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HD > Pathology 1: HIV & AIDS > Flashcards

Pathology 1: HIV & AIDS Flashcards

1
Q

What happens when a person has HIV?

A

HIV infects mainly CD4+ T cells, macrophages, and dendritic cells which express the surface receptor CD4.
Destroying CD4+ T cells leads to severe immunologic impairment and eventually death.

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2
Q

What happens in AIDS?

A

It’s the end stage of disease that is associated with CD4+ T cell depletion, multiple or recurrent opportunistic infections, and unusual cancer (kaposi sarcoma).

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3
Q

HIV belongs to which virus family?

A

Retroviridae.

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4
Q

The virion in HIV consists of what?

A

1- glycoprotein envelope (gp120, gp41).
2- matrix layer (p17).
3- capsid (p24).
4- two copies of (+) ssRNA.
5- enzymes (reverse tanscriptase, integrase, protease).

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5
Q

The HIV genome consists of ____ genes.
And what are they?

A

9 genes.
1- 3 structural genes (gag, pol, env).
2- 6 non-structural genes (tat, nef, rev,vif, vpr, vpu).

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6
Q

Which protein encode the gene “pol” and what is the function of proteins?

A

Protein: reverse transcriptase.
Function: transcribes RNA genome into DNA.

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7
Q

Which proteins encode the gene “env” and what is the function of proteins?

A

1- gp120: attachment to CD4 protein.
2- gp 41: fusion with host cell.

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8
Q

Which protein encode the gene “tat” and what is the function of proteins?

A

Protein: tat.
Function: activation of transcription of viral genes.

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9
Q

Which protein encode the gene “rev” and what is the function of proteins?

A

Protein: rev.
Function: transport of late mRNAs from nucleus to cytoplasm.

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10
Q

Which protein encode the gene “nef” and what is the function of proteins?

A

Protein: nef.
Function: decreases CD4 proteins.

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11
Q

Which protein encode the gene “vpr” and what is the function of proteins?

A

Protein: vpr.
Function: transports viral core from cytoplasm into nucleus.

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12
Q

List the 2 HIV species known to cause AIDS?

A

1– HIV-1.
2- HIV-2.

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13
Q

What are the properties of HIV-1?

A
  • Causes HIV infection worldwide.
  • Highly virulent.
  • Highly susceptible to mutations.
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14
Q

What are the properties of HIV-2?

A
  • Causes the infections in specific regions e.g. West Africa.
  • Relatively less virulent.
  • Relatively less susceptible to mutations.
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15
Q

List the 3 methods of transmission of HIV?

A

1- sexually (unprotected sex).
2- parenterally.
3- perinatally (from mother to baby).

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16
Q

How is HIV transmitted sexually through unprotected sex?

A

The virus is present in blood, semen and vaginal secretions.

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17
Q

How is HIV transmitted parenterally?

A
  • Direct exposure to infected blood of body fluids (e.g. receiving blood from infected donor).
  • Using contaminated or not adequately sterilized tools in surgical or cosmetic practice (dental, tattooing, body piercing).
  • Sharing contaminated needles, razors, or tooth brushes.
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18
Q

How is HIV transmitted perinatally (from mother to baby)?

A
  • Infected mother can transmit HIV to their babies transplacentally (25%).
  • Virus spread to child perinatally mainly (50%) during delivery (most common way).
  • Breastfeeding is also an important way of perinatal transmission (25%).
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19
Q

HIV is ________ inactivated.

A

Easily inactivated.

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20
Q

How is HIV inactivated?

A

By treatment for 10 min at 37C with any of the following:
- 10% house hold bleach, sodium hypochlorite.
- 50% ethanol.
- 35% isopropanol.
- 0.5% paraformaldehyde.
- 0.3% hydrogen peroxide.

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21
Q

HIV infection is divided to how many stages? and based on what?

A

3 stages, based on CD4+ T cell count and presence of opportunistic infections.

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22
Q

List the 3 stages of HIV infection?

A

1- the acute phase.
2- the chronic phase (PGL, ARC).
3- AIDS (the end stage of the disease).

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23
Q

How long is the incubation period for the acute phase of HIV infections?

A

Incubation period is 2 weeks and lasts for about 12 weeks.

24
Q

What are the symptoms in acute phase of HIV infection?

A

Mostly asymptomatic, but in 25-65% of the cases, patients may develop symptoms that resemble infectious mononucleosis or flu (fever, headache, anorexia, fatigue, lymphadenopathy, skin rash) which resolves in 2 weeks.

25
Q

What happens to viral replication and CD4+ T cell count in acute phase in HIV infections?

A

Rapid viral replication (high viral load > 10^6 copies/mL).
Gradual decrease in CD4+ T cell count.

26
Q

What are the blood markers found in acute stage of HIV infection?

A
  • normally to slightly decrease no of CD4+ T cells.
  • appearance of the viral RNA, and then the core antigen (p24 antigen) which indicate active viral replication.
  • appearance of two antibodies, anti-envelop (anti-gp120) & anti-core (anti-p24).
27
Q

What is the 1st choice marker for detection HIV in the acute phase?

A

HIV RNA.

28
Q

How long does the chronic phase in HIV infection last?

A

Lasts for about 10 yrs in adults, and 5 years in children.

29
Q

Which symptoms appear in chronic phase in HIV infections?

A

Totally asymptomatic but the patients are still contagious.

30
Q

What happens to viral load and CD4+ T cell count in chronic phase of HIV infection?

A

Relatively low viral load (<10^4 copies/mL).
CD4+ T cell count > 500 cells/mm^3.

31
Q

At the end of stage, two syndromes appear what are they?

A

1- persistent generalized lymphadenopathy (PGL).
2- AIDS-related complex (ARC).

32
Q

Definition: defined as enlargement of lymph nodes for at least 1 cm in diameter in the absence of any illnesses or medications.

A

Persistent generalized lymphadenopathy (PGL).

33
Q

List the clinical features in persistent generalized lymphadenopathy (PGL)?

A

1- in two or more lymph nodes out of the inguinal area.
2- persists for at least 3 months.

34
Q

Definition: a group of clinical symptoms that come before AIDS?

A

AIDS-related complex (ARC).

35
Q

List the clinical symptoms that are related to AIDS-related complex (ARC)?

A

1- fever of unknown origin that persists > 1 month.
2- chronic diarrhea, persisting > 1 month.
3- weight loss > 10% of the original weight (slim disease).
4- fatigue, night sweating, and malaise.
5- neurological disease as myelopathy and peripheral neuropathy.

36
Q

List the blood markers in the chronic stage of HIV infection?

A

1- viral load (HIV RNA) increases gradually, and HIV core antigen (p24) may appear in blood.
2- anti-envelop (Anti-gp120) & anti-core (anti-p24) are positive.
3- CD4+ T cell count gradually decreased but still more than 200 cells/mm^3.

37
Q

Which symptoms appear in the AIDS phase of an HIV infection?

A
  • Defects in cellular immunity.
  • Persistent or frequent multiple opportunistic infections,
  • Unusual cancer (kaposi sarcoma).
38
Q

What happens to the viral load and CD4+ T cell count in the AIDS phase in HIV infection?

A
  • continuous viral replication (high viral load).
  • marked decrease in CD4+ T cell count < 200 cell/mm^3.
39
Q

What are the blood markers in AIDS stage in HIV infection?

A

1- high viral load (HIV RNA), and HIV core antigen (p24) appears in blood.
2- detection of both HIV RNA and the antigen p24 indicative of active viral replication.
3- anti-envelop (anti-gp120) & anti-core (anti-p24) are positive.
4- CD+4 T cell count decreases to very low levels (<200 cell/mm^3).

40
Q

What is the diagnosis of HIV?

A

1- patient history with or without clinical symptoms.
2- detection of both HIV Ag & Ab in the patient serum by ELISA.
- if result is positive, repeat the screening test in duplicate.
- if repeatedly reactive (positive), do confirmatory tests (western blot, recombinant immunoblot assay (RIBA, or PCR).
3- blood viral load by PCR is also used to monitor HIV replication and follow up patients treatment.

41
Q

How do we prevent HIV?

A
  • no vaccine is available to prevent HIV infection.
  • best strategy to control the spread of HIV infection is by health education and HIV/AIDS awareness.
  • post exposure prophylaxis (PEP): should be given as soon as possible after exposure and continued for 28 days.
  • pre exposure prophylaxis (PrEP): given to individuals at high risk for infection.
42
Q

What is the treatment for HIV?

A

Combined therapy known as high active antiretroviral therapy (HAART).
- it doesn’t eradicate the virus.
- should be taken all life.
- HAART treated patient are still contagious even if their blood viral load below detection level (< 50 copies/mL).

43
Q

What is HAART composed of?

A

Two reverse transcriptase inhibitors and one integrase inhibitor or protease inhibitor.

44
Q

List the 2 types of reverse transcriptase inhibitors?

A

1- nucleoside analog RT inhibitors for HIV-1 and HIV-2.
2- non-nucleoside analog RT inhibitors for HIV-1 only.

45
Q

List nucleoside analog RT inhibitors for HIV-1 and HIV-2?

A

1- Zidovudine (AZT).
2- Stavudine (d4T).
3- Zalcitabine (ddC).
4- Lamivudine (3TC).

46
Q

List non-nucleoside analog RT inhibitors for HIV-1 only?

A

1- Nevirapine.
2- Delavirdine.
3- Efavirenz.

47
Q

List integrase inhibitors?

A

1- Dolutegravir.
2- Bicategravir.
3- Raltegravir.
4- Elevitegravir.
5- Cobicistat.

48
Q

List proteases inhibitors?

A

1- Sequinavir.
2- Indinavir.
3- Nelfinavir.
4- Ritonavir.

49
Q

List the 4 goals of HIV treatment?

A

1- to inhibit viral replication.
2- to control chronic immune activation and keep the immune system as close as possible to the normal state.
3- to prevent the development of opportunistic infections.
4- to minimize the chance of viral transmission especially from mother to neonate.

50
Q

List opportunistic infections that may happen because of an HIV infection?

A

1- pneumocystis pneumonia.
2- toxoplasmosis.
3- cryptococcal meningitis.
4- thrush caused by candida albicans.
5- retinitis caused by cytomegalovirus.
6- mycobacterium avium complex (MAC) infection.

51
Q

Which drug prevents pneumocystis pneumonia?

A

Trimethoprim - sulfamethoxazole.

52
Q

Which drug prevents toxoplasmosis?

A

Trimethoprim-sulfamethoxazole.

53
Q

Which drugs prevents cryptococcal meningitis?

A

Fluconazole.

54
Q

Which drug prevents thrush caused by candida albicans?

A

Glotrimazole.

55
Q

Which drug prevents retinitis caused by cytomegalovirus?

A

Ganciclovir.

56
Q

Which drug prevents mycobacterium avium complex (MAC) infection?

A

Azithromycin.

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