HIV Symposium Flashcards
Where did HIV come from?
HIV 1 from Chimpanzees and HIV2 from sooty managebeys
When did the start calling it AIDS?
1982
HIV was discovered in?
1983- Pasteur
Gallo- 1984
Which drug was primarily given to HIV patients?
Zidovudine
Prophylaxis in 1989 was?
Nebulised pentamidine
AZT could reduce transmission by?
25 to 8%
Lazarus syndrome?
Blood circulation return spontaneously after your heart stops beating and fails to restart despite CPR.
What is highly active anti-retro viral therapy, HAART?
Combination therapy- usually at least 3 anti retro viral drugs
Side effects of HAART?
Wasting of face
Lipodystrophy (gain fat some places and lose in other)
Gain of weight
HIV life cycle?
Attaches to CD4, require cofactors CCR5
Fuses with membrane and releases 3 enzymes
Uses reverse transcriptase to turn rna strand to dna
DNA integrated to host nucleus , integrase
Produces proteins
Protease to snip proteins and buds off
Anti- retro viral classes?
Fusion inhibitors
Coreceptor inhibitors
Nucleoside reverse transcriptase inhibitors
Non nucleoside reverse transcriptase inhibitors
Integrate inhibitors
Protease inhibitors
How many viruses produced per person per day?
10 billion
Mutations in HIV happen every?
10,000 bases
Normal values of CD4?
> 500
If diagnosed for CD4 was less than 350 then increased risk of death is by?
10 fold
Combination prevention?
Treatment as prevention TasP
Pre-exposure prophylaxis- PrEP
Expansion of HIV testing
U=U?
Undetectable is untransmittable
PrEP?
Truvada (tenofovir)
When was PrEP allowed to be given?
Oct 2020
How many people living with HIV globally?
37.7 million
How much reduction in infections since 1997?
52%
What happens initially in HIV?
Mucosal infection keeps developing, HIV specific CD8 T cells rise sharply and reduce viral load, gradual loss of CD4 t lymphocytes
Where does the virus undergo lyric replication?
CD4 t helper cells
Examples of opportunities diseases?
Tuberculosis
PCP, pneumonia
Kaposi sarcoma
What is the main receptor for HIV?
CD4 via gp120
What are the stages of HIV?
Fusion Viral genome is released Reverse transcription Integration Replication and protein synthesis Budding New mature vision
What co receptors are present when HIV tries to invade a cell?
CXCR4 or CCR5
What is CCR5?
Receptor for RANTES, MIP 1 alpha
What are rantes and MIP 1 alpha and SDF 1?
Molecules involved in lymphocyte chemotaxis and HIV suppression
Where are high levels of HIV entry co-receptor CCR5 expressed?
Lamina propria and intraepithelial CD4 T cells
What happens to the co-receptors during HIV infection and and why is their role important?
Depleted
Prevention of invasive infection
Killing infected epithelial cells
Immune regulation
The viruses using CCR5 co receptors are called?
R5 viruses
Which strains are most commonly transmitted sexually?
R5
When are viruses able to use CXCR4?
5 years into infection
When they are able to use CXCR4 what are the viruses called?
X4, if use both then called
R5X4
How are CD4 T cell destroyed after HIV infection?
Death by cytoplasmic effects
Activation induced cell death apoptosis
Killing of infected cells by cytotoxic t lymphocytes
What are the mucosal HIV transmission routes?
Genitourinary, rectal and oral mucosa
What percent of CD4 cells are in gut?
60%
Lamina propria CD4 T cells express high levels of?
CCR5
Depletion of CD 4 t cells in the gut leads to?
Increased translocation of gram negative lipopolysaccharide positive bacteria
Rise of LPS systemically causes?
Immune activation and TNF production, which drive HIV replication and upregulation of CCR5
Whe did antibody test for HIV come out?
1985
In 1989 what was the treatment for HIV?
Nebuliser pentamidine
What was the mono therapy for HIV?
AZT- zidovudine
What is current practice?
Combination therapy 3 drugs
Normal vaginal delivery f viral load less than 40
Transmission rates less that 1
In early replication what are the levels of virus?
More than 10 million copies/ml
Aim for viral load to be?
Less than 40
Significant risk of morbidity and mortality if CD4 count is less than?
350cells/mm
Over 200 CD4 you are prone to?
TB, Kaposi’s Sarcoma,
shingles, oral thrush,
seborrhoeic dermatitis
Between 50 and 200 you are prone to?
Pneumocystis pneumonia,
toxoplasmosis, lymphoma
Under 50 CD4 you are prone to?
MAC, CMV, PML, CNS lymphoma
What is treatment as prevention?
Taking ART to prevent
What are the aims?
All new diagnosis on ARVs by 30 days
98-100% to be taking effective treatment
100% have undetectable viral loads
Event based PrEP?
2 tablets 2-24 hours before sex
1 tablet 24 hours later
1 tablet 48 hours later
AIDS related death reduced by?
64%
