with a positive sexual partner or have behavioral factors (inconsistent condom use, multiple partners) that indicate a risk for frequent HIV exposure and the need for intensive risk reduction interventions including PrEP.
Post-exposure Prophylaxis (PEP)
Taking antiretroviral medications (ART) after potentially exposed to HIV to prevent coming infected.
PEP should be used only in emergency situations and must be started within 72 hours after possible
Post-exposure Prophylaxis (PEP)
Taking antiretroviral medications (ART) after potentially exposed to HIV to prevent coming infected.
PEP should be used only in emergency situations and must be started within 72 hours after possible
True or False:
HIV does not infect all cells of the body - only cells with specific receptors to which it can attach
True.
After infecting the immune system, HIV often destroys the very system designed to protected the body from foreign invaders. If successful, HIV and other opportunistic organisms can then replicate and cause disease with little or no effective response by the immune system.
True or False:
HIV infection is a disease that invariably kills the people who are infected with it
False.
ART therapies have transformed HIV from a disease that causes premature death to one that can be controlled in many ways. Treatment helps infected persons who feel healthy remain healthy. Treatment also helps people who are sick - they can generally be made better with treatment.
True or False:
HIV can be transmitted through unprotected sex, and through the inhalation of tiny particles expelled by sneezing
This statement is false. Blood, semen, pre-seminal fluid, rectal fluids, and vaginal fluids are the major means of transmission. While the virus has been found in other body fluids (e.g. Urine), transmission after contact with these secretions has not ben reported. The virus is not transmitted via sneezing or coughing.
True or False:
Sexually transmitted diseases can greatly facilitate HIV transmission
True.
STDs, and especially STDs that cause ulcers such as syphilis or chancroid, can greatly facilitate HIV infection.
True or False:
A large number of people who are infected with HIV are unaware of their infection
True. Approximately one in seven persons living with HIV in 2014 were unaware of their infection.
True or False:
Blood transfusion is the most frequently reported risk factor for transmission of HIV
False.
Condomless sex is the most frequently reported risk factor for transmission. Receptive anal intercourse carries the highest risk of transmission, followed by receptive vaginal intercourse.
Since 1985 all donated blood in the United States has been tested for HIV, and donations have been screened for HIV risk factors. These efforts have eliminated HIV infection acquired from donated blood or organs.
True or False:
Testing for HIV antibodies in bone marrow is the most common way to identify HIV infection
False.
Testing for HIV antibodies in blood (serologic testing) is the most common way to identify HIV infection. HIV infection is detected using a sequence of antibody tests.
True or False:
Enzyme immunoassay tests are the most widely used serologic tests for HIV screening in the United States
True.
However, rapid tests are being used more often, especially in clinics, testing centers, and outreach [or nonclinical] settings
True or False:
Rapid tests can produce results in 20 minutes or less, but they can only be conducted using blood serum.
False.
Rapid tests can produce results in 20 minutes or less, but they can be conducted on oral fluid, finger-stick whole blood, venous blood, serum, and plasma. Rapid tests allow individuals to receive test results the same day that they are tested. This can substantially improve the number of persons who receive their HIV test results.
True or False:
The main purpose of supplemental tests is to ensure that individuals are not incorrectly diagnosed as HIV-infected
True.
The main purpose of supplemental tests is to ensure that individuals with reactive screening tests are not incorrectly regarded as HIV-infected.
STD Cofactor Effect
Since the beginning of the HIV pandemic, researchers have consistently noted a strong epidemiologic association between HIV and other STDs. Research indicates at least a 2 to 5 fold increased risk for HIV acquisition for persons who have other STDs.
This “STD cofactor effect” is particularly strong for diseases characterized by genital ulcers; in particular, chancroid. In these diseases, the open sores allow the easy entry or exit of HIV.
These tests do not test for HIV itself, but detect the presence of antibodies:
a. Antigen tests
b. Nucleic acid tests
c. Antibody tests
d. None of the above
c. Antibody tests
The initial manifestation of HIV infection:
a. Acute HIV infection
b. AIDS
c. Clinical/latent HIV infection
d. When people have small amount of virus in their blood
a. Acute HIV infection
These tests look for the actual virus in the blood:
a. Antibody tests
b. Nucleic acid tests
c. Antigen tests
d. None of the above
b. Nucleic acid tests
These tests detect HIV at the earliest stage of infection:
a. Nucleic acid tests
b. Antibody tests
c. Antigen / antibody tests
d. None of the above.
a. Nucleic acid tests
This medicine is taken to treat HIV:
a. Pre-exposure prophylaxis (PrEP)
b. Antiretroviral therapy
c. Post-exposure prophylaxis (PEP)
d. None of the above
b. Antiretroviral Therapy
The most severe phase of HIV infection is:
a. Acute HIV infection
b. Acquired immune deficiency syndrome
c. Clinical / latent infection
d. None of the above
b. Acquired Immune Deficiency Syndrome (AIDS)
This is one of the riskiest behaviors to acquire HIV:
a. Condomless receptive anal sex
b. Using clean needles
c. Condomless vaginal sex
d. None of the above
a. Condomless receptive anal sex
This public health strategy aims to use health department surveillance data to identify HIV-diagnosed individuals who are not in care, link them to care, and support them in progressing along the HIV care continuum:
a. Partner Services
b. HIV testing
c. Data to Care
d. None of the above.
c. Data to Care
This HIV prevention strategy involves taking antiretrovirals before an exposure in order to prevent HIV infection:
a. PEP
b. prP
c. PrEP
d. None of the above
c. PrEP
Pre-exposure prophylaxis
The body fluid that is NOT likely to transmit HIV:
a. Semen / pre-seminal fluid
b. Vaginal Fluid
c. Saliva
d. Blood
c. Saliva
Infection with HIV:
a. Generally progresses to AIDS after 8 to 10 years, because the virus replicates slowly within the body
b. Attacks a specific type of immune system cell called CD4
c. Destroys the cells in which it replicates
d. All of the above
d. All of the above
Opportunistic infections:
a. Occur when CD4+ cells reach sufficiently low levels
b. Include tuberculosis
c. When a person gets opportunistic infections or specific cancers, they have reached the stage of AIDS
d. All of the above
d. All of the above
The immune system:
a. Is the body’s last line of defense in fighting infection
b. Uses B cells to initiate an immune response
c. Begins to break down once a certain number of T-helper cells are destroyed
d. None of the above
c. Begins to break down once a certain number of T-helper cells are destroyed.
HIV rapid tests:
a. Are used in clinical and nonclinical settings, usually with blood from a finger prick or with oral fluid
b. Can’t be self-administered
c. Provide results within 30 minutes
d. All of the above
d. All of the above
The main purpose of supplemental or confirmatory tests is to:
a. Eliminate the need to perform a screening test
b. Reduce testing costs
c. Confirm the accuracy of a reactive HIV screening test
d. All of the above
c. Confirm the accuracy of a reactive HIV screening test.
