HIV/AIDS Flashcards by Michael McMahan

The ___________ was first
isolated in 1983 and was retrospectively identified as
the cause of acquired immunodeficiency syndrome
(AIDS; reported 1981).
• It is a non-transforming retrovirus (Retroviridae
family) of the lentivirus subfamily.

human immunodeficiency virus (HIV)

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HIV-__ being more common (overall) particularly in
sub-Saharan Africa, while HIV-__ is more prevalent in
West Africa and associated with slower disease course.

HIV-1; HIV-2

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What gender is more commonly infected with HIV?

Males

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What is the largest single risk factor for getting HIV?

male-to-male sexual contact remains the

largest single risk factor

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Transmission of HIV is by exchange of infected bodily fluids predominantly
through ______ and ________ .(Sharing needles and
blood transfusions, organ transplants etc.)

intimate sexual contact and by parenteral means.

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The most common method of sexual transmission of HIV in the United States is ________?

anal
intercourse in men who have sex with men (MSM), in whom the risk of HIV
infection is 40 times higher than in other men and in women.

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___________ is the second most
common form of transmission of HIV in the United States but accounts for 80% of the
world’s HIV infections.

Heterosexual transmission (male to female or female to male)

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• Transmission of HIV from _______ is the third largest group affected in the
United States

sharing needles

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T/F: The presence of erosions, ulcerations, and hemorrhagic inflammatory pathoses
(e.g., gingivitis, periodontitis) may predispose an individual to oral transmission of HIV

True

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What does Gag produce in the HIV virus?

Nucleocapsid
Matrix
Caspid

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What does pol produce in the HIV virus?

Enzymes

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What does Env produce in the HIV virus?

Envelope

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HIV primarily infects cells with _________ molecules at the site of HIV entry.

CD4 cell-surface
receptor molecules (CD4+ T helper lymphocytes
mainly)

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The HIV virus uses CD4+ cells to gain entry by _____ or ______

fusion
with a susceptible cell membrane or by
endocytosis

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The probability of HIV infection depends on both the

_______ and _______

number of infective HIV virions in the body fluid
which contacts the host and the number of cells
with appropriate CD4 receptors available at the
site of contact.

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The enzyme product of the pol gene, a
\_\_\_\_\_\_\_\_\_ that is bound to
the HIV RNA, synthesizes linear
double-stranded cDNA that is the
template for \_\_\_\_\_\_\_\_.

reverse transcriptase; HIV integrase

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_____ protein
interacts with the RNA within
the capsid

Nucleocapsid (NC)

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______ protein surrounds

the RNA of HIV

Capsid (CA)

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______ protein surrounds
the capsid and lies just beneath
the viral envelope.

Matrix (MA)

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Just before the budding process,
\_\_\_\_\_\_\_ cleaves Gag proteins
into their functional form which get
assembled at the inner part of the
host cell membrane, and virions
then begin to bud off.

HIV protease

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________ is the transition from the point of viral infection to when antibodies
of the virus become present in the blood (circulating antibodies).

Seroconversion

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Stage ___ of HIV infection
Laboratory confirmation of HIV infection, no AIDS defining conditions and CD4+ T
lymphocyte count of ≥500 cells/μL or CD4+ T lymphocyte percentage of total lymphocytes of
≥29***.

Stage 1 (Immediately after HIV exposure and may last for years)

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Stage ____ of HIV infection
Laboratory confirmation of HIV infection, no AIDS defining condition, and laboratory
confirmation of HIV infection and CD4+ T lymphocyte count of 200–499 cells/μL or CD4+ T
lymphocyte percentage of total lymphocytes of 14–28***.

Stage 2 (Progressive immunosuppression and early symptomatic disease*)

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Stage ____ of HIV infection

Laboratory confirmation of HIV infection and CD4+ T lymphocyte count is <200 cells/μL or
CD4+ T lymphocyte percentage of total lymphocytes is <14 or documentation of an AIDS-
defining condition. Documentation of an AIDS-defining condition supersedes a CD4+ T
lymphocyte count of ≥200 cells/μL and a CD4+ T lymphocyte percentage of total lymphocytes
of ≥14***.

Stage 3 (AIDS; variety of immunosuppression-related diseases**)

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Stage ____ • During the first 2 to 6 weeks after initial infection with HIV, ~70% of patients develop an acute flulike syndrome marked by viremia (acute seroconversion syndrome) that may last 10 to 14 days (sometimes up to 4 weeks). Others may not manifest this symptom complex. • Symptomatic persons often develop mononucleosis-like symptoms: lymphadenopathy, fever, pharyngitis, weakness, diarrhea, nausea, vomiting, myalgia, headache, weight loss, and a skin rash (roseola-like or urticarial). Only an estimated 20% of symptomatic persons seek medical attention. • A concomitant transient fall in CD4+ cells occurs along with high titers of plasma HIV, but patients do not develop evidence of immunosuppression (>500 cell/ml; CD4+ cell count tend to return toward normal levels after acute symptoms. • This is usually followed by developing antibodies (anti-gag, anti-gp120, anti-p24) between weeks 6 and 12. A few may take 6 months or longer to achieve seroconversion particularly in patients without acute symptoms. (6 weeks –6 months, 97% within the first 3 months of infection) • The severity of the initial acute infection with HIV (i.e., level of viremia) is predictive of the course the infection will follow. Generally, the longer the acute infection lasts the earlier patients develop AIDS. • Can last up to 8–10 years. • The virus disseminates throughout lymphoid tissue, incubates, replicates (several thousand copies), and alters many physiologic processes, resulting in hyperimmune activation, persistent inflammation, and impaired gut function and flora. • Evolution of the virus within its host to generate closely related yet distinct mutant viruses that serve to evade the surveying immune response and circulating antibodies. • There is a progressive decline in immune function evident as progressive depletion of CD4+ cell count (CD4+ lymphocytes >500 cells/μL) & slow but usually progressive increase in viral load. • <1% are non-progressors and maintain a low viral load. • Silent clinically except for persistent generalized lymphadenopathy (Up to 70% of patients).

Stage 1

Stage ___ Early symptomatic period • Can last 1–3 years. • Signs and symptoms increase as the CD4+ count drops below 500 cells/μL and approaches 200 cells/μL(often between 200 and 300/μL) • Viral load continues to increase. • Platelet count may decrease in about 10% of patients. Any or a combination of the following: • Persistent generalized lymphadenopathy • Fungal infections • Vaginal yeast and trichomonal infections • Oral hairy leukoplakia (OHL) • Herpes Simplex Viruses (HSV-1 & HSV-2) • Herpes Zoster (VZV) • HIV-related retinopathy • Constitutional symptoms: fever, night sweats, fatigue, diarrhea, weight loss, weakness.

Stage 2

Stage ___ • When the CD4+ count drops to below 200 cells/μL (also high viral load) or documentation of an AIDS-defining condition, the person has AIDS and is susceptible to opportunistic infections and maliganacies. • Opportunistic infection(s): Pneumocystis jiroveci pneumonia, cryptococcosis, tuberculosis, toxoplasmosis, histoplasmosis, others • Platelet count may be low. • Neutrophil count may be low. • CD4+ cell count <50/μL at high risk for lymphoma and death. • Malignancies: Kaposi sarcoma, Burkitt lymphoma, non- Hodgkin lymphoma, primary CNS lymphoma, invasive cervical cancer, carcinoma of rectum, slim (wasting) disease • Death usually occurs because of wasting, opportunistic infection, or malignancies.

Stage 3 (AIDS)

In stage 1 HIV, what is the CD4+ cell count?

>500 CD4+

In stage 2 HIV, what is the CD4+ cell count?

200-499

In stage 3 HIV, what is the CD4+ cell count?

< 200

What is the best test to show HIV infection?

Nucleic acid test

_____ tests • Detect the actual virus in the blood. • Polymerase chain reaction (PCR)–based assays of the viral RNA is performed to determine if a person has HIV or the viral load in the blood (i.e., degree of viremia) and monitor response to therapy. • Detect HIV sooner (superior) than other types of tests. • More expensive and not routinely used. • Detection ranges are from 40 copies/mL to more than 750,000 copies/mL. The greatest viral load is found during the first 3 months after initial infection and during late stages of the disease.

Nucleic acid tests

_____ tests • Detect both HIV antibodies and antigens in blood samples. • In HIV-infected individuals, p24 is produced even before antibodies develop. • Antigen/antibody tests are recommended for testing done in labs and are now common in the United States. • This lab test involves drawing blood from a vein. There is also a rapid antigen/antibody test available that is done with a finger prick. • E.g., Abbott has developed a combination assay, the ARCHITECT HIV Ag/Ab Combo assay (Abbott Laboratories, Abbott Park, IL), that can simultaneously detect the combined presence of HIV antigens (p24 antigen) and antibodies to HIV. This test is important for diagnosing HIV infection in the acute phase of the disease when antibodies are not yet present and for ongoing monitoring of patients.

Antigen/antibody tests

What test is the most commonly used test for HIV?

Antigen/Antibody test

_____ tests • Only detect antibodies to HIV in blood or oral fluid. • In general, antibody tests that use blood from a vein can detect HIV sooner after infection than tests done with blood from a finger prick or with oral fluid. • Most rapid tests and the only currently approved HIV self- test (OraQuick) are antibody tests. • Enzyme-linked immunosorbent assay (ELISA) testing for HIV in saliva is 98% sensitive in detecting antibodies to HIV.

Antibody tests

• Current practice in medical setting is to screen first _____. If the results are positive, a second _____ is performed (due to high rate of false positive). All positive results are then confirmed with __________. This combination of tests is accurate more than 99% of the time and the patients are considered potentially infectious.

ELISA; ELISA; Western blot

Guidelines developed for effective drug therapy to treat HIV/AIDS in most patients living with HIV/AIDS incorporate a _____ regimen as a standard for long-term therapeutic effectiveness against the virus.

three-drug ART regimen

__________ • A way for people who do not have HIV but who are at very high risk of getting HIV to prevent HIV infection by taking a pill every day. • The pill (brand name Truvada) contains two medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV. • When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing a permanent infection.

Pre-exposure prophylaxis

In the United States, __% of individuals who have acquired HIV are unaware of their status, contributing to as high as __% of continuous HIV spread.

15%; 40%

T/F: The risk of HIV transmission from infected patients to health care workers is very low, reportedly about 3 of every 1000 cases (0.3%) through a needlestick or other sharp instrument contaminated with the virus.

Tru

The CDC recommends ________ as soon as possible after exposure to HIV-infected blood, regimen recommended is based on the severity of the exposure and the HIV status of the source patient (two- vs three- drug regimen of antiretroviral medication).

postexposure prophylaxis (PEP)

Tests for seroconversion should be performed at __, ____, and __ months after being exposed to HIV

3, 6, and 12

Can you turn a pt away bc they have AIDS?

Two major consideration in dental treatment for patients living with HIV/AIDS

1. Current CD4+ lymphocyte count. | 2. Level of viral load.

The level of viral load can be measured by what protein?

p24

At what point do you prescribe pre-tx abx?

<200 CD4+ cells

What is the most common oral manifestation of HIV?

Candidiasis

• After seroconversion, HIV disease often remains silent except for PGL. • The prevalence of this early clinical sign varies; however, in several studies it approaches 70%. • PGL consists of lymphadenopathy that has been present for > 3 months and involves two or more extrainguinal sites. • The most frequently involved sites are the posterior and anterior cervical, submandibular, occipital, and axillary nodes. • Nodal enlargement usually is larger than 1 cm, and varies from 0.5 to 5.0 cm. • Because lymphoma is known to occur in this population, a lymph node biopsy may be indicated for localized or bulky adenopathy, when cytopenia or an elevated ESR is present, or when requested for patient reassurance. • PGL does warn of progression to AIDS; almost one-third of affected and untreated patients will have diagnostic features of AIDS within 5 years.

Persistent generalized lymphadenopathy

Which candida is seen <200 CD4+ cells?

Pseudomembranous

Which candida is seen with <400 CD4+ cells

Erythematous

What is the Tx for oral candidiasis from HIV?

Azoles or Amphotericin B

What is the 2nd most common oral manifestation of HIV

Oral hairy leukoplakia

Mucosal, cutaneous, and/or nail(s) ______may be induced by: 1. A variety of drugs taken by HIV/AIDS patients such as zidovudine and emtricitabine-based HIV regimens. 2. Drugs used to control microbial infections in these patients such as ketoconazole (fungal- infections), clofazimine (leprosy and some TB), and pyrimethamine (toxoplasmosis/anti- parasitic). 3. Destruction of the adrenal cortex by disseminated infections (e.g. deep fungal infections) in this immunocompromised population is another possible cause of the observed hyperpigmentation. 4. Pigmentation with no apparent cause has arisen in HIV-infected patients, and some investigators have theorized that this may be a direct result of HIV infection.

hyperpigmentation

______ appears with a distinctive linear band of erythema that involves the free gingival margin and extends 2 to 3 mm apically. • The alveolar mucosa and gingiva may demonstrate punctate or diffuse erythema in a significant percentage of cases. • This diagnosis should be reserved for gingivitis that does not respond to improved plaque control and exhibits a greater degree of erythema than would be expected for the amount of plaque present • Results from an abnormal host immune response to subgingival bacteria or may represent an unusual pattern of candidiasis.

Linear gingivitis

________ appears as ulceration and necrosis of one or more interdental papillae with no periodontal attachment loss. • Patients with this have interproximal gingival necrosis, bleeding, pain, and halitosis.

Necrotizing ulcerative gingivitis (NUG)

________ is characterized by gingival ulceration and necrosis associated with rapidly progressing loss of periodontal attachment. (Attachment loss of more than 6 mm within a 6-month period is not unusual) • Although severe cases can affect all teeth, multiple isolated defects often are seen and contrast with the diffuse pattern associated with typical chronic periodontitis. • Edema, severe pain, and spontaneous hemorrhage are common. • Deep pocketing usually is not seen because extensive gingival necrosis typically coincides with loss of the adjacent alveolar bone.

• Necrotizing ulcerative periodontitis (NUP)

_______ may be seen as an extension of NUP or may involve oral mucosa separate from the gingiva. (biopsy in this case is indicated) • Involves predominantly soft tissue or extend into the underlying bone, resulting in extensive sequestration.

Necrotizing stomatitis

The prevalence of oral recurrent HSV infection among HIV-infected individuals increases significantly once the CD4+ cell count

< 50/mm 3.

Persistence of active HSV infection for more than ___ months in a patient infected with HIV is one accepted definition of AIDS.

1 month

• Most lesions are of the more uncommon forms—major and herpetiform. • With more severe reduction of CD4+ cell count, major lesions become more prevalent. • Lesions that are chronic or atypical or that do not respond to treatment should be biopsied. • Treatment of persistent lesions involves potent topical or intralesional corticosteroids. Systemic steroids generally are avoided to prevent further immunosuppression.

Recurrent aphthous stomatitis (RAS)

• The EC-Clearinghouse-WHO cohorts (1993) defined oral ulceration in the context of HIV as a distinct entity not corresponding to any pattern (minor, major, or herpetiform) of recurrent aphthous stomatitis (RAS) nor caused by fungal, bacterial, or viral organisms.

HIV-related (non-specific) oral ulceration

Can • Electrocautery and laser ablation be used to treat HPV when combined with HIV infection?

_______ currently represents the most common malignancy among the AIDS population in the United States.

Non-Hodgkin lymphoma (NHL)

If CD4+ cells get below 50, what is the pt at risk of?

Lymphoma or death

Oral lesions are seen in approximately 4% of patients with | AIDS-related NHL and most frequently involve the ____, ____, ______

gingiva, | palate, and tongue.

_______ currently represents the second most common malignancy among people with AIDS in the United States.

Kaposi sarcoma

The lesion most likely arises from endothelial cells, which may express markers for both lymphatic and blood vessel differentiation and is caused by _______

human herpesvirus 8 (HHV-8).

HIV/AIDS Flashcards

(67 cards)