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MCB 1 > HIV > Flashcards

HIV Flashcards

(22 cards)

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1
Q

What’s the family and subgroup of HIV?

And what are the types of HIV?

A
  • Family: Retroviridae
  • Subgroup: Lentivirus
  • Types:
    • HIV-1: Global; dominant
    • HIV-2: Mainly West Africa
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2
Q

What’s the Structure & Genome & Accessory

A
  • Envelope glycoproteins: gp120 (binds CD4), gp41 (fusion)
  • Structural genes:
    • env: gp120, gp41
    • gag: p24 (capsid), p17 (matrix)
    • pol: reverse transcriptase, integrase, protease
  • Regulatory/Accessory genes:
    • Essential: tat, rev
    • Accessory: nef, vif, vpr, vpu
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3
Q

What are the Serotypes & Subtypes of HIV

A
  • HIV-1 groups: M (main), N, O, P
    • Group M has 10 subtypes (A–J)
  • HIV-2 groups: A–H (limited to West Africa)
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4
Q

Whats the mode of transmission & Risk per exposure

A

Transmission Modes (Global %)

  • Sexual: 75% (vaginal > anal > oral)
  • Mother-to-child: 10%
  • IV drug use: 10%
  • Blood transfusion: 5%
  • Needlestick: <0.5%

Risk per exposure

  • Transfusion: 90–95%
  • Mother-child: 20–40%
  • IV drug: 0.5–1%
  • Needlestick: 0.3%
  • Sexual:
    • Anal: 0.065–0.5%
    • Vaginal: 0.05–0.1%
    • Oral: 0.005–0.1%
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5
Q

What’s the pathogenesis?

A

Pathogenesis

  • Step 1: gp120 binds CD4 on host cells
  • Step 2: Requires co-receptors CCR5 (macrophage-tropic) or CXCR4 (T-cell-tropic)
  • Step 3: Fusion ⏩ Reverse transcription ⏩ dsDNA
  • Step 4: Integration via integrase ⏩ forms provirus
  • Latency: Virus can still replicate & infect others
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6
Q

What are the Cells Infected?

A

Cells Infected

  • CD4+ T cells
  • Monocytes/macrophages
  • Langerhans cells
  • Astrocytes, glial cells
  • Keratinocytes
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7
Q

What are the Stages of Disease Progression in

A

Stages of Disease Progression

  1. Acute Retroviral Syndrome
    • Flu-like illness, high viral load
  2. Asymptomatic Stage
    • Latent, slow CD4 decline
  3. Persistent Generalized Lymphadenopathy (PGL)
  4. Symptomatic HIV (ARC)
    • Opportunistic infections begin
  5. AIDS
    • CD4 <200 cells/mm³ or AIDS-defining illness
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8
Q

What are the **WHO Clinical Staging of HIV/AIDS (Adults) **

A

**WHO Clinical Staging of HIV/AIDS (Adults) **

Stage 1

  • Asymptomatic
  • Persistent generalized lymphadenopathy

Stage 2

  • Unexplained moderate weight loss (<10%)
  • Recurrent upper respiratory tract infections (sinusitis, tonsillitis, otitis media, pharyngitis)
  • Herpes zoster
  • Angular cheilitis
  • Recurrent oral ulcers
  • Papular pruritic eruptions
  • Seborrheic dermatitis
  • Fungal nail infections

Stage 3

  • Unexplained severe weight loss (>10%)
  • Unexplained chronic diarrhea >1 month
  • Unexplained persistent fever >1 month
  • Oral candidiasis
  • Oral hairy leukoplakia
  • Pulmonary TB
  • Severe bacterial infections
  • Acute necrotizing ulcerative gingivitis/stomatitis/periodontitis
  • Unexplained anemia, neutropenia, or chronic thrombocytopenia

Stage 4 (AIDS)

HIV wasting syndrome:

> > 10% weight loss + chronic diarrhea or prolonged fever (>1 month)

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9
Q
A

Bacterial Infections

  • Recurrent severe bacterial infections
  • Extrapulmonary TB
  • Disseminated nontuberculous mycobacteria
  • Recurrent septicemia (e.g. nontyphoidal Salmonella)

Viral Infections

  • Chronic herpes simplex ulcers (>1 month)
  • CMV (retinitis or other organs, excluding liver/spleen/LNs)
  • Progressive multifocal leukoencephalopathy (PML)

Fungal Infections

  • Pneumocystis jirovecii pneumonia (PCP)
  • Esophageal candidiasis
  • Extrapulmonary cryptococcosis (e.g. meningitis)
  • Disseminated mycoses (e.g. histoplasmosis, coccidioidomycosis)

Parasitic Infections

  • Toxoplasma encephalitis
  • Chronic intestinal isosporiasis or cryptosporidiosis (>1 month)
  • Atypical disseminated leishmaniasis

Neoplasms

  • Kaposi’s sarcoma
  • Invasive cervical cancer
  • Lymphomas (CNS, B-cell, non-Hodgkin)

Other

  • HIV encephalopathy
  • HIV-associated nephropathy or cardiomyopathy
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10
Q

What are the Laboratory Diagnosis of HIV

A

Laboratory Diagnosis of HIV

Screening Tests (Antibody detection)

  • ELISA (2–3 hrs)
  • Rapid tests (<30 min)

Supplemental (Antibody Detection)

  • Western blot
  • Immunofluorescence assay
  • RIPA
  • Line immunoassay (LIA)

Confirmatory Tests

  • p24 antigen detection
  • HIV RNA detection (best method)
    • RT-PCR
    • Real-time PCR (viral load)
    • Branched DNA assay
    • NASBA
  • HIV DNA detection (for pediatric HIV)
  • Viral culture (co-cultivation)

Non-specific Immunologic Markers

  • Low CD4 T-cell count
  • CD4:CD8 ratio altered
  • Hypergammaglobulinemia
  • Raised neopterin, β2-microglobulin
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11
Q

Clinical diagnosis

Two such systems are currently in use:
CDC classification system (revised 1993) based on associated clinical conditions and CD4 T-cell count of the patient
WHO clinical staging of HIV/AIDS for adults (revised 2007) is based only on the clinical conditions.

A
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12
Q

What are the Tools used to monitor response to ART:

A

What are the Tools used to monitor response to ART:

  • CD4 T-cell count: Most commonly used
  • HIV RNA viral load: Most reliable and consistent tool
  • p24 antigen: Less commonly used
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13
Q

What are the Goals of ART TREATMENT OF HIV/AIDS

A
  1. Clinical: Reduce symptoms, prevent opportunistic infections
  2. Virological: Suppress viral load
  3. Immunological: Restore/maintain immune function
  4. Transmission: Reduce risk of transmission
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14
Q

List the Antiretroviral Drugs (ARVs)
Class, Example & Function

A

Antiretroviral Drugs (ARVs)

Class Examples Function
NRTIs (Nucleoside Reverse Transcriptase Inhibitors) | Zidovudine, Lamivudine, Stavudine, Didanosine, Emtricitabine, Abacavir | Inhibit reverse transcription by being incorporated into viral DNA |
| NtRTIs (Nucleotide RTIs)

| PIs (Protease Inhibitors) | Ritonavir, Lopinavir, Saquinavir, Indinavir, Atazanavir, Darunavir, Fosamprenavir, Tipranavir | Inhibit viral protease enzyme

| Fusion Inhibitor | Enfuvirtide | Blocks virus entry into cell |
| Integrase Inhibitors | Dolutegravir, Raltegravir | Inhibit viral genome integration |
| CCR5 Receptor Inhibitor | Maraviroc | Blocks viral entry via CCR5 |
| Pharmacokinetic Booster | Cobicistat | Inhibits liver enzymes to boost other drugs |

Tenofovir | Similar to NRTIs
| NNRTIs (Non-Nucleoside RTIs) | Nevirapine, Efavirenz, Etravirine, Delavirdine, Rilpivirine
Bind directly to reverse transcriptase

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15
Q

What’s HAART (Highly Active Antiretroviral Therapy)
Why it’s used & Lines of treatment

A

HAART (Highly Active Antiretroviral Therapy)

  • Combines ≥3 drugs to prevent resistance and suppress virus effectively.

First-Line Regimen (Adults & Adolescents)

Preferred:

  • TDF + 3TC (or FTC) + DTG ⏩ e.g. TLD regimen

Alternatives:

  • TAF + 3TC + DTG
  • ABC + 3TC + DTG
  • AZT + 3TC + EFV (400 mg)

Second-Line Regimen

Used when first-line fails due to resistance or side effects.

Preferred:

  • AZT + 3TC + ATV/r or LPV/r

Alternatives:

  • TDF + 3TC + DTG
  • AZT + 3TC + DRV/r
  • Double-dose LPV/r for TB-HIV coinfection
  • DTG dose doubled (50 mg BID) with rifampicin
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16
Q

Special Conditions

What’s IRIS (Immune Reconstitution Inflammatory Syndrome)

Study These Flashcards
A

Special Conditions

IRIS (Immune Reconstitution Inflammatory Syndrome)

  • Occurs after starting ART.
  • Recovered immunity reacts aggressively to hidden infections.
  • Paradoxical worsening of symptoms.
17
Q

How do you perform PEP (Post-Exposure Prophylaxis)?

Study These Flashcards
A

PEP (Post-Exposure Prophylaxis)

  • For needle stick or mucosal exposure.
  • Start within 2 hours (maximum window = 72 hours).
  • Regimen: TLD once daily for 28 days
18
Q

How’s PMTCT (Prevention of Mother-to-Child Transmission) done?

Study These Flashcards
A

PMTCT (Prevention of Mother-to-Child Transmission)

4 Pillars:

  1. Prevent HIV in women of reproductive age
  2. Prevent unintended pregnancies in HIV+ women
  3. Prevent transmission from HIV+ mothers to infants
  4. Provide care/support for mothers, infants, families
19
Q

PMTCT (Prevention of Mother-to-Child Transmission)

What are the Package of Services for Mothers

Study These Flashcards
A

PMTCT (Prevention of Mother-to-Child Transmission)

Package of Services for Mothers

  • ART for all HIV-positive women
  • Cotrimoxazole prophylaxis
  • TB screening, prophylaxis, and treatment
  • Infant feeding counselling and support
  • Nutritional counselling and support
  • Sexual and reproductive health services (incl. family planning)
  • Cervical cancer screening
  • Psychosocial support
  • Partner counselling and testing
  • PrEP for HIV-negative partners in serodiscordant couples
20
Q

PMTCT (Prevention of Mother-to-Child Transmission)

Package of Services for HIV-Exposed Infants

Study These Flashcards
A

PMTCT (Prevention of Mother-to-Child Transmission)

Package of Services for HIV-Exposed Infants

  • ARV prophylaxis
  • Routine immunization, growth monitoring, and support
  • Cotrimoxazole prophylaxis starting at 6 weeks
  • HIV testing:
    • Virologic testing (DNA-PCR or NAT) at:
      • Birth (if available)
      • 6–8 weeks of age
      • 6 weeks after breastfeeding ends
    • HIV antibody test:
      • For children >9 months (if no virologic test available)
      • Confirmatory diagnostic at >18 months
  • Infant feeding counselling
  • TB screening and treatment
  • Malaria prevention and treatment
  • Nutritional support
21
Q

What are the ARV Prophylaxis for HIV-Exposed Infants? & Cotrimoxazole Prophylaxis for HIV-Exposed Infants

Study These Flashcards
A

ARV Prophylaxis for HIV-Exposed Infants

  • Start within 72 hours of birth

Risk Status ARV Prophylaxis Regimen Duration

| High risk | AZT (twice daily) + NVP (once daily) | 12 weeks |

Cotrimoxazole Prophylaxis for HIV-Exposed Infants

  • Start at 6 weeks of age
  • Continue until HIV infection is ruled out
    • Use age-appropriate test done 8–12 weeks after breastfeeding ends

Low risk | NVP once daily | 6 weeks |

22
Q

What are the HIV Vaccine Challenges?

Study These Flashcards
A

Why no effective vaccine yet?

  • High mutability of HIV
  • Long latent period before symptoms appear
  • Lack of ideal animal models for preclinical studies

MCB 1 (11 decks)

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