Lecture 6

Question 1

What is the pathology of HIV?

Answer 1

Retrovirus(uses own RNA to replicate) invades CD4 T helper, dendrite, and monocytes to replicate
Causing our body to be susceptible to infections and cancers

Question 2

What is the pathology of AIDS?

Answer 2

Outcome of chronic HIV
Depletion of CD4 (<200 cells) OR had AIDS defining condition

Question 3

Who are at risk populations for HIV?

Answer 3

Men who have sex with men
Transgender people
People who inject drugs
Sex workers
Heterosexuals
Healthcare workers (needle sticks 3/1000)

Question 4

How is HIV transmitted?

Answer 4

Blood
Semen
Pre-seminal fluid
Rectal fluids
Vaginal fluids
Breast milk

Question 5

What is the common entry for HIV?

Answer 5

Anogenital mucosa
Notes: anal intercouse

Question 6

How does HIV invade cells?

Answer 6

Infects T cells by interacting between glycoprotein(gp120) and T-cell coreceptor (CXCR4) and monocyte by interacting with CCR5 co-receptor

Question 6

How does HIV invade cells?

Answer 6

Infects T cells by interacting between glycoprotein(gp120) and T-cell coreceptor (CXCR4) and monocyte by interacting with CCR5 co-receptor

Question 7

How does HIV transfer from DCs to CD4?

Answer 7

DCs capture and bind HIV
HIV is traveled along with the DC
HIV is transferred to CD4 T cells through trans-infections

Question 8

What are the stages of HIV infection?

Answer 8

Viral transmission/ HIV acquisition
Acute HIV infection/Acute retroviral syndrome(symptomatic stage)
Chronic HIV infection
Advanced HIV infection (CD4 count <50cells/mL)

Question 9

Can features help define a chronic HIV infection?

Answer 9

Can be asymptomatic
Aids <200 cells/mL
Presence of AIDS defining condition

Question 10

What are the clinical manifestations of of acute retroviral syndrome?

Answer 10

Nonspecific viral syndrome (fever, chills, diaphoresis, pharyngitis, lymphadenopathy, myalgias/arthrlagias, cephalgia, fatigue)

Spontaneous resolution
Latent until profession into AIDS

Question 11

Who should be tested for HIV?

Answer 11

Known or suspected sexual or hematologic exposure
Have sexual history
Known drug abuse, especially IVDU
Accidental needlestick
Pregnancy
Recent sexually transmitted infection
CDC recommends routine screening ages 13 - 64 years at least once in their lifetime

Question 12

What should you take if you test positive on an ELISA test for HIV to make sure?

Answer 12

Western Blot (this test is expensive)
Second ELISA

Question 13

What are other tests to consider when diagnosing for HIV?

Answer 13

Pregnancy Test
Serum hepatitis B serology
Serum hepatitis C serology
CBC with Diff
BMP or CMP
UA, LFTs, Fasting plasma glucose, Lipid profile
Human leukocyte antigen-B*5701 testing
PPD, CXR

Question 14

What can you take for Pre-exposure prophylaxis (PrEP)?

Answer 14

For high-risk patients
Behavioral changes
Tenofavir(Truvada, drug class NRTI)

Question 15

When someone has HIV what should we also test for?

Answer 15

Tuberculosis

Question 16

What are some routine immunizations to help prevent HIV?

Answer 16

Pneumococcal vaccine
Inactivated influenza vaccine annually in season
Hepatitis A/B vaccine
Tdap vaccine
HPV vaccine for patients <45 years of age
Haemophilus influenzae type b vaccine

Question 17

What non-medical things can we do that helps prevent HIV?

Answer 17

Safe sex practice
Avoids consumption of raw meat, eggs, shellfish (toxoplasma, salmonella, campylobacter)
Avoid cleaning cat litter (toxoplasma)
Avoid cat scratches/bites (bartonella)
Consider consumption of bottled water(cryptosporidium)

Question 18

What is the goal of antiretroviral therapy?

Answer 18

Suppression of HIV replication

Question 19

What are the types of drugs used for antiretroviral therapy?

Answer 19

NuecleoSIDE reverse transcriptase inhibitors(NRTI)
NueloTIDE reverse transcriptase inhibitors(NRTI)
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Protease inhibitors
Entry inhibitors / Fusion inhibitors
Integrase inhibitors

Question 20

What do we need to consider when choosing antiretroviral therapy?

Answer 20

Prior treatment experiences
Medication side effects
Underlying conditions
Convenience of formulation
Genotypic resistance testing
Results of resistance testing → 15 - 20% of treatment naive patients resistant!

Question 21

Do we need to know specific drugs?

Answer 21

NOPE, only class

Question 22

What are PIs used for?

Answer 22

Suppress HIV replication
Administered as combination therapy
Metabolized by P450 (high potential for drug interaction)
Used to boost other regimens

Question 23

What are some aids defining conditions?

Answer 23

Mucocutaneous candidiasis
Oral hairy leukoplakia
Genital herpes
Herpes zoster/ shingles
Molluscum Contagious
Community acquired pneumonia
Pnuemocystis jiroveci penumonia
Esophageal candidiasis
Kaposi’s sarcoma
Wasting syndrome
Mycobacterium avium infection
Crytococcal meningitis
Cytomegalovirus retinitis
Toxoplasmosis