HIV and HAART

Question 1

HIV Structure

Answer 1

Envelope: lipid bilayer containing Gp120 (surface) and Gp41 (within membrane) that can interact with CCR5 and CXCR5 on T cells
Nucleocapsid: proteins enclosing genome
Genome: ss RNA
Other proteins: integrate, protease, reverse transcriptase

Question 2

Stages of HIV

Answer 2

1) Acute infection (primary) - modes of transmission can be sexual, blood-borne, vertical
2) Seroconversion - developing Abs, HIV test +
3) Asymptomatic - no sx, look and feel well
4) Symptomatic - unexplained weight loss, fatigue
5) AIDS - advanced HIV infection, can’t fight against illnesses due to CD4 T cell destruction

Question 3

Normal CD4 T cell count

Answer 3

> 400/uL

if <200/uL = DANGEROUS

Question 4

CD4 T cell count and Viral Load in development of HIV

Answer 4

High Viral Load (ex. >30,000 copies HIV RNA per mL)

Low CD4 T cell count (esp < 200/uL)

Question 5

Opportunistic infections at CD4 count <200/mm3

Answer 5

• Pneumocystis jiroveci pneumonia (PCP)
• Progressive multifocal leukoencephalopathy (PML)
• Oral Thrush (yeast infection in mouth)

Question 6

Opportunistic infections at CD4 count <100/mm3

Answer 6

• Toxoplasmosis (in cat feces)
• CMV retinitis (cytomegalovirus, in 50% ppl, typically latent and reactivate in retina)
• Cryptococcal meningitis (fungal infx in CNS)

Question 7

Opportunistic infections at CD4 count <50/mm3

Answer 7

• Mycobacterium avium complex (MAC)

Question 8

Opportunistic infections at any CD4 count

Answer 8

• Tuberculosis

- can be primary in lungs, or present outside of lungs

Question 9

HIV-related cancers

Answer 9

• Lymphoma
• Cervical cancer (HPV)
• Kaposi’s sarcoma (limited to HIV pts, vascular cancer affecting blood vessels - dark purple spots)

Question 10

Antiretrovirals
ARV
ART
HAART (Highly active anti-retroviral therapy)
CART (combination antiretroviral therapy)

Answer 10

• control HIV replication
• use 3 different types at same time = combo tx
• monitor with HIV viral load ( 200/uL
• prevent progression of disease

Question 11

Types of ART

Answer 11

1. NRTI (Nucleoside reverse transcriptase inhibitor)
2. NNRTI ( Non-nucleoside reverse transcriptase inhibitor)
3. PI (protease inhibitors)
4. Integrase inhibitors
5. Fusion inhibitors
6. CCR5 antagonist

Question 12

Most common ARV Regimens

Answer 12

2 NRTIs + 1 PI
2 NRTI + 1 NNRTI
2 NRTI + 1 Integrase inhibitor

Question 13

Prophylaxis of HIV

- prevent disease from occurring or coming back

Answer 13

Primary prophylaxis: prevent disease from happening for first time
Secondary prophylaxis: prevent disease from returning (ex. Septra for toxoplasmosis, PCP)

Lifestyle: careful about cat feces - todo

Medications: Abs to prevent PCP, toxo, MAC

Vaccinations: pneumococcus, influenza, hepatitis A/B, HPV

Question 14

Management of HIV

Answer 14

• TB skin test (exposure to TB)
• screen for other STIs or injection related diseases (ex. Hep C)
• cervical cancer screening (Pap tests)
• eye exam if CD4<100 (test for CMV retinitis)