HIV Slides 1-13: Intro

Question 1

How do retroviruses work?

Answer 1

Reverse transcriptase integrates viral RNA into host DNA - stays forever

Question 2

What do viral oncogenes do?

Answer 2

Transform the host cell to express oncogenes, growth factors. Malignant transformation occurs.

Question 3

What do host proto-oncogenes do?

Answer 3

Host non active genes that viral DNA activates to transform cells.
Leukemia or sarcoma viruses

Question 4

What is HTLV1

Answer 4

Human T-cell leukemia

Question 5

What is HTLV2?

Answer 5

Hairy T-cell leukemia

Question 6

What is the origin of HIV?

Answer 6

Cross-species transmission of Simian Immunodeficiency virus (SIV)

Question 7

How does HIV infect the cells?

Answer 7

Binds CD4 receptor on human t-lymphocytes (gp 120 and gp 41 on virus)

Question 8

What proteins does the HIV virus code for?

Answer 8

Reverse transcriptase, integrase, and protease

Question 9

What do viral encoded proteases do?

Answer 9

Cleave functional viral proteins from precursors

Question 10

How many new virions are produced each day?

Answer 10

10^9

Question 11

Infected T-cells have a half life of?

Answer 11

1.6 days

Question 12

Time from release of new virion to infection of a new cell and release of another new virion is?

Answer 12

2.6 days

140 generations of virus each year

Question 13

What are the goals of therapy for HIV?

Answer 13

Maximal and durable suppression of viral load (HIV RNA less than 50 copies per mL)

Reduction of HIV-related morbidity and mortality

Improvement of quality of life

Restoration of immunologic function

Prevent HIV transmission

Question 14

What treatment considerations are there for HIV?

Answer 14

Resistance (6-16% to at least one drug class)
Tropism (CCR5 or CXCR4)
Contraindications (CD4 count/HLA typing)
Co-morbidities (Hepatitis)
Adherence potential (greater than 95%) - dosing frequency, number, size of pills, cost, food and fluid restrictions
Adverse drug reactions (Potential drug interactions and pregnancy)

Question 15

In the first 2-4 weeks, what occurs to CD4+ cell count?

Answer 15

It decreases, then increases

Question 16

In the first 6-10 years, what happens to CD4+ cell count?

Answer 16

It continues to decrease

Question 17

In the last 2-3 years of HIV, what happens to CD4+ cell counts?

Answer 17

It continues to decrease

Question 18

In the first 2-4 weeks, what happens to virus levels in the blood?

Answer 18

They increase to a peak, causing flu like symptoms

Question 19

In the first 6-10 years, what happens to virus levels in the blood?

Answer 19

They decrease but stay at steady levels

Question 20

In the last 2-3 years, what happens to virus levels in the blood?

Answer 20

They start to increase again,

Question 21

What happens to anti-HIV antibody in the first 2-4 weeks?

Answer 21

They begin to increase when the HIV virus levels spike

Question 22

What happens to anti-HIV antibody in the first 6-10 years?

Answer 22

They increase to a peak and stay steady

Question 23

What happens to anti-HIV antibody in the last 2-3 years?

Answer 23

They start to decrease as virus levels increase

First skin and mucous membrane immune defects occur, then systemic immune deficiency

Question 24

When do we treat HIV patients?

Answer 24

All HIV infected individuals should be treated regardless of CD4 count to reduce morbidity and mortality from HIV infections and prevent transmission by infected individuals.

Question 25

What groups of patients require special attention with HIV treatment/

Answer 25

Pregnant women
Patients with HIV associated nephropathy, HIV associated dementia, or malignancies
Patients co-infected with HBV or HBC when treatment is indicated

Question 26

All patients treated for HIV should receive what?

Answer 26

Genotypic drug resistance
HLA-B 5701 testing (hypersensitivity reaction with Abacavir)
Co-receptor tropism testing (prior to Maraviroc use; CCR5 changes to CXCR4 or mixed tropic with decreased CD 4 counts)
Plasma viral RNA load (at baseline and regular basis thereafter esp after changes in therapy)

Question 27

What are the general treatment guidelines for HIV?

Answer 27

Two nucleoside reverse transcriptase inhibitors plus ONE of the following groups:

Non nucleoside reverse transcriptase inhibitor (2 NRTI + 1 NNRTI)

Protease inhibitor (boosted with Ritonavir) (2 NRTI + 1-2 PI)

Integrase stand transfer inhibitor based (2 NRTI + INSTI)