HIV

Question 1

gag gene encodes for

Answer 1

p24 capsid protein

Question 2

env gene encodes for

Answer 2

gp120, gp41 envelope proteins, which allow HIV to bind CD4 receptor, and CCR5/CXCR4 respectively

Question 3

pol gene encodes for

Answer 3

reverse transcriptase

integrase

Question 4

diagnose AIDS

Answer 4

CD4

Question 5

pneumocystis jirovecii pneumonia (PCP)

Answer 5

interstitial infiltrates on CXR with CD4

Question 6

TB, mycobacterium avium complex (MAC, MAI)

Answer 6

CD4

Question 7

histoplasma capsulatum (immunocompetent)

Answer 7

mild pulmonary disease
associated with bird and bat droppings in OH and MS river valleys

in AIDS patients, systemic disease with HSM, fever, cough
CD4

Question 8

cryptococcal meningitis

Answer 8

most common meningitis in AIDS patients

Question 9

ring-enhancing lesions on MRI

Answer 9

toxoplasmosis, or primary CNS lymphoma (more likely to have solid lesions)

Question 10

CMV retinitis

Answer 10

CS4

Question 11

progressive multifocal leukoencephalopathy (PML)

Answer 11

reactivation of latent JC virus

Question 12

cryptosporidiosis

Answer 12

chronic, watery diarrhea

CD4

Question 13

oral thrush

later, esophageal candidiasis

Answer 13

candida albicans

esophageal candidiasis with CD4

Question 14

oral hairy leukoplakia

Answer 14

EBV, CD4

Question 15

oral infections

Answer 15

HSV (herpes), CMV

Question 16

Kaposi sarcoma

Answer 16

HHV8, increased blood vessels

CD4

Question 17

bartonella henselae

Answer 17

bacillary angiomatosis

CD4

Question 18

Non Hodgkin lymphoma

Answer 18

primary CNS lymphoma
large B cell lymphoma
EBV coninfection for both of the above

Question 19

malignancy associated with HPV in AIDS

Answer 19

squamous cell carcinoma of cervix/anus. HPV types 16 and 18

Question 20

PPX CD4

Answer 20

TMP-SMX for PCP

dapsone if sulfa all
pentamidine (aero)

Question 21

ppx cd4

Answer 21

TMP-SMX for toxoplasmosis ppx if positive IgG titer for toxo

dapsone+pentamidine+leucovorin

Question 22

ppx CD4

Answer 22

MAC prophylaxis

azithrymycin

Question 23

ppx cd4

Answer 23

histoplasmosis (endemic area) itraconazole

Question 24

HAART

Answer 24

combination of at least 3 different HIV medications
goal is to treat infection and prevent resistance (attach HIV at different points in its replication/infection cycle in order to control the infection and avoid resistance)

combine 2 NRTIs + 1 from a different class

Consider initiating in everyone with HIV, regardless of CD4 count

should be initiatied in anyone with CD4

Question 25

protease inhibitors

Answer 25

The viral protease clips viral polypeptide into their functional parts. Without a protease, new viruses cannot mature. ``` saquinavir ritonavir indinavir nelfinavir fosamprinavir lopinavir tipranavir atazanavir darunavir ``` ``` side effects: GI intolerance inhibit CYP450 (esp ritonavir) hyperlipidemia/hypertriglyceridemia lipodystrophy pancreatitis nephrolithiasis-indinavir, atazanavir increased bilirubin- atazinavir ```

Question 26

ritonavir side effects

Answer 26

pancreatitis, inhibits CYP450

Question 27

protease inhibitor that causes nephrolithiasis

Answer 27

indinavir, atazanavir

Question 28

Atazanavir side effects

Answer 28

increased bilirubin, nephrolithiasis

Question 29

Nucleoside reverse transcription inhibitor

Answer 29

competitively inhibits HIV reverse transcriptase, keeps the virus from replicating nucleoside analogs (guanosine or cytosine) must be phosphorylated or activated by thymidine kinase ``` zidovudine didanosine lamivudine abacavir emtricitabine ```

Question 30

nucleoTide reverse transcription inhibitor

Answer 30

tenofovir competitively inhibits HIV reverse transcriptase, keeps the virus from replicating nucleotide analog

Question 31

zidovudine (AZT)

Answer 31

used in newborns born to HIV+ mothers can be given to mom at time of delivery if she hasn't been on a regular regimen already during her pregnancy (otherwise stay on course)

Question 32

how to treat occupational exposures

Answer 32

3 drug regimen for 4 weeks | for anyone who has been exposed

Question 33

NRTI zidovudine side effect

Answer 33

bone marrow suppression

Question 34

NRTIs that cause pancreatitis and peripheral neuropathy

Answer 34

didanosine, zalcitabine, stavudine

Question 35

didanosine, stavudine side effects

Answer 35

hepatic steatosis, pancreatitis, peripheral neuropathy

Question 36

Abacavir side effect

Answer 36

hypersensitivity reaction

Question 37

NNRTIs

Answer 37

Non-competitively inhibit HIV reverse transcriptase at a different site than NRTIs Do not require phosphorylation to be active ``` Nevirapine Delavirdine Efavirenz Etravirine Rilpivirine ```

Question 38

NNRTI general side effect

Answer 38

rash

Question 39

Efavirenz side effects

Answer 39

neuropsychiatric symptoms (nightmares, vivid dreams, dizziness, worsening depression) false- positive drug test to cannabinoids teratogenic

Question 40

enfuvertide

Answer 40

binds gp41, inhibiting viral fusion and entry. expensive given by injection indicated in patient with a lot of drug resistance side effects: injection site reactions, and increased risk of bacterial pneumonia

Question 41

raltegravir, elvitegravir

Answer 41

integrase (from the pol gene) inhibitor side effects: nausea, rash, myopathy

Question 42

maraviroc

Answer 42

CCR5 (cofactor, typically seen on macrophages) antagonist inhibits gp120 conformational change so virus cannot bind host cell effectively tropism test before therapy to make sure the virus is not X4 only patients with all R5 virus qualify for treatment

Question 43

ritonavir

Answer 43

protease inhibitor

Question 44

didanosine

Answer 44

NRTI

Question 45

delavirdine

Answer 45

NNRTI

Question 46

zidovudine

Answer 46

NRTI

Question 47

abacavir

Answer 47

NRTI

Question 48

lamivudine

Answer 48

NRTI

Question 49

nelfinavir

Answer 49

protease inhibitor

Question 50

efavirenz

Answer 50

NNRTI

Question 51

what drug blocks gp41

Answer 51

enfuvertide

Question 52

what drug blocks gp120

Answer 52

maraviroc

Question 53

side effect: lactic acidosis

Answer 53

NRTIs

Question 54

side effect: GI intolerance

Answer 54

protease inhibitors

Question 55

side effect: peripheral neuropathy

Answer 55

didanosine, stavudine, zalcitabine

Question 56

side effect: megaloblastic anemia

Answer 56

zidovudine (AZT)

Question 57

side effect: rash

Answer 57

NNRTIs

Question 58

side effect: hyperglycemia, diabetes mellitus, lipid abnormalities

Answer 58

protease inhibitors

Question 59

side effect: bone marrow suppression

Answer 59

zidovudine

Question 60

given to pregnant women with HIV

Answer 60

zidovudine, if the woman is not already on a regimen