Flashcards in HIV Deck (35):
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
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
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
How can you be immune to HIV?
homozygous for CCR5 mutation
hetero: slower progression
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
What does it take to make a diagnosis of AIDS?
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
What are the some opportunistic infections seen when CD4
candida thrush (scrapable)
EBV oral hairy leukoplakia (non-scrapable) lateral.
Cryptosporidium--chronic watery diarrhea, acid fast oocysts in stool
HPV-anal or cervical cancer
What are some opportunistic infections seen in HIV patients w/ CD4
Toxoplasmosis-brain abscesses. multiple ring-enhancing lesions on MRI
JC-Progressive multifocal leukoencephalopathy-demyelination on MRI
PCP--ground glass on CXR from interstitial infiltrates
What are some opportunistic infections when CD4
Aspergillus: hemoptysis, cavitation on imaging
Cryptococcus-meningitis (India ink stain see capsules)
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
Where is histoplasma endemic?
bird and bat dropping
Ohio and Mississippi River Valleys
When you see AIDs patient w/ pulmonary symptoms---what do you think?
When you see an AIDS patient w/ meningitis, what do you think?
When you see an AIDS patient w/ a ring-enhancing lesion what do you think?
primary lymphoma of CNS
What is the prophylaxis for CD4
What is involved in HAART?
3 drugs: 2NRTIs, 1 other drug
What is the MOA of protease inhibitors?
inhibit protease that cleaves mRNA products into functional parts
**all end in NAVIR
What are the main side effects of protease inhibitors?
What are some special extra side effects of ritonavir?
What are some special extra side effects of atazanavir?
Which HIV drugs can cause nephrolithiasis (kidney stones)?
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
What is an important drug used for pregnant women and neonates who are HIV+ but not on HAART?
What are the NRTIs?
Which HIV drug causes bone marrow suppression...could see anemia (megaloblastic) or other things...
Which drugs cause pancreatitis and peripheral neuropathy?
pancreatitis and peripheral neuropathy-
Which drugs cause hepatic steatosis?
Which HIV drug causes a life-threatening hypersensitivity reaction?
What is the MOA of NNRTIs?
noncompetitive inhibition of reverse transcriptase
don't require phosphorylation by thymidine kinase for activation
What are the NNRTIs?
Which HIV drug causes vivid dreams/worsens depression and can screen + for cannabinoids?
Which of the NNRTIs are teratogenic?
What are the integrase inhibitors?
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