HIV

Question 1

What is a T(CD4)-cell

Answer 1

• Important for immune system
• Protection from infections and cancers
• 2 main groups
  ○ Killer
  § ‘x ray vision’
  § Circulate body and look for abnormal cells / germs
  ○ Helper
  § Messenger
  § Initiate activity of other immune cells
  § Generate antibodies
• Cut out one arm of this immune response = more at risk

Question 2

what was the early names of HIV when it was first being discovered

Answer 2

> gay cancer
> "slim"
> gay pneumonia
> gay related immune deficiency (GRID)
> gay compromise syndrome
> community acquired compromise syndrome

Question 3

what is the causative agent of AIDS

Answer 3

human immunodeficiency virus

HIV

Question 4

what was the problem with the first test for HIV-1 antibodies

Answer 4

> very sensitive
high false positive rate
lots were given the wrong diagnosis and there was no way to prove if this was right or not

Question 5

what is HIV PrEP

Answer 5

> a pill that can stop the person taking it from getting HIV
it is for HIV negative people who are at high risk of getting HIV (continually having high risk sexual encounters)
extremely effective at preventing HIV when taken as directed

Question 6

how is HIV transmitted

Answer 6

• unprotected sex
• drug addicts
• blood transfusion
• pregnancy
• non sterile instruments

Question 7

how is HIV not transmitted

Answer 7

• touching
• through food
• with a kiss
• insect bites
• in the pool

Question 8

where did HIV come from

Answer 8

• ingestion / exposure to blood from animals

- zoonoses (derived from animals)

Question 9

how many people live with HIV / AIDS globally

Answer 9

• 37.9 million

Question 10

what are the 2 main HIV viruses

Answer 10

> HIV 1
- the one that caused the pandemic 
- categorised into 3 groups 
= major
= new 
= other

> HIV 2

Question 11

how is the HIV virus able to survive outside the body

Answer 11

• lipid envelope

Question 12

what is glycoproteins role in HIV viruses

Answer 12

important in replication

Question 13

what is the HIV life cycle

Answer 13

• HIV releases genetic material into CD4 cell
• reverse transcriptase copies RNA-DNA
• viral DNA inserted in cell DNA
• many copies of the viral RNA and proteins made
• new viral particles assemble and bud from the cell

Question 14

what is the virus half life

Answer 14

5.7 hours

Question 15

how many virons are found per ml of blood in an infected person

Answer 15

100-10million

Question 16

define AIDS

Answer 16

the presence of one of 25 conditions indicative of severe immunosuppression

OR

HIV infection in an individual with a CD4+ cell count <200 cells per cubic mm of blood

AIDS is therefore the end point of an infection that is continuous, progressive and pathogenic

Question 17

what are clinical features of AIDS

Answer 17

> lymphadenopathy and fever

• insidious onset
• may be accompanied by weight loss and malaise

> opportunistic infections

• pneumocystis carinii pneumonia
• cerebral toxoplasmosis
• cryptococcal meningitis
• candidosis
• herpes virus infections
• diarrhoeal disease

> malignancies

• kaposi’s sarcoma
• non-hodgkin’s lymphoma

> wasting
- common in africa

> AIDS-related dementia
- decrease in cognitive and / or motor functions

Question 18

what is done in testing to diagnose HIV

Answer 18

> first generation test = antibody test

• sensitive
• only detected infection 6-12 weeks so tested before this meant the infection was missed

> viral detection antigen detection

• better than antibodies
• done within 2 weeks

Question 19

what are alternative tests that dont involve blood

Answer 19

> rapid tests
oral fluid tests
dried blood spot (DBS)

Question 20

what is the advantages and disadvantages of doing a dried blood spot test

Answer 20

handy
easy
good for research
not always great for diagnostic

Question 21

what are the advantages and disadvantages of rapid tests and oral fluid tests

Answer 21

not too sensitive

needs to be confirmed

Question 22

how is dental care impacted for patient’s with HIV

Answer 22

have poorer oral health
greater dental care needs - painful oral lesions are common in HIV patients
experience high levels of HIV related stigma and discriminations

Question 23

what are the oral lesions associated with HIV

Answer 23

> group 1 
lesions strongly associated with HIV infection
= candidosis
= hairy leukoplakia
= kaposi's sarcoma
= non hodgkin lymphoma
= periodontal disease

> group 2
lesions less commonly associated with HIV infection

> group 3
lesions seen in HIV infection

Question 24

what role do dentists play in HIV diagnosis

Answer 24

> several key HIV indicators are encountered by the dental professional
play a role in early diagnosis to improve health outcomes and provide opportunities to prevent further transmission events
may be able to offer chairside HIV screening to patient during dental appointments

Question 25

what does the duty of candour legislation state / include

Answer 25

dentists must notify patients if they have been put at risk of a number of conditions due to failure to deliver satisfactory service
(need to ask how the patient wants to be notified before they are notified - this is difficult)
> need to notify the patient within 2 days
> must be the GDP delivering the service to notify the patietn

Question 26

what is the risk of HIV transmission

Answer 26

mucosal: 1/1000
percutaneous: 1/300

Question 27

what is the risk of getting HIV from a needle stick injury

Answer 27

1 in 37,500

Question 28

how is the risk of HIV transmission further reduced

Answer 28

> source on cART with undetectable viral load
(undetectable viral load means the HIV is untransmissible)
follow up and management with PEP