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Flashcards in HIV Deck (25):
1

What is the main HIV group globally?

M
others: N, O

2

Where is HIV-2 mainly found?

West Africa, SE Asia

3

What enzymes are coded for by pol

RT, protease, integrase

4

Env codes for a polypeptide that is cleaved to form _____ and ____ on the viral envelope

pg120, gp41

5

What does gag code for?

proteins that make up the viral core

6

List 8 steps in HIV viral replication

1. attachment of gp120 to CD4 and a co-receptor
2. fusion of viral envelope, release of genome into host cell
3. RT converts viral RNA to DNA which goes to the nucleus
4. Integrase inserts viral genome into host genome
5. transcription and translation of viral genome
6. viral protease cleaves polyproteins
7. viral assembly
8. budding/ acquisition of envelope and glycoproteins

7

Innumerable HIV ______ exist within each infected individual

quasispecies

** due to compact genome, error prone RT, replication kinetics

8

After crossing the mucosal barrier, _____ cells transport HIV to regional lymph nodes and CD4+ cells in the paracortical regions of the node interact with HIV

dendritic

9

Widespread dissemination of HIV to the CNS, reticuloendothelial system, and GALT occurs within _____ days of infection

4-11

primary viremia, but asymptomatic

10

The hallmark of HIV disease is:

CD4 depletion

occurs in GI tract over first 2-3 weeks of infection (loss of 80% of CD4 T cells)

11

List components of the immune system that are dysregulated in HIV infection

lymphoid tissue- distorted architecture
CD8 cells
B cells- hypergammaglobulinemia
NK cells
Neutrophils- impaired opsonizing activity
Monocytes/ macrophages- reservoir for virus, role in CNS disease

12

_____________ serve as reservoirs for HIV and play a prominent role in CNS disease via infection of microglial cells

monocytes/ macrophages

13

HIV immunosuppression involves not only intracellular
pathogens and malignancies (for which we rely on the _______) but also common bacterial
pathogens for which we rely on the _________ defenses

CMI for intracellular pathogens/ malignancies

humoral and neutrophil for bacterial pathogens

14

Why do antibodies against HIV fail to provide high levels of neutralizing capacity?

- genetic diversity of viral isolates

balance at viral set point correlates with development of HIV specific antibodies

15

Chronic immune system ______ is harmful over time, as the ability to respond to any specific antigen is lessened and a broad response to other antigens is compromised

hyperactivation

16

The massive depletion of GI tract CD4+ T lymphocytes can lead to _________ across the GI mucosa, which has been shown to drive immune activation

products of bacterial translocation

17

What is the most common mode of HIV transmission worldwide? What are other notable modes of transmission?

Sexual transmission

MTC, IDU, transfusion/ transplantation, accidental needle stick

18

Why is the acute antiretroviral syndrome so clinically significant?

most transmission occurs by those who just acquired the virus themselves
Viral load is very high during this time

19

What are the most common presenting symptoms of somebody experiencing primary antiretroviral syndrome? Which are (relatively) specific to HIV as compared to other infections?

fever, fatigue, rash, adenopathy, pharyngitis, myalgia, night sweats, thrombocytopenia, luekopenia, diarrhea, aseptic meningitis, oral or genital ulcers

specific: rash, aseptic meningitis, ulcers

20

What other infections should be on the differential for acute HIV infection?

influenza
mono
measles
hepatitis
rubella
secondary syphilis

21

One manifestation of chronic symptomatic infection is _____, which is a manifestation of EBV on the sides of the tongue

oral hairy leukoplakia

22

Describe the immune reconstitution inflammatory syndrome

Immune reconstitution due to antiretroviral therapy can lead to the expression of opportunistic
infectious processes because now the immune system can react to latent organisms that have been present, but not previously recognized due to immune system dysfunction

23

What prophylaxis should be offered against opportunistic infections and at what CD4 count should they be initiated?

pneumocystis- TMP/SMX at CD4=200
toxoplasmosis TMP/SMX at CD4= 100
M avium azithromycin at CD4=50

24

Describe phenotypic and genotypic drug resistance testing

genotypic resistance testing: provides a list of detected mutations that have
occurred in the viral genome that are associated with drug resistance.


phenotypic resistance testing: compares the concentration of
antiretroviral medications required to inhibit the patient’s virus to that of wild type virus.

25

What are the goals of HAART?

Clinical well being

Achieve maximal and durable viral suppression

Achieve maximal and durable immune reconstitution