HIV

Question 1

Describe the structure of HIV.

Answer 1

2 copies of RNA w/ reverse transcriptase
capsid protein p24
matrix protein p17
lipid membrane w/ gp41 transmembrane glycoprotein, used for fusion and entry
gp120 docking glycoprotein

Question 2

What are the 3 structural genes that code for HIV?

Answer 2

env: gp120 and gp41
gag: p24 capsid protein
pol: reverse transcriptase and aspartate protease and integrase

Question 3

What does gp120 on HIV bind?

Answer 3

CCR5 on macrophages and dendritic cells early on in the infection
then CXCR4 on T cells later in the infection

Question 4

How can you be immune to HIV?

Answer 4

homozygous for CCR5 mutation

hetero: slower progression

Question 5

What are the tests used for the diagnosis of HIV?

Answer 5

ELISA: highly sensitive
WEstern Blot Assay: highly specific
Viral load tests–early on in course when ab aren’t made and for neonates that may screen as falsely pos. b/c of mom’s ab crossing the placenta

Question 6

What does it take to make a diagnosis of AIDS?

Answer 6

1. CD4

Question 7

Describe the time course of HIV.

Answer 7

First month: asymptomatic
2-3 months: flu-like illness
3–? months: latent, feel fine, CD4 gradually drops
Final crisis when CD4 is low enough for opportunistic infections to take over
**this is interrupted by HIV therapy

Question 8

What are the some opportunistic infections seen when CD4

Answer 8

candida thrush (scrapable)
EBV oral hairy leukoplakia (non-scrapable) lateral.
Bartonella-Bacillary angiomatosis
HHV8-Kaposi’s Sarcoma
Cryptosporidium–chronic watery diarrhea, acid fast oocysts in stool
HPV-anal or cervical cancer

Question 9

What are some opportunistic infections seen in HIV patients w/ CD4

Answer 9

Toxoplasmosis-brain abscesses. multiple ring-enhancing lesions on MRI
AIDS dementia
JC-Progressive multifocal leukoencephalopathy-demyelination on MRI
PCP–ground glass on CXR from interstitial infiltrates

Question 10

What are some opportunistic infections when CD4

Answer 10

Aspergillus: hemoptysis, cavitation on imaging
Cryptococcus-meningitis (India ink stain see capsules)
Candida esophagitis
CMV retinitis or esophagitis. Cotton wool spots, owl eye.
EBV-B cell lymphoma or CNS lymphoma w/ ring enhancing lesion
Histoplasma-oval yeast cells w/ macrophages
MAC/MAI–fever, night sweats, weight loss

Question 11

Where is histoplasma endemic?

Answer 11

bird and bat dropping

Ohio and Mississippi River Valleys

Question 12

When you see AIDs patient w/ pulmonary symptoms—what do you think?

Answer 12

PCP
TB
MAC/MAI

Question 13

When you see an AIDS patient w/ meningitis, what do you think?

Answer 13

cryptococcus meningitis

Question 14

When you see an AIDS patient w/ a ring-enhancing lesion what do you think?

Answer 14

Toxoplasmosis

primary lymphoma of CNS

Question 15

What is the prophylaxis for CD4

Question 16

What is involved in HAART?

Answer 16

3 drugs: 2NRTIs, 1 other drug

Question 17

What is the MOA of protease inhibitors?

Answer 17

inhibit protease that cleaves mRNA products into functional parts

**all end in NAVIR
Ex: ritonavir

Question 18

What are the main side effects of protease inhibitors?

Answer 18

GI complications
hyperlipidemia
inhibits CytP450
lipodystrophy

Question 19

What are some special extra side effects of ritonavir?

Answer 19

pancreatitis

Question 20

What are some special extra side effects of atazanavir?

Answer 20

increased bilirubin–jaundice

Question 21

Which HIV drugs can cause nephrolithiasis (kidney stones)?

Answer 21

indinavir, atazanavir

Question 22

What is the MOA of the NRTIs? What is a special thing that most of them require?

Answer 22

competitive inhibitors of reverse transcriptase
most of them require thymidine kinase phosphorylation for activation–they are nucleoside analogs
Exception: nucleotide analog is tenofovir

Question 23

What is an important drug used for pregnant women and neonates who are HIV+ but not on HAART?

Answer 23

zidovudine

Question 24

What are the NRTIs?

Answer 24

tenofovir
zidovudine
zalcitabine
abacavir
SLED
stavudine
lamivudine
emtricitabine
didanosine
**some vudines

Question 25

Which HIV drug causes bone marrow suppression…could see anemia (megaloblastic) or other things…

Answer 25

zidovudine

Question 26

Which drugs cause pancreatitis and peripheral neuropathy?

Answer 26

ritonavir-pancreatitis
pancreatitis and peripheral neuropathy-
didanosine
zalcitabine
stavudine

Question 27

Which drugs cause hepatic steatosis?

Answer 27

didanosine

stavudine

Question 28

Which HIV drug causes a life-threatening hypersensitivity reaction?

Answer 28

abacavir

Question 29

What is the MOA of NNRTIs?

Answer 29

noncompetitive inhibition of reverse transcriptase

don’t require phosphorylation by thymidine kinase for activation

Question 30

What are the NNRTIs?

Answer 30

Delavirdine
Etravirin
Rilpivirine
Nevirapine
Efavirenz

Question 31

Which HIV drug causes vivid dreams/worsens depression and can screen + for cannabinoids?

Answer 31

efavirenz

Question 32

Which of the NNRTIs are teratogenic?

Answer 32

efavirenz

delavirdine

Question 33

What are the integrase inhibitors?

Answer 33

raltegravir

Question 34

What are the inhibitors of surface proteins of HIV?

Answer 34

gp120—inhibits CCR5 receptor, maraviroc (only if pt has ONLY CCR5 HIV)
gp41-inhibits viral entry–Enfuvirtide

Question 35

What are the SE of raltegravir?

Answer 35

Nausea
rash
myopathy