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Pathophysiology > Chapter 12 > Flashcards

Chapter 12 Flashcards

1
Q

Hallmark of AIDS and HIV

A
  • decrease in CD4+ (t-helper/introducer) lymphocytes
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2
Q

Epidemiology of AIDS

A
  • primary immunodeficiency caused by the retroviruses HIV type 1 and type 2
  • virus has continued to mutate and spread globally
  • increasingly becoming a disease of poor, uneducated, or undereducated people of color
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3
Q

HIV type 1

A
  • thought to have originated in central africa
  • cause of most AIDS cases found in central africa, US, Europe, Australia
  • has at least 10 subtypes
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4
Q

HIV type 2

A
  • thought to have originated in west africa
  • found primarily in west africa
  • characterized by a longer latency/asymptomatic periosd, a milder form of the disease and lower mortality rates, can progress to AIDS
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5
Q

Transmission of AIDS

A

3 types

  • sexual (most common)
  • parenteral
  • perinatal
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6
Q

Parenteral

A

transmission via blood, blood products, or blood contaminated needles or syringes

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7
Q

HIV (Human immunodeficiency Virus)

A

RNA retrovirus that causes defect in cell-mediated immunity that may progress to AIDS

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8
Q

Chemokine Coreceptors

A

must be present for the virus to gain entry into cells in order for the virion to fuse with the host cell

  • CCR5 must be present for HIV particles to bind to CD4+
  • CXCR4 must be present in later infection
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9
Q

Antiretroviral Therapy

A

This polydrug therapy approach
involves the administration of multiple antiretroviral agents. It provides
better viral suppression, thereby decreasing viral load, increasing
CD4+ counts, and decreasing resistance for a longer period.

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10
Q

AIDS B cell changes

A

overproduction of nonessential anitbodies
antibodies are ineffective against diseases
increased apoptosis

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11
Q

HIV disguises itself

A

with large amount of carbohydrate on surface of gp120

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12
Q

Acute Infection oh HIV

A

HIV is widespread throughout body, with viremia and viral seeding of lymph tissures

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13
Q

Progression to asymptomatic phase

A

seeded HIV replicates in lymph nodes; graduly destroy’s lymph tissues

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14
Q

Verimia

A

virus enters the blood stream; recurs after lymph tissues are destroyed

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15
Q

AIDS

A

is syndrome, the virus can express itself in multiple ways

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16
Q

HIV virion

A
  • enters body and quickly repllicates
  • present in the blood and cerebrospinal fluid
  • not detected by usual laboratory tests
  • usually asymptomatic
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17
Q

Seroconversion

A

the time in which enough HIV antibodies develop and become detectable in the blood
- occurs between 3 weeks to 6 months after exposure

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18
Q

Symptoms of primary HIV infection

A
  • flu or mono like symptoms
  • CD4+ t cell count greater thatn 400cells/ul
  • ## elevated ESR
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19
Q

ESR

A

erythrocyte sedimentation rate - a measurement of sedimentation

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20
Q

CRP

A

C reactive protein - preferred test for inflammation

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21
Q

Clinical latency period after seroconversion

A

ranges from 3 to 12 years

  • CD4+ cell count greater that 400/ul
  • virus is extremely active, producing up to 2 mil per day
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22
Q

Rapid virus production after latency period

A

persistent and continuing drop in CD4+ T-cell count to less than 400/ul

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23
Q

Symptomatic stage/chronic HIV infection

A
  • complete anergy, no response to skin testing
  • development of skin/membrane infections/problems
  • in children there are growth delays and they are frequently sick
24
Q

AIDS Diagnosis

A
  • CD4+ t cell count is less than 200/ul
  • one or more opportunistic infections
  • one or more tumors or cancers
  • most common symptoms are night sweats, fever, and nausea
25
Q

Steps of HIV

A

infection of mucous tissue -> death of mucosal cd4+ cells -> Infection establishes in lymph tissues -> infection spreads throughout body -> immune response -> clinical latency -> AIDS

26
Q

CD4+ T cell categories

A

Category A = count >or= 500ul
Categoty B= count ranges from 200 to 499
Category C= count < 200

27
Q

Clinical Category A

A

variety of clinical conditions, asymptomatic persistent generalized lymphadenopathy, history of or current acute HIV infection

28
Q

Clinical Category B

A

conditions secondary to impaired cell mediated immunity

29
Q

Clinical Category C

A

Conditions listed in AIDS surveillance case condition

30
Q

ELISA (enzyme - linked immunosorbent assay)

A
  • positive for HIV antibodies if blood or oral mucosal transudate of an infected person reacts with the surface antigen of killed HIV virus
  • highly sensitive and specific
  • must be performed with both HIV 1 and 2 viral antigens
31
Q

Western Blot

A
  • used when ELISA test is positive
  • used to confirm the presence of HIV
  • uses electrophoresis
  • identifies specific antibodies against the HIV protein antigen
  • specificity (combo’d with ELISA) > 99.9%
  • patient must wait 1-2 wks for confirmation
32
Q

Absolute CD4+ cell count

A
  • specific indicator of disease progression of HIV to AIDS
33
Q

CD4+ lymphocyte percentage

A

<20% risk of AIDS development is higher

34
Q

Plasma Viral Load

A
  • indicates the amount of viral replication and the effectiveness of therapy
  • helps to predict disease progression
  • goal: to reduce viral load
35
Q

Genotypic Resistance Testing

A
  • identifies gene mutations

- very expensive

36
Q

HAART Therapy

A

Highly Active Antiretroviral Therapy

37
Q

Anergy/delayed hypersensitivity (type IV) test

A
  • tests for M. tuberculosis, mumps, or measles viruses

- Early HIV: Skin test results normal

38
Q

Megestrol acetate

A

a progestational agent; patients are at risk for blood clots in the legs

39
Q

Dronabinol

A

antiemetic: decrease nausea and increase appetite

40
Q

Systemic Manifestations of HIV/AIDS

A

-Malnutrition/wasting syndrome

41
Q

Gastrointestinal Manifestations

A
  • nearly universal in HIV infected people
  • chronic diarrhea is a Major GI complication (common cause is protozoa cryptosporidum)
  • candida albiacans infections
42
Q

GI Symptoms

A
  • chronic diarrhea
  • oral candidiasis
  • anorexia
  • nausea/vomiting
  • mucous membrane ulcers
  • retrosternal pain on swallowing
  • abdominal pain
  • low serum vitamin B12
43
Q

Pulmonary Manifestations

A
  • major source of morbidity/mortality in AIDS patients
  • opportunistic pneumonias
  • parenchymal lung diseases
44
Q

Mucocutaneous Manifestations

A
  • occur early and late in HIV
  • HIV viral exanthem is usually the first symptom
  • can have allergic, infectious, or neoplastic origin
45
Q

Types of Mucocutaneuous manifestations

A 
herpes zoster
oral hairy leukoplakia 
Herpes simplex 1 & 2
S aureus 
Fungal skin infections 
Kaposi Sarcoma
46
Q

Gynecologic manifestations

A

persistent monilial vaginitis, cervual dysplasia, cervical neoplasia, PID

47
Q

Neurologic Manifestations

A
  • neurologic system is invaded early

- primarily HIV encephalopathy

48
Q

Ocular Manifestations

A

CMV retinitis

HIV associated retinopathy

49
Q

Cardiovascular Manifestations

A

hypertriglyceridemia

lipidemia

50
Q

Manifestations in other systems

A

renal impairment
hematologic impairment
liver dysfunction
endocrine dysfunction

51
Q

Major classes of Antiretroviral Therapt

A

nucleotide reverse transcriptase inhibitors (NRTIs)
Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
Protease Inhibitors (PIs)
fusion inhibitors
Integrase strand transfer inhibitors (INSTIs)
CCR5 antagonists

52
Q

NRTIs

A

prevent HIV replication by preventing DNA synthesis

53
Q

NNRTIs

A

inhibit reverse transcriptase
do not need to be converted intracellularly
potent antiretrovirals
only given in combination with other antiretrovirals

54
Q

Protease Inhibitors

A

inhibits protease that clips the viral protein precursors to the appropriate size
extremely expnsive
names typically end in “vir”

55
Q

Fusion inhibitors

A

blocks fusion between viral and target cell membranes

56
Q

CCR5 antagonists

A

blocks infection by blocking CCR5 and preventing HIV binding to cell membrane

57
Q

Integrase transfer inhibitors

A

target and inhibit integrase encoded by the viral pol gene

Pathophysiology (34 decks)

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