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Pathology > I - HIV > Flashcards

I - HIV Flashcards

(59 cards)

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1
Q

How many people have AIDS worldwide

A

37 million

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2
Q

How many ppl have died of aids

A

39 million

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3
Q

How is HIV transmitted

A

Sexual
Infected blood
Vertical - mother to child

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4
Q

What type of virus is HIV

A

RNA retrovirus

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5
Q

What type of cell does HIV target as a host

A

Cd4 t helper cells mainly
Also cd4+ monocytes and dendritic cells

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6
Q

How does HIV replicate in host cell

A

Reverse transcriptase converts RNA to DNA to integrate in host genes

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7
Q

What is the receptor for HIV

A

Cd4 molecule

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8
Q

How does the virus bind to cd4+ cells (2 steps)

A

Gp120 - initial binding
Gp41 - conformational change

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9
Q

What coreceptors are used by hiv to bind to cd4 cells and on what cells are the found

A

Ccr5 and cxcr4 chemokine receptors (on macrophages)

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10
Q

What protein is the intrastructural support for HIV

A

Gag protein

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11
Q

Describe innate response to HIV

A

Activation of macrophages, nk cells and complement
Stimulation of dendritic cells via TLR
Release of cytokines and chemokines

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12
Q

Describe adaptive response to hiv

A

Neutralising & non neutralising ABs
Cd8+ T cells prevent HIV entry via chemokine production

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13
Q

Neutralising ABs to HIV

A

anti gp120 and anti gp41

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14
Q

Non neutralising AB to HIV

A

anti p24 gag IgG

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15
Q

What chemokines do cd8+ T cells produce to prevent hiv entry

A

Mip-1a
Mip-1b
RANTES

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16
Q

How does HIV damage the immune response

A

Activated infected cd4+ helper T cells are killed by cd8+ T cells / are anergised (disabled)
—> cd4 T cell memory lost and can’t activate memory cytotoxic T lymphs —> monocytes / dendritic cells not activated by cd4+ cells —> can’t prime naive cd8+ cyctoxic T lymphs

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17
Q

How does reverse transcriptase helps HIV evade immune response

A

It is error prone, so quasi species are produced which escape detection

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18
Q

Is HIV infectious when AB coated

A

YES

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19
Q

What are 2 key ingredients for effective HIV immunity

A

ABs to prevent infection and neutralise virus
Sufficient cytotoxic T lymphs to eliminate latent infected cells

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20
Q

Median time from HIV infection to AIDS

A

8 to 10 years

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21
Q

What is the median time from HIV infection to AIDS in rapid progressions

A

2-3 years

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22
Q

What are long term non progressors of HIV

A

Stable cd4 count and no symptoms after 10 years

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23
Q

% of HIV patients who are rapid progressors ? Long term non progressors ?

A

Rapid 10%
Long term non <5%

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24
Q

What predicts disease progression in HIV

Study These Flashcards
A

initial viral burden

25
How is HIV screened for
ELISA detects anti HIV ABs
26
How is HIV diagnosed
Western blot to detect AB
27
How long does it take after infection for a person to test positive for HIV via western blot & why
10 weeks - western blot requires patient to have SEROCONVERTED (start to produce AB), which happens after 10 week incubation period
28
How is viral load of HIV determined
PCR - detects viral RNA
29
How is CD4 count determined
FACS - flow cytometry
30
What is cd4 count used for in HIV Mx
Course of disease Onset of AIDS (reduction in cd4 T cells)
31
Define the cd4 count of aids
<200 cells / uL blood
32
How is resistance to antiretrovirals tested
Phenotypic - viral replication is measured in cell cultures under increased concentrations of the drug then compared to wild type Genotypic - mutations observed by sequencing of amplified HIV genome
33
When should treatment be started after diagnosis of HIV
IMMEDIATELY (used to only be if Sx or low cd4)
34
What is the mainstay of treatment for HIV & what does this consist of
HAART - highly active anti retroviral therapy 2 NRTIs (nucleoside reverse transcriptase inhibitors) and PI (protease inhibitor) (or NNRTI - nonNRTI)
35
3 benefits of HAART
substantial control of viral replication Increase in cd4 count Decline in opportunistic infection and deaths
36
Give an example of HAART regime
Emtricitabine + tenofovir + efavirenz (Available as one pill - atripla)
37
HAART regime in preg for mother & baby (drug, route & when)
Zidovudine Antenatal PO, delivery IV PO to baby for 6 weeks to reduce transmission
38
Limitations of HAART (7)
doesn’t eradicate latent HIV Doesn’t restore HIV specific T cell response Toxicities High pill burden / Adherence Threat of drug resistance QoL Cost
39
Describe HIV lifecycle
Attachment /entry Reverse transcription and DNA synthesis Integration to host DNA Viral transcription Viral protein synthesis Assembly & budding
40
Which part of HIV lifecycle do attachment / fusion inhibitors target
Attachment and entry
41
Which part of HIV lifecycle do integrate inhibitors target
Integration to host DNA
42
Which part of HIV lifecycle do protease inhibitors target
Assembly and budding
43
Which part of HIV lifecycle do reverse transcriptase inhibitors target
Reverse transcription and DNA synth
44
Which part of HIV lifecycle do NRTI / NNRTI target
DNA synthesis
45
Example drug of fusion inhibitors
Enfuvirtide
46
Side effects of fusion inhibitors
Injection reactions
47
Drug example of attachment inhibitors
Maraviroc
48
Examples of NRTIs
Zidovudine Didanosine Stavudine Lamivudine Zalcitabine Abacavir Emtricitabine Epzicom Combivir Trizivir
49
Side effects of NRTIs
Rare Fever, GI issues
50
Specific side effect of zalcitabine / stavudine
Peripheral neuropathy
51
Which NRTI gives mitochondrial toxicity
Stavudine
52
Side effect of abacavir
Hypersensitivity
53
Example of nucleotide RTI
Tenofovir
54
Side effect of tenofovir
Bone and renal toxicity
55
Examples of NNRTIs
Nevirapine Delavirdine Efavirenz
56
Side effects of NNRTIs
Hepatitis and rash CNS effects
57
Example of integration inhibitors
Raltegravir Elvitegravir
58
Examples of protease inhibitors
Indinavir Nelfinavir Ritonavir Amprenavir Fosamorenavir Lopinavir Atazanavir Saquinavir
59
Side effects of protease inhibitors
Hyperlipidaemia Fat redistribution T2DM

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