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LAST EXAMMMMMM Year I > Retroviruses, HIV and AIDS > Flashcards

Retroviruses, HIV and AIDS Flashcards

1
Q

What are the 3 unique big picture conceps of retroviruses

A

that they have reverse transcriptase
they can activate pro to-oncogenes
they can destroy CTLs

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2
Q

what do most retroviruses cause

A

leukemias and sarcomas

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3
Q

What are acute transforming viruses

A

retroviruses that carry intact oncogenes with genome

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4
Q

What enzyme to retroviruses have to incorporate viral genome into hose

A

integrase

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5
Q

what are defective acute transforming viruses

A

retroviruses that have lost own RNA needed for replication so need coinfecting virus to cause cancer(if obtained oncogene)

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6
Q

what are non-acute transforming viruses

A

activate host pro to-oncogenes by integrating viral DNA into key regulatory area

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7
Q

What would you have high on Ddx if patient from tropics has tropical spastic paraparesis

A

Human T cell leukemia virus I

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8
Q

What is the structure of HIV

A

spherical enveloped virus with central cylindrical nucleocapsid
2 ss RNA pieces with a nucleocapsid proteins and 3 essential enzymes
icosahedreal symmetry with capsid proteins (p24)

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9
Q

What 3 enzymes must HIV have

A

protease, reverse transcriptase and integrase

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10
Q

What surface glycoproteins are on HIV

A

gp120 and 41

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11
Q

What are the long terminal repeats in retroviruses

A

sticky ends and have promoter/enhancer functions

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12
Q

What genes are encoded on all retroviruses

A

gag
pol
env

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13
Q

What additonal genes does HIV encode for besides gag pol env

A

tat, rev, nef, vif, vpr, vpu

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14
Q

what gene codes for the major structural proteins in retroviruses and what are these proteins

A

gag(Group Ag)

Nucleocapsid, capsidAg(p24) and matrix proteins

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15
Q

What gene encodes for retroviral enzymes

A

pol

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16
Q

What does env encode for in retroviruses

A

envelope proteins that form glycoprotein spikes gp 120 and gp41 (gp160 and bind to CD4 T cells)

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17
Q

What are the early proteins in HIV

A

tat, rev and nef

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18
Q

What are the late proteins in HIV

A

vif, vpr, vpu

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19
Q

What does tat encode

A

Transactivator protein that binds genome and activates transcription

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20
Q

what does rev encode

A

binds to env to decrease splicing so increases reading of gag, pol and env to increase virions

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21
Q

what does nef encode

A

down regulates CD4 and MHC class I to escape CTL killing

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22
Q

What does vif encode

A

required for ds DNA to be produced from HIV RNA genome

also blocks APOBEC3 enzymes

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23
Q

What are the APOBEC enzymes

A

that break down newly made viral DNA

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24
Q

What does vpr encode

A

Viral protein R that regulates nuclear import of HIV-1 and is required for viral replication in non-dividing cells

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25
Q

What does vpu encode

A

downregulates CD4 and MHC I expression on cell surfaces and facilitates HIV virion release from cells

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26
Q

Why is HIV so hard to create a vaccine against

A

has highest mutation rates in many of its components

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27
Q

What group of HIV is responsible for majority of worlds HIV

A

Group M

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28
Q

What area is subtype HIV B common in

A

North America and Europe

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29
Q

How is HIV spread

A

parenteral route

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30
Q

Why are you more prone to HIV is have concurrent STD

A

the already there inflammation increases change of HIV-laden macrophages and lymphocytes

31
Q

What are the risks from needle prick to contract HIV? Hep B? Hep C?

A

HIV 0.3%
Hep B 30%
Hep C 3%

32
Q

what other cells besides T helper cell shave CD4 R

A

macrophages, monocytes, dendritic cells

33
Q

What must the cell have for fusion and translocation of HIV into host

A

co R CCR5 or CXCR4

34
Q

What proteins from lymphocytes inhibit HIV infection by binding CCR5

A

RANTES
MIP1-alpha
MIP1-beta

35
Q

where is viral RNA reverse transcribed into DNA

A

cytoplasm

36
Q

What are the 3 stages after HIV infection

A

acute viral illness
a clinical latency
AIDS

37
Q

describe acute viral illness from HIV

A

like mononucleosis: fever, malaise, lymphadenopathy, pharyngitis)
high levels blood bourne HIV that infect lymph nodes and macrophages

38
Q

describe clinical latency from HIV

A

median of 8 years
no symptoms but general lymphadenopathy
steady gradual destruction of CD4 T cells
at end more susceptible to bacterial infections and have systemic symptoms like fever, weight loss, night sweats and adenopathy

39
Q

Define AIDS and average lifespan

A

live about 2 years
CD4 count less than 200 with serologic evidence of HIV
many opportunistic infections-AIDS related

40
Q

What are the AIDS related opportunistic infections

A

Candida esophagitis, pneumocystis carinii pneumonia and Kaposi’s sarcoma

41
Q

What are normal CD4 counts and how steadily do they decline in HIV

A

1000 is normal, decline 60 cells/ulblood/year

42
Q

what are symptoms of CD4 count around 400-200

A 
weight loss, fever, night sweats, adenopathy
skin infections(candida)
bacterial infections (M TB)
43
Q

What type of infections occcur in patients under 200 ul

A

Pneumocystitis carinii pneumonia
Cryptococcus neoformans
Taxoplasma gondii

44
Q

What infection (rare to humans) occurs in AIDs patients with CD4 less than 50

A

Mycobacterium avium-intracellulare MAC

CMV also

45
Q

What are the best predictor of opportunistic infections in HIV patient

A

CD4 counts

46
Q

The viral load of HIV can tell you what about the disease

A

how quickly the CD4 are dropping

47
Q

How do infected T cells form multinucleated giant cells

A

the gp 160 fuse together

48
Q

How are uninfected bystander CD4 T cells destroyed in HIB

A

from Fas mediated mechanism as result HIV proteins being released open and sitmulating apoptosis

49
Q

How are B cells affected by HIV

A

polyclonal activation causing hypergammagloculinemia causing IC formation and autoAbs

50
Q

What cells are not destroyed by HIV but rather are reservoirs

A

monocytes and macrophages

51
Q

What are the widespread symptoms from AIDS

A

night sweats, fevers, lymphadenopathy and severe weight loss

52
Q

What type of meningitis occurs with AIDS

A

aseptic

53
Q

What type of malignancies are common in AIDS

A

B cell lymphoma(with EBV)
Kaposi’s sarcoma HHV-8
non-hodgkins lymphoma, cervical cancer and anal intraepithelial neoplasia

54
Q

What does kaposi’s sarcoma look like

A

red to purple lesions that are plaques or nodules and all over the body

55
Q

What does MAC cause

A

smoldering wasting disease
fever, night sweats, weight loss and diarrhea
elevated liver function tests
Fever of unknown origin in AIDS

56
Q

What type of fungal infections do AIDS patients suffer from

A

candida albicans
cryptococcus neoformans
histoplasma capsulatum and cocidoides immitis
pneumocystis jiroveci pneumonia (PCP)

57
Q

what does cryptococcus neoformans cause in AIDS pateitns

A

meningitis
fever, nausea, vomiting
not meningeal inflammation- may just be fever
HA, mental status changes, fever.

58
Q

what does histoplasma capsulatum and coccidoides immitis cause in AIDS patients

A

disseminated disease in meninges, lungs skin and other areas

59
Q

What is the most common opportunistic infection in US among AIDS patients

A

PCP or PJP
cough and hypoxia
CXR interstital infiltrates or normal

60
Q

What viral infections are common in AIDS patients

A

Herpes Zoster
EBV
Herpes simplex
CMV

61
Q

what does herpes zoster look like in AIDS patients

A

non dermatomal zoster

62
Q

what does EBV cause in AIDS patients

A

oral hairy leukoplakia

white hairlike projections from side of tongue(will not rub off like thrush)

63
Q

What does CMV look like in AIDS patients

A

chorioretinitis and blindness

dysphagia and diarrhea

64
Q

What protozoal infections are common in AIDS patients

A

toxoplasma gondii

Cryptosporidium, Microsporidia an dIsosporabelli

65
Q

Toxoplasma gondii causes what in some AIDS patients

A

lesions in the brain

fever, HA, focal neurologic deficits like seizures

66
Q

what do the other protozoal parasites cause in AIDS patients

A

chronic diarrhea

67
Q

When can viral RNA Ag like p24 be detected after HIV exposure

A

in weeks

68
Q

When can Ab agains HIV Ag be detected after exposure

A

3-6 weeks

69
Q

What is used to confirm HIV Dx

A

western blot after +ELISA

70
Q

What proteins are checked in western blot for HIV

A

gag, pol and env

71
Q

What is a + western blot for HIV

A

if has 2 HIV gene products

p24, gp41 and gp120

72
Q

are the rapid HIV tests confirmatory

A

no even though super specific and sensitive, must have western blot pulled

73
Q

in the 3-6 week incubation period after HIV exposure what will clinicians do for Dx

A

measure HIV RNA with PCR

74
Q

What is HAART

A

Highly Active Antiretroviral Therapy

use of 3 drug therapies

LAST EXAMMMMMM Year I (24 decks)

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