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MTC 3- Immunology > 10.10 HIV > Flashcards

10.10 HIV Flashcards

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1
Q

The spleen is an important site for storage of _ and _

A

The spleen is an important site for storage of platelets and lymphocytes (B & T)
* The spleen is considered a secondary lymphoid organ

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2
Q

The spleen also filters the blood and removes _

A

The spleen also filters the blood and removes damaged RBCs/ platelets

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3
Q

The spleen is also the site of _ before the development of bone marrow

A

The spleen is also the site of hematopoiesis before the development of bone marrow

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4
Q

The (red/ white) pulp of the splenic parenchyma functions to filter out the damaged RBCs from circulation and is involved in lymphocyte development

A

The red pulp of the splenic parenchyma functions to filter out the damaged RBCs from circulation and is involved in lymphocyte development
* We have more red pulp than white in our spleens

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5
Q

The white pulp in the spleen serves the main function as _

A

The white pulp in the spleen serves the main function as repository for lymphocytes
* Acts as a secondary immune organ

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6
Q

The spleen is located in _ quadrant of the body

A

The spleen is located in left upper quadrant of the body
* Inside the peritoneum
* It is the largest lymphovascular organ

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7
Q

The spleen is located (in front/ behind) the stomach and (above/ below) the diaphragm

A

The spleen is located behind the stomach and below the diaphragm

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8
Q

The two main functions of the splenic capsule are to _ and _

A

The two main functions of the splenic capsule are to:
1. Discharge RBCs into circulation
2. Stretch to accommodate incoming RBCs

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9
Q

The contractile cells found in the spleen are called _ ; they help discharge RBCs into circulation

A

The contractile cells found in the spleen are called myofibroblasts; they help discharge RBCs into circulation

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10
Q

The splenic capsule also has a layer of dense _ that will stretch to accommodate incoming blood cells as needed

A

The splenic capsule also has a layer of dense fibroelastic tissue that will stretch to accommodate incoming blood cells as needed

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11
Q

At the hilum, the splenic capsule forms septa called _ that pierce the splenic parenchyma so that the splenic artery, vein, lymphatics, and nerves can get send blood out

A

At the hilum, the splenic capsule forms septa called trabeculae that pierce the splenic parenchyma so that the splenic artery, vein, lymphatics, and nerves can get send blood out

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12
Q

The _ ligament connects the spleen to the greater curvature of the stomach

A

The gastrosplenic ligament connects the spleen to the greater curvature of the stomach
* Also contains the gastric arteries and veins and the gastroepiploic artery and vein

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13
Q

The _ ligament connects the spleen to the left kidney; it also contains the splenic artery and vein as well as the tail of the pancreas

A

The splenorenal ligament connects the spleen to the left kidney; it also contains the splenic artery and vein as well as the tail of the pancreas

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13
Q

The splenic artery is a branch off of the _ artery and it enters and exits the spleen at the _

A

The splenic artery is a branch off of the celiac artery and it enters and exits the spleen at the hilum

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13
Q

The splenic vein travels towards the liver and merges with the superior mesenteric vein to form the _

A

The splenic vein travels towards the liver and merges with the superior mesenteric vein to form the portal vein

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14
Q

The splenic lymph nodes are found at the _ , next to the _

A

The splenic lymph nodes are found at the hilum , next to the tail of the pancreas

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14
Q

In open circulation, blood first enters the _ before RBCs can move through the sinusoids and back into circulation

A

In open circulation, blood first enters the splenic cords before RBCs can move through the sinusoids and back into circulation

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15
Q

What are splenic cords?

A

Splenic cords are extravascular structures that contain tissue macrophages that phagocytose the old RBCs
* They also contain reticular cells and connective tissue as support

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16
Q

During open circulation, RBCs will percolate through the splenic cords; then the healthy ones re-enter the circulation through the _

A

During open circulation, RBCs will percolate through the splenic cords; then the healthy ones re-enter the circulation through the splenic sinusoids

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17
Q

Explain the components of the slit-like openings in the spleen

A

Stave cells are elongated endothelial cells
* They are surrounded by reticular fibers, in a barrel like fashion

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18
Q

Only (damaged/ healthy) RBCs pass through the slits in the spleen

A

Only healthy, nonsenescent RBCs pass through the slits in the spleen –> enter the sinusoids –> return to circulation
* Damaged RBCs are inflexible and cannot pass through the slits; they are left behind to be phagocytosed by macrophages in the splenic cords

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19
Q

The two structures found in the white pulp are _ and _

A

The two structures found in the white pulp are periarteriolar lymphoid sheath (PALS) and splenic follicles

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20
Q

The PALS component of the white pulp mostly contains (B cells/ T cells)

A

The PALS component of the white pulp mostly contains T cells

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21
Q

The splenic follicles component of the white pulp mostly contains (B cells/ T cells)

A

The splenic follicles component of the white pulp mostly contains B cells

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22
The center of the follicle is called the _ and contains the activated B cells
The center of the follicle is called the **germinal center** and contains the **activated B cells**
23
The _ lies just outside of the germinal center (follicle) and it contains _
The **mantle zone** lies just outside of the germinal center (follicle) and it contains **resting B cells**
24
The _ zone is found outside of the mantle zone, it is an important link between B-cell containing follicles and the T-cell containing PALS
The **marginal zone** is found outside of the mantle zone, it is an important link between B-cell containing follicles and the T-cell containing PALS
25
Maraviroc & Enfuvirtide
**Maraviroc & Enfuvirtide**: HIV entry and fushion inhibitor
26
Tenofovir Emtricitabine Lamivudine Abacavir Zidovidine (AZT) Didanosine Stavudine
Tenofovir Emtricitabine Lamivudine Abacavir Zidovidine (AZT) Didanosine Stavudine **NRTIs - Reverse transcription inhibitors** (nucleotide/ nucleoside)
27
Efavirenz Nevirapine Rilpivirine Etravirine Doravirine
Efa**vir**enz Ne**vir**apine Rilpi**vir**ine Etra**vir**ine Dora**vir**ine **NNRTIs- Reverse transcrption inhibitors** (non-nucleoside)
28
Raltegravir Elvitegravir Dolutegravir Bictegravir Cabotegravir
Ral**tegravir** Elvi**tegravir** Dolu**tegravir** Bic**tegravir** Cabo**tegravir** **Integration inhibitors**
29
Darunavir Atazanavir Fosamprenavir Indinavir Lopinavir Ritonavir Saquinavir
Daru**navir** Ataza**navir** Fosampre**navir** Indi**navir** Lopi**navir** Rito**navir** Saqui**navir** **Budding/ maturation** (protease inhibitors)
30
Maraviroc is a drug that prevents the binding of HIV to human cells by blocking the receptor, _
**Maraviroc** is a drug that prevents the binding of HIV to human cells by blocking the receptor, **CCR5**
31
Enfuvirtide blocks the entry of HIV by binding to glycoprotein _
**Enfuvirtide** blocks the entry of HIV by binding to glycoprotein **gp41** * Becomes exposed once HIV binds to *gp120*
32
Tenofovir is an HIV nucleotide reverse transcriptase inhibitor that acts as a _ analog
**Tenofovir** is an HIV nucleotide reverse transcriptase inhibitor that acts as a **adenosine** analog
33
Emtricitabine & lamivudine are HIV nucleotide reverse transcriptase inhibitors that act as _ analogs
**Emtricitabine** & **lamivudine** are HIV nucleotide reverse transcriptase inhibitors that act as **cytosine** analogs
34
Abacavir is an HIV nucleotide reverse transcriptase inhibitor that acts as a _ analog
**Abacavir** is an HIV nucleotide reverse transcriptase inhibitor that acts as a **guanosine** analog
35
Zidovudine (AZT) is an HIV nucleotide reverse transcriptase inhibitor that acts as a _ analog
**Zidovudine (AZT)** is an HIV nucleotide reverse transcriptase inhibitor that acts as a **thymidine** analog
36
Non-nucleoside reverse transcriptase inhibitors inhibit reverse transcriptase by _
Non-nucleoside reverse transcriptase inhibitors inhibit reverse transcriptase by **binding directly to reverse transcriptase**
37
One advantage to _ inhibitors is that they do not affect cholesterol or trigglycerides
One advantage to **integrase strand transfer inhibitors** is that *they do not affect cholesterol or trigglycerides*
38
_ inhibitors inhibit the final step of replication when polyprotein chains get chopped into smaller proteins that are mature HIV units
**Protease inhibitors** inhibit the final step of replication when polyprotein chains get chopped into smaller proteins that are mature HIV units
39
Protease inhibitors often require a booster of a CYP450 inhibitor, like _ or _
Protease inhibitors often require a booster of a CYP450 inhibitor, like **ritonavir** or **cobicistat**
40
Combination therapy is often used against HIV: including the use of two _ and one _
Combination therapy is often used against HIV: including the use of two **NRTIs** and one **INSTI**
41
In the US, the most common resistance to HIV medications is to _ class of drugs
In the US, the most common resistance to HIV medications is to **NNRTIs** class of drugs
42
The use of NRTIs can lead to mitochondrial toxicity, such as _ or _
The use of NRTIs can lead to **mitochondrial toxicity**, such as **pancreatitis** or **neuropathy**
43
_ is known to cause kidney injury or bone loss
**Tenofovir** is known to cause kidney injury or bone loss * *Due to reduced reabsorption of PO4- in the PCT*
44
_ is known to cause bone marrow suppression (neutropenia)
**Zidovudine** is known to cause bone marrow suppression (neutropenia)
45
_ can cause pancreatitis
**Didanosine** can cause pancreatitis
46
_ is known to cause CNS toxicity and QT prolongation & changes in hepatic enzymes
**Efavirenz** is known to cause CNS toxicity and QT prolongation & changes in hepatic enzymes
47
Protease inhibitors may cause issues with _ or _
Protease inhibitors may cause issues with **diabetes/ insulin resistance** or **hyperlipidemia/ dyslipidemia**
48
_ may cause severe rash and fever and elevated liver enzymes
**Darunavir** may cause severe rash and fever and elevated liver enzymes
49
Efavirenz is an NNRTI that (induces/ inhibits) CYP450
Efavirenz is an NNRTI that **induces** CYP450
50
For high risk populations, PrEP can be adminstered; this is a combination of _ and _
For high risk populations, PrEP can be adminstered; this is a combination of **tenofovir** and **emtricitabine**
51
_ and _ are two examples of opportunistic infections that are more likely to occur in HIV patients
***P jiroveci* pneumonia** and **toxoplasmosis** are two examples of opportunistic infections that are more likely to occur in HIV patients
52
Kaposi sarcoma
**Kaposi sarcoma** is a vascular tumor caused by herpesvirus 8 that causes brown and purple blotchy lesions in organ systems, mucous membranes, and on the skin
53
Life cycle of HIV virus
1. HIV virus **binds and fuses** host cell 2. HIV **releases viral proteins** like reverse transcriptase and integrase 3. **RT** converts RNA --> DNA 4. Inside the nucleus the DNA gets integrated into host DNA via **integrase** 5. Integrated DNA is **transcribed** by host cell machinery to make new HIV RNA 6. **Assembly** of viruses 7. **Protease** cleaves mature HIV viruses
54
HIV damages the immune system by infecting _
HIV damages the immune system by infecting **CD4**
55
HIV binds to CD4 and to chemokine co-receptors CXCR4 or CCR5 binding _ and entering via fusion with _
HIV binds to CD4 and to chemokine co-receptors CXCR4 or CCR5 binding **gp120** and entering via fusion with **gp41**
56
How do HIV patients normally present?
Acute HIV illness may occur 2-4 weeks after infection * Fever * Sore throat * Rash * Lymphadenopathy * GI upset * Myalgia *Might mimic mono*
57
Severely immunocompromised HIV (progression to AIDS) is defined as a CD4 count less than _
Severely immunocompromised HIV (progression to aids) is defined as a CD4 count less than **200 mm3**
58
We often diagnose HIV with _ test, which can detect antibodies; we confirm with HIV-1/ HIV-2 differentiation ELISA and Western blot
We often diagnose HIV with **ELISA** test, which can detect antibodies; we confirm with HIV-1/ HIV-2 differentiation ELISA and Western blot
59
What illnesses are common < 200 mm3
60
What illnesses are common < 100 mm3
61
What illnesses are common < 50 mm3
62
Within about 2 days post HIV infection, dendritic cells are presenting and infecting the CD4+ cells --> About 3 days after HIV infection, the infected cells have traveled to the _ --> After 3 days (72 hours) the infection has entered the bloodstream and affected target organs (brain, spleen, GALT, GU)
Within about **2 days** post HIV infection, **dendritic cells** are presenting and infecting the **CD4+** cells --> About **3 days** after HIV infection, the infected cells have traveled to the **regional lymph nodes** --> **After 3 days (72 hours)** the infection has entered the **bloodstream** and affected target organs (brain, spleen, GALT, GU)
63
The structural gene *env* encodes for the glycoprotein _ which allows attachment for HIV
The structural gene *env* encodes for the glycoprotein **gp120** which allows **attachment** for HIV
64
The structural gene *env* encodes for the glycoprotein _ which allows for fusion/entry of HIV into cells
The structural gene *env* encodes for the glycoprotein **gp41** which allows for **fusion/entry** of HIV into cells
65
The primary problem with HIV infection is that the virus causes direct lysis of _ cells
The primary problem with HIV infection is that the virus causes direct lysis of **CD4+** cells
66
Downstream effects of CD4+ cell death:
Downstream effects of CD4+ cell death: * **Thymic dysfunction** * **Bone marrow dysfunction** * **Limited ability of T cells to expand in periphery** * **CD8** * **Decreased innate immunity**: Th1 normally stimulates macrophages (INF-gamma) * **Drop in IgG, IgE, etc** :can't get class switching
67
Acute HIV usually involves a sharp increase in viral load; _ cells are responsible for bringing this down
Acute HIV usually involves a sharp increase in viral load; **CD8+** cells are responsible for bringing this down
68
Acute retroviral syndrome can present with no symptoms or may present with symptoms that mimic _
**Acute retroviral syndrome** can present with no symptoms or may present with symptoms that mimic **mono**
69
The *gag* gene encodes for the capsid proteins, including _
The *gag* gene encodes for the capsid proteins, including **p24**
70
The *pol* genes encode for the important enzymes _ , _ , and _
The *pol* genes encode for the important enzymes **reverse transcriptase** , **integrase** , and **protease**
71
Recall that HIV is a _ retrovirus
Recall that HIV is a **+ssRNA** retrovirus
72
The four stages of HIV viral replication that are targeted by HIV drugs:
1. Fusion/entry 2. Reverse transcription 3. Integration 4. Proteolysis
73
(gp120/ gp41) attaches to CD4 marker on the host cell
**gp120** attaches to CD4 marker on the host cell
74
(gp120/ gp41) attaches to CCR5 receptor on the host cell
**gp41** attaches to CCR5 receptor on the host cell
75
_ drugs can cause lactic acidosis
**NRTIs** drugs can cause lactic acidosis
76
NRTIs can cause _ effects on the liver
NRTIs can cause **hepatic steatosis**
77
_ drugs can cause peripheral fat wasting
**NRTIs** drugs can cause peripheral fat wasting (lipoatrophy)
78
Hepatotoxicity is a side effect of _
Hepatotoxicity is a side effect of **efavirenz**
79
Hyperlipidemia, insulin resistance, and diabetes are side effects of _
Hyperlipidemia, insulin resistance, and diabetes are side effects of **protease inhibitors**
80
We can boost the efficacy of protease inhibitors by adding _
We can boost the efficacy of protease inhibitors by adding **cobicistat** or **ritonavir** which act as **CYP3A4 inhibitors**
81
The standard HAART regimen is two _ and one _
The standard HAART regimen is two **NRTIs** and one **PI** or **Int-I** (usually integrase inhibitor used) * Common: tenofovir + emtricitabine, abacavir + lamivudine
82
During the 1st trimester of pregnancy, (integrase/ protease) inhibitor should be used in HAART
During the 1st trimester of pregnancy, **protease inhibitor** should be used in HAART
83
After the 1st trimester of pregnancy, (integrase/ protease) inhibitor should be used in HAART
After the 1st trimester of pregnancy, **integrase inhibitor** should be used in HAART
84
Post-exposure (PEP) HIV treatment is _
Post-exposure (PEP) HIV treatment is **standard HAART** (2 NRTI + 1 integrase inhibitor)
85
Pre-exposure (PreP) HIV treatment is _ or _
Pre-exposure (PreP) HIV treatment is **two NRTIs** or **one NRTI + one integrase inhibitor** * Ex: tenofovir + emtricitabine * Ex: raltegravir + lamividine

MTC 3- Immunology (8 decks)

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