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Flashcards in HIV Deck (35):
1

Describe the structure of HIV.

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

2

What are the 3 structural genes that code for HIV?

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

3

What does gp120 on HIV bind?

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

4

How can you be immune to HIV?

homozygous for CCR5 mutation
hetero: slower progression

5

What are the tests used for the diagnosis of HIV?

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

6

What does it take to make a diagnosis of AIDS?

1. CD4

7

Describe the time course of HIV.

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

8

What are the some opportunistic infections seen when CD4

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

9

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

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

10

What are some opportunistic infections when CD4

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

11

Where is histoplasma endemic?

bird and bat dropping
Ohio and Mississippi River Valleys

12

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

PCP
TB
MAC/MAI

13

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

cryptococcus meningitis

14

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

Toxoplasmosis
primary lymphoma of CNS

15

What is the prophylaxis for CD4

16

What is involved in HAART?

3 drugs: 2NRTIs, 1 other drug

17

What is the MOA of protease inhibitors?

inhibit protease that cleaves mRNA products into functional parts

**all end in NAVIR
Ex: ritonavir

18

What are the main side effects of protease inhibitors?

GI complications
hyperlipidemia
inhibits CytP450
lipodystrophy

19

What are some special extra side effects of ritonavir?

pancreatitis

20

What are some special extra side effects of atazanavir?

increased bilirubin--jaundice

21

Which HIV drugs can cause nephrolithiasis (kidney stones)?

indinavir, atazanavir

22

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

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

23

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

zidovudine

24

What are the NRTIs?

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

25

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

zidovudine

26

Which drugs cause pancreatitis and peripheral neuropathy?

ritonavir-pancreatitis
pancreatitis and peripheral neuropathy-
didanosine
zalcitabine
stavudine

27

Which drugs cause hepatic steatosis?

didanosine
stavudine

28

Which HIV drug causes a life-threatening hypersensitivity reaction?

abacavir

29

What is the MOA of NNRTIs?

noncompetitive inhibition of reverse transcriptase
don't require phosphorylation by thymidine kinase for activation

30

What are the NNRTIs?

Delavirdine
Etravirin
Rilpivirine
Nevirapine
Efavirenz

31

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

efavirenz

32

Which of the NNRTIs are teratogenic?

efavirenz
delavirdine

33

What are the integrase inhibitors?

raltegravir

34

What are the inhibitors of surface proteins of HIV?

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

35

What are the SE of raltegravir?

Nausea
rash
myopathy