(1) HIV Flashcards by Geno Alinsub

most common medical condition associated with HIV patients

Pneumonia

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continuous uprise of the
chest when breathing

Retractions

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the px presenta a Respiratory Rate of 25, what category does this fall?

tachypnea

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characterized by having blue finger tips; lack of oxygen

Cyanotic

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caused by the Human Immunodeficiency Virus (HIV) attacking the CD4+ T lymphocytes

ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

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AIDS individuals have lowered count of this cell

CD4+ levels (T helper)

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what CD4+ level presents with px with AIDS

y CD4+ levels of less than or
equal to 0.1

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what is teh LAST STAGE of HIV infection

AIDS (<200 CD4+)

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what family HIV belongs to, also give the family’s characteristic

**Retroviridae
**
- 2 Copies of ssRNA
- Genome packed with several enzymes

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Give the characteristic of RETROVIRIDAE

ssRNA
Postive sense
Enveloped
Icosahedral

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where does HIV virus binds to?

CD4+ cells

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what happens to HIV virus after binding to CD4+ cells

D4+ cells and becomes internalized which will then decrease to an undetectable level

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why when a px with HIV have lower body immune defense to other pathogens?

the immune system is focused on the HIV so it left the other pathogen unnoticed making the px immunocompromised and nagkakasakit

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what is the replication princple for HIV virus

Reverse transctription

RNA –> DNA

uses reverse transcriptase

Viral DNA becomes incorporated into the host DNA, enabling further replication and multiplication

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HIV virus are member of?

Retroviruses and Lentivirus

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can HIV virus multiply on its own? Yes or mo

nawp, in need of host DNA then reverse transcription

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TOF

HIV virus can destroy so many of these cells that the body can’t fight
infections or opportunistic diseases

EURT

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TOF

HIB infection is a lifetime disease

F (HIV) gurl if nag t ka whats HIB then????

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how many HIV Genome

9 genes

3 categories:
- Structural proteins
- Regulatory proteins
- Accessory/Auxiliary proteins

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HIV Structure

genomic region encoding capsid proteins which mainly functions as part of the viral structure

Group-specific Antigen
(gag)

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Enumerate the Group-specific Antigen
(gag)

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HIV structure

genomic region encoding the viral enzymes

Polymerase
(pol)

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Enumerate the Polymerase
(pol)

Reverse Transcriptase (p66/p51)
Protease (p10)
Integrase (p31)

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HIV structure

genomic region encoding for glycoproteins

Envelope
(env)

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Enumeare the ENV proteins

- gp160 - gp120 - gp41

# HIV structure - Precursor, therefore, cannot be seen within the viral structure. - Myristolated protein

p55

# HIV structure **Matrix**; helps hold the envelope proteins to the virus.

p17

# HIV structure Capsid and Nucleocapsid

p24 (capsid) p7 (nucleocapsid)

# HIV structure Copies the virus’s RNA genome into DNA

Reverse Transcriptase (p66/p51)

# HIV structure - Processes proteins made from HIV’s genome so that they can become part of new fullyfunctioning HIV particles - Important for the viral replication.

Protease (p10)

# HIV structure - Integrates the DNA copy of HIV’s genome into the host DNA. - without this, means no replication.

Integrase (p31)

# 9 HIV GENOME positive regulator of transcription; accelerates the production of more HIV

Transactivator (tat)

# 9 HIV GENOME stimulates the production of HIV proteins, but suppresses the expression of HIV’s regulatory genes

Regulator of Viral Expression (rev)

# 9 HIV GENOME retards HIV replication (cellular proteins)

Negative Replication Factor (nef)

# 9 HIV GENOME increases the infectivity of the HIV (APOBEC3G), causing longer infections

Virion Infectivity Factor (vif)

# 9 HIV GENOME Transport of DNA to nucleus; accelerates the production of HIV proteins; arrests cell cycle

Viral Protein R (vpr)

# 9 HIV GENOME promotes intracellular degradation of CD4 and enhances release of virus from cell membrane

Viral Protein U (vpu)

# 9 HIV GENOME act aspromoters/enhancers of infection; “sticky ends”, which the integrase protein uses to insert the HIV genome into host DNA

Long Terminal Repeat (LTR)

Structural Proteins

gag, pol, env

Regulatory Proteins

tat, rev

Accessory Proteins

nef, vif, vpr, vpu, LTR

# Types of HIV 3 distinct virus groups (env gene based): M, N, O

HIV-1

# Types of HIV 5 subtypes identified: A, B, C, D, E

HIV-2

# Types of HIV Contains genes that encodes the structural proteins of the virus: gag, pol, env

HIV-1

# Types of HIV MAJOR difference with HIV– 1 is that it lacks the vpu gene and has a **vpx gene** not contained in HIV-1

HIV-2

# Types of HIV Also contains 6 other genes (tat, rev, nef, vif, vpr, and vpu)

HIV-1

origin of HIV virus came from cross-species infection by what virus from monkeys in rural Africa

simian viruses from monkeys

# Origin of AIDS/HIV In 1930 the Simian Immunodeficiency Virus (SIV) was introduced to humans that gave rise to ?

HIV–1 group M

TOF Current evidence: primate counterparts of HIV-1 & HIV – 2 transmitted to humans on multiple (at least 7) different occasions

True

enumerate the transmission of HIV virus

- Sexual Contact - Needle Sharing - Mother-to-child transmission (vertical transmission) - Contaminated blood transfusions and organ transplan

HIV cannot be transmitted through??

 Kissing  Hugging and other forms of touching  Sharing food and cutlery  Insect bites  Toilet seats  Bathing  Sneezes and coughs  Sweat

High titers of HIV are found in?

Blood and Semen

# Life Cycle of HIV after the VIRUS enter through transmission, what will happen next

it will go to the **macrophages** and the **dendritic cells**, affecting the lymphatic system, and then to the blood. | bold = APCs (recall hema)

# Life cycle of HIV TOF When the transmission is through needle sharing, the pathogenesis is faster as the infection goes straight to the blood

True

Enumerate the life cycle of HIV

1. Binding 2. Fusion 3. Reverse transcription 4. Integration 5. Replication 6. Assembly 7. Budding (ikaw)

# life cycle of HIV The HIV virus would attach itself to the receptors of the surface of a CD4 cell

BINDING

# Life cycle of HIV what receptors are in the surafe of a CD4 cell for budding

CD4 receptor along with the **CCR5** and **CXCR4** coreceptors.

# Life cycle of HIV The HIV envelope and the CD4 cell membrane fuse together which allows entry of HIV enzymes and cells to the CD4 cells

FUSION

# Life cycle of HIV HIV reverse transcriptase convert its genetic material RNA to DNA.

REVERSE TRANSCRIPTION

# Life cycle of HIV Inside the CD4 cell nucleus, HIV releases integrase (an HIV enzyme) then integrates to insert its viral DNA into the DNA of the CD4 cells.

INTEGRASE

# Life cycle of HIV - Then HIV virus begins to use the machinery of the CD4 cell to make long chains of HIV proteins. - The protein chains are building blocks for more HIV

REPLICATION

# Life cycle of HIV The new HIV proteins and HIV RNA move to the surface of the cell and assemble into immature noninfectious HIV

ASSEMBLY

# Life cycle of HIV Newly formed immature HIV pushes itself away from the host CD4 cell then releases protease which acts to break up the long protein chains that form the immature virus

BUDDING

# Life cycle of HIV The smaller HIV proteins combine to form mature infectious HIV.

BUDDING

proteins involved in binding

gp160 | 120 + 41

proteins involved in Fusion

gp41

proteins involved in Reverse transcription

p66/51

proteins involved in integration

p31

proteins involved in budding

p10

pathogenesis of HIV virus

Preferentially infects and kills helper (CD4+) T lymphocytes

what happens when HIV infects and kills cd4?

o Loss of cell-mediated immunity o High probability of opportunistic infections

# Pathogenesis TOF Main immune response consists of cytotoxic (CD8+) lymphocytes

eurt

# Primary HIV to Chronic Infection what is the first thing should take place for HIV virus?

Primary infection

# Primary HIV to Chronic Infection early signs/manifestration of HIV

infection in lymphoid tissue-lymphadenopathy

# Primary HIV to Chronic Infection leading to a wide dissemination to lymphoid organs. During this, there is a partial immunologic control of virus replication

Massive viremia

# Primary HIV to Chronic Infection Trapping of virus and establishment of?

chronic, persistent infection

# Primary HIV to Chronic Infection immune activation is mediated by?

cytokines and HIV envelope-mediated aberrant cell signaling

# Primary HIV to Chronic Infection Accelerated virus replication occurs wherein there is a rapid?

rapid CD4+ T cell turnover

# Primary HIV to Chronic Infection final part (diko gets hehi)

Destruction of the Immune system

# STAGES OF INFECTION HIV Virus: peaked (all time high) CD4: still high but decreasing (di biumababa ng 500 Anti-HIV antibody: gradual increase 2-4 weeks

Primary Infection

# STAGES OF INFECTION HIV virus: decrease (near the 0 value, has fluctuation) CD4: gradual decrease (<500) anti-HIV antibody: all time high 6-10 years

Latency

# STAGES OF INFECTION HIV virus: increasing from a dormant value cd4: decreasing Anti-HIV antibody: decrease 2-3 years (after 6-10 years)

AIDS

# STAGES OF INFECTION skin and mucous membrane immune defects systematic immune deficiency

AIDS

etting tested immediately for HIV will not work. Therefore, it is recommended to be tested within

3rd or 6th month of infection

# CLINICAL SYNDROMES - M. tuberculosis (disseminated tuberculosis) - HSV (HSV esophagitis) - C. albicans (esophageal candidiasis) - HHV-8 (Kaposi’s sarcoma)

CD4: <500

# CLINICAL SYNDROMES - P. jiroveci (PCP pneumonia) - T. gondii (cerebral toxoplasmosis) - C. neoformans (Meningoencephalitis) - C. immitis (Coccidioidomycosis) - C. parvum (chronic diarrhea)

CD4: <200

# CLINICAL SYNDROMES - M. avium (invasive pulmonary disease) - H. capsulatum (Histoplasmosis) - CMV (CMV retinitis)

CD4: <50

# STAGES OF THE VIRUS - Primary infection - Short, lasts for 2-4 weeks - Accompanied by flu-like illness; might also include fevers, chills, night sweats, and rashes

Stage 1

# STAGES OF THE VIRUS - The CD4+ cell count is at least 500 cells per microliter. - Diagnostic tests are not applicable

Stage 1

# STAGES OF THE VIRUS - Clinically asymptomatic/ WINDOW PERIOD - Lasts for an average of 5-10 years - This stage is free from symptoms.

Stage 2

# STAGES OF THE VIRUS - The CD4+ cell count is 350 to 499 cells per cubic meter - HIV antibodies are detectable in the blood

Stage 2

# STAGES OF THE VIRUS - Symptomatic HIV infection - The symptoms are mild such as skin rashes, fatigue, night sweats, slight weight loss, mouth ulcers, and fungal skin (candida albicans) and nail infections. - The CD4+ cell count is 200 to 349 cells per cubic meter. - Clinical diagnosis and blood test may be used.

Stage 3

# STAGES OF THE VIRUS - HIV to AIDS - Most common opportunistic infections manifest including pneumocystis carinii pneumonia (PCP), mycobacterium avium complex (MAC) disease, cytomegalovirus (CMV), toxoplasmosis, and **candidiasis**. | candidiasis - MOST COMMON

Stage 4

# STAGES OF THE VIRUS - The CD4+ cell count is less than 200 or the percent of CD4+ cells is less than 15% of all lymphocytes. - Clinical diagnosis and blood test may be used.

Stage 4

# CLINICAL STAGES OF HIV (WHO) - Asymptomatic - Generalized lymphadenopathy - Normal activity

Clinical Stage I

# CLINICAL STAGES OF HIV (WHO) - Weight loss <10% - Minor mucocutaneous conditions - Zoster <5 years - Recurrent upper respiratory infection

Clinical Stage II

# CLINICAL STAGES OF HIV (WHO) * Weight loss > 10% * Unexplained diarrhea > 1 month * Unexplained fever > 1 month * Thrush * Oral hairy leucoplakia * PTB in the past year * Severe bacterial infection * Bedridden <50% of days in the pastmonth

Clinical Stage III

# CLINICAL STAGES OF HIV (WHO) * AIDS defining illness * Bedridden for >50% of days in the past month

Clinical Stage IV

Cardinal feature of HIV infection is the depletion of

T helper-inducer lymphocytes

HIV co-receptor on lymphocytes includes the

CSCR4 chemokine receptor

serve as major reservoir for HIV in the body

Monocytes and macrophages

which organs play a central role in HIV infection

Lymphoid organs

HIV is actively replicating in?

lymphoid tissues

# TOF The macroenvironment of the lymph node is ideal for establishment and spread of HIV infection.

F (microenvironment)

Cytokines are released activating a large pool of?

CD4 (highly susceptible to HIV infection)

* Late stage of the disease characterized by CD4 < 200 cells/mm * Development of opportunistic infections, selected tumors, wasting & neurologic conditions

AIDS

# AIDS INDICATOR CONDITIONS Candidiasis in the esophagus, trachea, bronchi, lungs

16%

# AIDS INDICATOR CONDITIONS Cervical cancer, invasive

0.6%

# AIDS INDICATOR CONDITIONS Coccidioidomycosis, extrapulmonary

0.3%

# AIDS INDICATOR CONDITIONS Cryptococcosis, extrapulmonary

# AIDS INDICATOR CONDITIONS Cryptosporidiosis > 1 month diarrhea

1.3%

# AIDS INDICATOR CONDITIONS CMV other than liver & spleen

WHO SHOULD BE TESTED FOR HIV?

- Persons with high-risk behaviors (basta sex, pero MSM *gay shit* marami) - Persons with Certain Medical Conditions - Persons who have been sexually assaulted - Persons who have had occupational exposures (sexual workerss

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pa study ng schematics for HIV DIAGNOSTIC

TOF HIV infection established by detecting antibodies to the virus, viral antigens, viral DNA/RNA, or by culture

Screening serologic test?

ELISA

confirmatory testing serologic test

Western blot

at least how many ELISA reactive test before western blot?

at least 2 REACTIVE TEST

Western blot always coupled with?

**Enzyme immunoassay (EIA)** due to false positive results - 2%

False-negative results occurs if tests were done during the?

window period

Window period is the time delay from infection to presence of antibodies, average of what days

14-22 days | Antibodies present within 6 months

# WESTERN BLOT INTERPRETATION No bands | eyy central cee

Negative

# WESTERN BLOT INTERPRETATION Reactivity to gp41 + gp120/160 or p24 + gp120/160

Positive

# WESTERN BLOT INTERPRETATION Presence of band pattern that does not meet criteria for positive result

Intermediate

enumerate the screening process

1. Counselling 2. Blood sample is taken 3. Twice positive for screening, do confirmatory test 4. If 1st screening is negative, no further test done 5. Post test Counselling

5 hospitals in our country that specializes with HIV counseling and testing

- Research Institute of Tropical Medicine (RITM) - San Lazaro Hospital - St. Lukes Medical Center - Makati Medical Center - The Medical City

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read through INITIAL EVALUATION OF AN HIV INFECTED PERSON

When to initiate antiretroviral drugs?

- Symptomatic AIDS - CD4 < 200 previously - WHO: <350 cells/uL

- Provides ART for free to persons living with HIV (PLHIV) - Include consultation fee and lab tests - P 30,000 paid to the treatment facility where PLHIV is enrolled. - Provides financial support and covers the biomedical aspect of the HIV

Out-Patient HIV/AIDS Treatment (OHAT) Package

what are the ANTI-RETROVIRAL THERAPY

- Lamivudine/Tenofovir TDF/ Efavirenz (LTE) - Lamivudine/Tenofovir TDF/ Dolutegravir (TLD)

# ART - One-pill once a day regimen in the Philippines - Known to cause neuropsychiatric symptoms such as vivid dreams, severe depression or suicidal ideations

Lamivudine/Tenofovir TDF/ Efavirenz (LTE)

# newer version which replaces Efavirenz - One-pill once a day regimen in the Philippines - Started in 2020 - Officially recommended Dolutegravir-based ART as the first line regimen for PLHIV in 2022

Lamivudine/Tenofovir TDF/ Dolutegravir (TLD) | newer version which replaces Efavirenz

vaccine is available for HIV?

nawp Vaccine development difficult due to the following reasons: - HIV mutates rapidly - Not expressed in all cells that are infected - Not completely cleared by host response after primary infection

RECOMMENDED VACCINES FOR ALL PEOPLE WITH HIV

- Hepatitis B - Influenza (flu) - Human Papillomavirus (HPV) - Pneumococcal (pneumonia) - Tetanus, diphtheria, and pertussis - COVID vaccine

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study the facts, di naman to lalabas lahat basta key to remember - M2M - top 5 regions NCR, 3, 4A, 6, and 7 - 50% - aged 25-34 y.o - OFWs remain vulnerable to HIV

use this card rto familliarize stigma

gew na sa trans

# UNAIDS what are the set global target by 2030?

95-95-95 - know their HIV status - are on ART - achieved viral load suprresion

# UNAIDS Philippines achieved, as of Sept 2022, state the numbers

63-65-97 63 - knows their HIV statuse 65 - are on ART 97 - achieved viral load suppression

(1) HIV Flashcards

(139 cards)