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Part 3 – PM3A > (PM3A) HIV & Anti-Retroviral Therapy > Flashcards

(PM3A) HIV & Anti-Retroviral Therapy Flashcards

1
Q

How many people have died from HIV?

A

33 million

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2
Q

How many people in the world are living with HIV?

A

38 million

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3
Q

Where is HIV most prevalent?

A

Africa - 2/3 of total HIV cases

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4
Q

How many people die from HIV every year?

A

700,000

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5
Q

How many new HIV infections are there every year?

A

1.7 million

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6
Q

How many people have access to anti-retroviral therapy?

A

25.4 million

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7
Q

How many people in the UK are living with HIV?

A

105,000

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8
Q

What age range is affected most by HIV infection?

A

35-49

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9
Q

What is UNAIDS 90-90-90?

A

A global target set for countries to have:

(1) ≥90% HIV+ to be diagnosed
(2) ≥90% HIV+ to be on ART
(3) ≥90% HIV+ to have viral load depressed

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10
Q

What is ART

A

Anti-retroviral therapy

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11
Q

What does HIV stand for?

A

Human Immuno-deficiency Virus

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12
Q

What is the cause of HIV?

A

Lentivirus - a type of retrovirus

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13
Q

What type of virus is lentivirus?

A
  • Group IV
  • ssRNA
  • Positive sense
  • Enveloped
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14
Q

How does lentivirus cause HIV?

A

Infects immune cells

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15
Q

What are the immune cells infected by lentivirus to cause HIV?

A

(1) CD4+ T helper cells
(2) Macrophages
(3) Dendritic cells

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16
Q

What is a CD4+ T cell also known as?

A

Helper T cell

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17
Q

What is a helper T cell also known as?

A

CD4+ T Cell

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18
Q

(1) What is most commonly caused by lentivirus?

(2) What is also caused by lentivirus?

A

(1) HIV-1

(2) HIV-2 - less virulent and less infective

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19
Q

How does the infection of immune cells by lentivirus lead to low levels of helper T cells?

A

(1) Direct viral killing of infected cells
(2) Increased apoptosis of infected cells
(3) Killing of infected CD4+ T cells by CD8 cytotoxic lymphocytes

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20
Q

What does a CD8 cytotoxic lymphocyte do?

A

Kills infected CD4+ (Helper) T cells

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21
Q

What white blood cell kills CD4+ (Helper) T cells?

A

CD8 cytotoxic lymphocytes

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22
Q

What effect does increased death of CD4+ (Helper) T cells have?

A

(1) Increased susceptibility to opportunistic infections

(2) Susceptibility increases as CD4+ (Helper) T cell count falls below critical level

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23
Q

What is the 1st stage of the HIV life cycle?

A

Lentivirus binds to CD4 receptor to fuse with host cell membrane

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24
Q

What is the 2nd stage of the HIV life cycle?

A

Virus uncoats and viral RNA + proteins enter host cell

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25
What is the 3rd stage of the HIV life cycle?
Viral DNA is transcribed via reverse transcriptase
26
What is the 4th stage of the HIV life cycle?
Viral DNA enters nucleus Integrates into host genome using viral integrase
27
What is the 5th stage of the HIV life cycle?
New viral DNA is used as genomic RNA This is used to make new viral proteins
28
What is the 6th stage of the HIV life cycle?
Viral RNA and viral proteins gather at the cell membrane
29
What is the 7th stage of the HIV life cycle?
Budding leads to a mature viral particle being released from the cell
30
How many stages are there in the HIV life cycle?
7 stages
31
How can HIV enter the body?
(1) Into the bloodstream | 2) Mucous membranes (vagina/ penis/ anus
32
Where is HIV present in the body once contracted?
- Semen - Vaginal fluids - Breast milk - Blood - Rectal excretions
33
How can HIV be transmitted?
(1) Unprotected sex (2) Mother-to-baby (3) IV drug use - needle sharing/ needle stick injury (4) Blood transfusions
34
How can HIV spread be prevented?
(1) HIV testing (2) Condoms (3) Post-exposure prophylaxis (PEP) (4) Pre-exposure prophylaxis (PrEP) (5) Needle exchange programmes + clean needles (6) Blood screening
35
How is HIV diagnosed?
ELISA - immunoassay Detection of antibodies for HIV Detection of p24 antigen
36
What is the period for which HIV+ patients may test negative with older tests?
3 months
37
Where can tests be accessed by the public?
ø Sexual health clinics ø Hospitals ø GP surgeries ø Community pharmacies
38
What tests are undertaken by the patient following an HIV positive diagnosis?
(1) Immunoassay (ELISA) to differentiate between HIV-1 and HIV-2 (2) HIV NAT (Nucleic Acid Test)
39
When do AIDS symptoms occur following HIV infection?
7.5yrs post-infection
40
How does HIV lead to death if left untreated?
Progressively destroys all CD4+ (Helper) T cell lymphocytes
41
What is the acute infection stage of HIV infection called?
Seroconversion
42
What is seroconversion?
The acute infection stage of HIV
43
What is the chronic infection (asymptomatic) stage of HIV infection called?
Clinical latency
44
What is clinical latency? What are its symptoms?
The chronic infection stage of HIV Presents as asymptomatic
45
(1) What are the potential symptoms of initial HIV infection? (2) What is this initial infection stage called?
(1) Flu-like symptoms: Fever, headache, rash | (2) Seroconversion - Acute infection stage
46
Are HIV antibodies present in the acute infection stage (seroconversion)?
No They are only starting to be made
47
When does the body's CD4+ (Helper) T lymphocyte count begin to decline in an HIV infection?
Acute infection stage - Seroconversion
48
When can common infections be seen in an HIV infection?
(1) Clinical latency stage - chronic infection stage
49
What characterises AIDS?
(1) Immune system can no longer fight infection (2) Low CD4+ (Helper) T lymphocyte count (3) High viral load
50
When are opportunistic infections observed in HIV infections?
AIDS stage of infection
51
What happens if an HIV infection (AIDS) is left untreated?
Death
52
How is AIDS developed?
Untreated HIV infection
53
What is ART?
Anti-retroviral therapy
54
What are the aims of ART?
- Increase CD4+ (Helper) T lymphocyte count - Increase quality of life + life expectancy - Decrease risk of infections - Decrease transmission - Decrease viral load - Decrease risk progression
55
What are the types of ART?
(1) Entry/ fusion inhibitors (2) RT (reverse transcriptase) inhibitors (3) Integrase inhibitors (4) Protease inhibitors
56
What stage(s) of the HIV-life cycle does an entry/ fusion inhibitor affect?
Stage 1: Virus receptor binding Stage 2: Virus uncoating and entry of RNA and proteins into CD4+ (Helper) T cell
57
What stage(s) of the HIV life-cycle does an RT inhibitor affect?
Stage 3: Viral DNA transcription using reverse transcriptase
58
Which stage(s) of the HIV life-cycle does an integrase inhibitor affect?
Stage 4: Prevents integration of viral DNA into host genome
59
Which stage(s) of the HIV life-cycle does a protease inhibitor affect?
Stage 5: Prevents generation of new viral proteins Stage 6: Prevents assembly of viral proteins and RNA at the CD4+ (Helper) T cell membrane
60
What are the types of reverse transcriptase inhibitor?
(1) NRTIs | (2) NNRTIs
61
What is an NRTI?
- Cause DNA chain termination | - Analogue of dNTPs
62
What is an NNRTI?
- Direct inhibitor of HIV reverse transcriptase
63
How can the formation of mature viral particles be prevented?
Protease inhibitor drugs
64
How can host integration be prevented?
Integrase inhibitor drugs
65
What is the 1st line treatment for HIV? (2) What drug(s) are included in the first line treatment for HIV?
(1) Combination therapy | 2 ø 2 NRTIs ø + 1 NNRTI/ PI/ INI
66
How can viral load be decreased in HIV infections in pregnancy?
Integrase inhibitor drug
67
How is transmission of an HIV infection from mother to child prevented?
Antenatal screening
68
What does PrEP stand for?
Pre-exposure prophylaxis
69
What is currently the only PrEP on the market?
Truvada
70
Who is PrEP medicine intended for?
HIV negative individuals who are at risk of HIV infection
71
How much, as a %, does PrEP treatment reduce HIV infection risk by?
>90%
72
What PEP (also known as PEPSE) stand for?
Post-exposure prophylaxis
73
When is PEP treatment implemented?
Following a high-risk exposure to HIV, e.g. sex/ needle-stick

Part 3 – PM3A (28 decks)

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