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Test 2 Acquired Immunodeficiency Flashcards

1
Q

HIV

A

Human Immunodeficiency Virus

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2
Q

AIDS

A

Acquired Immuno Deficiency Syndrome

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3
Q

Role of Lipid Membrane in HIV and AIDS

A

Makes it so virus can’t reproduce without a host

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4
Q

Role of GP120 and GP41 in HIV/AIDS

A

Glycoproteins that allow the virus to get entry into WBCs

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5
Q

Role of P24 in HIV/AIDS

A

Sits of the protein coat
Tests looks for this

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6
Q

Role of reverse transcriptase in HIV/AIDS

A

Helps to cut and shape
Makes HIV unique bc it can insert as viral RNA which makes viral DNA that inserts into genetic material

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7
Q

Anatomy of HIV

A

Capsid
- 2 single strand RNA
- reverse transcriptase
- P17
- P24
Envelope
- lipid bilaterally
- GP120
- GP41

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8
Q

Retrovirus DNA Transcription

A

How it can infect T4 cells
GP120 and GP41 help it to bing to the CD4 receptor that sits on the T4 cells
Then it inserts itself into the cell
Reverse transcriptase takes the viral DNA from it and makes strands of viral DNA that then go into the nucleus and insert into genetic material

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9
Q

Retrovirus Production of New Virions

A

The virus partial buds off of the nucleus and reproduces itself
GP120 and 41 are expressed on the surface and it goes to find more receptors to repeat process

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10
Q

Why body can’t fight off HIV

A

MHC1 identifies new cells and problems of the cell surfaces
CD4 receptors and GP120 and GP41 are all NORMAL things so it makes it hard to identify
T cells can ONLY kill it when it is actively replicating

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11
Q

Viral RNA after released from nucleus

A

Moves out of the nucleus into the cytoplasm and makes long chains of viral proteins and enzymes
Immature viral particle forms containing cellular and HIV proteins
Chains cut into smaller pieces by protease
Infectious viral particle ready to be released containing HIV RNA viral proteins and enzymes

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12
Q

Two branches of immune system

A

Antibody mediated and cell mediated

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13
Q

Antibody mediated immune response

A

Copes with disease causing microbes in the BLOOD

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14
Q

Cell mediated immune response

A

Copes with microbes located within CELLS

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15
Q

Help T cells - CD4 Cells

A

Helper cells coordinate and activate both B lymphocytes (antibody mediated) and cell killing cytotoxic lymphocytes (cell mediated)

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16
Q

HIV and Helper T cells

A

HIV infects and destroys the CD4 (helper T) cells
The loss of these cells leads to immune system collapse and HIV disease
Decline in these cells is used as a marker of HIV progression

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17
Q

Cytotoxic T-cells - CD8 Cells

A

Important in initial immune response to HIV and latent stage
Kill infected cells that are producing virus
Secrete soluble factors that suppress HIV replication by occupying receptors necessary for the entry of certain strains of HIV into the target cell

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18
Q

HIV replication rate

A

Billions per day
99% if HIV in vlood is from newly infected cells
30% of HIV in plasma replaced daily
Entire HIV population turnover Q14 days

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19
Q

HIV mutation rate

A

1 in 3 replication cycles > 3300 mutant viruses per day

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20
Q

HIV half life

A

1-2 days

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21
Q

HIV and immune system effects

A

Extensive seeding occurs early in disease
“Sanctuary sites” - dendritic cells of lymph nodes and glial cells of the CNS (very bad)
Billions of CD4 cells are produces, infected and destroyed per day
CD8 cells destroy CD4 and macrophage infected cells bc it is recognized as not host > makes immune system very weak

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22
Q

Life span of CD4 cells

A
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23
Q

Transmission of HIV

A

Bodily fluids:
Blood
Semen
Vaginal secretions
CSF
Synovial fluid
Pleural and amniotic fluid

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24
Q

Non transmissible body fluids

A

Urine
Sweat
Saliva
Tears
Vomit
Mucus
Feces

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25
Risk factors for HIV
Sexual activity Injection drug use Recipients of blood produces (1975-March 1985) Hemophiliacs who received pooled plasma Children with HIV moms Needle sticks
26
ELISA
HIV SCREENING testing Enzymes Linked ImmunoSorbent Assat Determines response of antibodies to HIV virus Only used in children older than 18 months
27
Western Blot
HIV CONFIRMATORY test Confirms the presence of HIV antibodies Useful in children older than 18 months + in younger than 18 months only indicates that the mother is infected
28
p24 Antigen
HIV testing - INDICATES ACTIVE HIV REPLICATION Used to detect HIV antigen in children younger than 18 months Can be useful at any age Only a + result is significant 2 or more + results are diagnostic
29
CD4+ test
HIV test PREDICTOR OF PROGRESSION Used to assess immune status, risk for disease progression and need for PCP prophylaxis
30
DNA HIV - Viral nucleic acid tests
HIV test MEASURES AMOUNT OF ACTIVELY REPLICATING HIV - Polymerase Chain Reaction (PCR) - Nucleic acid sequence based amplification - Branched chain DNA tests
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Viral Culture
HIV Test Highly specific but negative results are meaningless Not frequently used to diagnose HIV
32
Immunofluorescence Antibody Testing
HIV Test Alternative to western blot for confirmation of HIV infection
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Urine and Saliva Serologic Testing
HIV Test Urine EIA Saliva EIA
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Rapid Enzyme EIA
HIV Test
35
Home Testing
HIV test Finger stick specimen sent to a lab
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DC4 Lymphocyte Percentage Test
Predictor of HIV progression Monitor immune function Increased risk for infection/malignany if CD4 < 20%
37
Laboratory Criteria
Positive result from an HIV antibody screening test confirmed by a positive results from a supplemental HIV antibody test OR Positive result or report of detectable quantity from any of the HIV virologic (non-antibody) tests
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Description of HIV
Chronic infection Variable course Infects cells with CD4 receptors - T4 or Helper T lymphocytes Causes cell death and decline in immune function
39
HIV s/s
Acute infection Self limiting syndrome lasting about 6-8 weeks post infection Associated with development of IV antibody Asymptomatic infection Persistent generalized lymphadenopathy
40
S/s of a true HIV infection
Mononucleosis-like syndrome Fever Rash Myalgia Malaise
41
Asymtomatic infection of HIV
Follows initial infection Variable duration
42
Persistent generalized lymphadenopathy
Lymph node enlargement 1 cm or greater in 2+ extra-inguinal sites Adenopathy persists longer than 3 months
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1-3 months of HIV
HIV infection Flu like symptoms
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1-10+ years following HIV infection
Can be asymptomatic OR Fatigue Diarrhea Fever Thrush Skin rash Weight loss Swollen glands
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HIV Stage 1
No AIDS defending condition And either: CD4+ T-lymphocyte count of >500 cells/3L OR CD4+ T-lymphocyte percentage of total lymphocytes of > 29
46
HIV Stage 2
NO AIDS defending condition And either: CD4+ T-Lymphocyte count of 200-499 cells/3L OR CD4+ T-Lymphocyte percentage of total lymphocytes of 14-28
47
HIV Stage 3 (AIDS)
CD4+ T-lymphocyte count <200 cells/3L OR CD4+ T-lymphocyte percentage of total lymphocytes <14 OR Documentation of an AIDS-defining condition (This supersedes a CD4+ count of >200 and a CD4+ percentage >14)
48
HIV Infection Stage Unknown
No info available on CD4+ T-lymphocyte count or percentage and no info available on AIDs-defining conditions
49
AIDS-Defining Conditions
MAJOR cancers and opportunistic infections are the big ones
50
Systemic effects of HIV
Fever Night sweats Weight loss Nausea
51
System effects of HIV - Sinopulmonary
Pneumocystis jiroveci pneumonia Non-infectious pneumonia Sinusitis
52
Systemic effects of HIV - CNS Disease
Toxoplasmosis CNS lymphoma AIDS dementia complex Cryptococcal meningitis HIV myelopathy Progressive multifocal leukoencephalopathy
53
Systemic effects of HIV - Peripheral NS disease
Peripheral neuropathy
54
HIV Systemic effects - Other
Rheumatologic - Arthritis - SLE Myopathy Retinitis Oral Lesions
55
Systemic effects of HIV - GI
Candidal espohagitis Hepatic disease Biliary disease Enterocoilitis Gastropathy Malabsorption syndrome
56
Skin manifestations of HIV
Herpes simplex infection Herpes zoster Molluscum contagiosum Folliculitis Superficial abscesses Bullous impetigo Bacillary angiomatosis Fungal rashes Kaposi’s sarcoma Sevorrheic dermatitis Psoriasis
57
Drug Resistance Testing
Genotypic Assays - detect drug resistance mutations present in relevant vital genes Phenotypic Assays - measure the ability of a virus to grow in different concentrations of antiretroviral drugs
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HIV treatment goals
Reduce HIV related morbidity and prolong serval Improve quality of life Restore and preserve immunologic function Maximally and durably suppress viral load Percent vertical HIV transmission
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HAART
Highly Active Antiretroviral Treatment - keep viral load to undetectable levels and minimize seeding of the lymphatic system with HIV - multi-drug approach through to strike at various points of the viral life cycle - decrease dec of resistance to meds - minimize medication toxicities
60
Reverse Transcriptase Inhibitors
Type of Antiretroviral: can be Nucleoside or Non-nucleoside Acts early in the life cycle of HIV Prevent to HIV enzyme from creating HIV or viral DNA from viral RNA > prevents new viruses from being produced
61
Non-nucleoside Reverse Transcriptase Inhibitors
do NOT require intracellular phosphorylation for activation; directly bind to and disrupt catalytic site of reverse transcriptase > chain termination
62
Nucleoside Reverse Transcriptase Inhibitors
work by chain termination and competitive inhibition of nucleoside triphosphate
63
Protease Inhibitors
Type of Antiretroviral - act late in the life cycle of the HIV - Block HIV enzyme protease > prevent creation of cleavage of HIV polyproteins necessary for production of new virions
64
Fusion Inhibitor
Type of Antiretroviral - Attach to proteins on surface of T-cells or HIV - Prevent binding of proteins on HIV’s outer coat (GP120 and GP41) with surface receptors on T-cells (CCR5, CXCR4) - At present Enfurvirtides bind to GP41
65
Drug Side Effects
Diarrhea Pancytopenia Dyslipidemias Lipodystrophy Lactic acidemia Hypertriglyceridemia Nephrolithiasis Insulin resistance Adherence is a KEY issue
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Patho 2 (6 decks)

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