Lecture 6 Flashcards
(24 cards)
What is the pathology of HIV?
Retrovirus(uses own RNA to replicate) invades CD4 T helper, dendrite, and monocytes to replicate
Causing our body to be susceptible to infections and cancers
What is the pathology of AIDS?
Outcome of chronic HIV
Depletion of CD4 (<200 cells) OR had AIDS defining condition
Who are at risk populations for HIV?
Men who have sex with men
Transgender people
People who inject drugs
Sex workers
Heterosexuals
Healthcare workers (needle sticks 3/1000)
How is HIV transmitted?
Blood
Semen
Pre-seminal fluid
Rectal fluids
Vaginal fluids
Breast milk
What is the common entry for HIV?
Anogenital mucosa
Notes: anal intercouse
How does HIV invade cells?
Infects T cells by interacting between glycoprotein(gp120) and T-cell coreceptor (CXCR4) and monocyte by interacting with CCR5 co-receptor
How does HIV invade cells?
Infects T cells by interacting between glycoprotein(gp120) and T-cell coreceptor (CXCR4) and monocyte by interacting with CCR5 co-receptor
How does HIV transfer from DCs to CD4?
DCs capture and bind HIV
HIV is traveled along with the DC
HIV is transferred to CD4 T cells through trans-infections
What are the stages of HIV infection?
Viral transmission/ HIV acquisition
Acute HIV infection/Acute retroviral syndrome(symptomatic stage)
Chronic HIV infection
Advanced HIV infection (CD4 count <50cells/mL)
Can features help define a chronic HIV infection?
Can be asymptomatic
Aids <200 cells/mL
Presence of AIDS defining condition
What are the clinical manifestations of of acute retroviral syndrome?
Nonspecific viral syndrome (fever, chills, diaphoresis, pharyngitis, lymphadenopathy, myalgias/arthrlagias, cephalgia, fatigue)
Spontaneous resolution
Latent until profession into AIDS
Who should be tested for HIV?
Known or suspected sexual or hematologic exposure
Have sexual history
Known drug abuse, especially IVDU
Accidental needlestick
Pregnancy
Recent sexually transmitted infection
CDC recommends routine screening ages 13 - 64 years at least once in their lifetime
What should you take if you test positive on an ELISA test for HIV to make sure?
Western Blot (this test is expensive)
Second ELISA
What are other tests to consider when diagnosing for HIV?
Pregnancy Test
Serum hepatitis B serology
Serum hepatitis C serology
CBC with Diff
BMP or CMP
UA, LFTs, Fasting plasma glucose, Lipid profile
Human leukocyte antigen-B*5701 testing
PPD, CXR
What can you take for Pre-exposure prophylaxis (PrEP)?
For high-risk patients
Behavioral changes
Tenofavir(Truvada, drug class NRTI)
When someone has HIV what should we also test for?
Tuberculosis
What are some routine immunizations to help prevent HIV?
Pneumococcal vaccine
Inactivated influenza vaccine annually in season
Hepatitis A/B vaccine
Tdap vaccine
HPV vaccine for patients <45 years of age
Haemophilus influenzae type b vaccine
What non-medical things can we do that helps prevent HIV?
Safe sex practice
Avoids consumption of raw meat, eggs, shellfish (toxoplasma, salmonella, campylobacter)
Avoid cleaning cat litter (toxoplasma)
Avoid cat scratches/bites (bartonella)
Consider consumption of bottled water(cryptosporidium)
What is the goal of antiretroviral therapy?
Suppression of HIV replication
What are the types of drugs used for antiretroviral therapy?
NuecleoSIDE reverse transcriptase inhibitors(NRTI)
NueloTIDE reverse transcriptase inhibitors(NRTI)
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Protease inhibitors
Entry inhibitors / Fusion inhibitors
Integrase inhibitors
What do we need to consider when choosing antiretroviral therapy?
Prior treatment experiences
Medication side effects
Underlying conditions
Convenience of formulation
Genotypic resistance testing
Results of resistance testing → 15 - 20% of treatment naive patients resistant!
Do we need to know specific drugs?
NOPE, only class
What are PIs used for?
Suppress HIV replication
Administered as combination therapy
Metabolized by P450 (high potential for drug interaction)
Used to boost other regimens
What are some aids defining conditions?
Mucocutaneous candidiasis
Oral hairy leukoplakia
Genital herpes
Herpes zoster/ shingles
Molluscum Contagious
Community acquired pneumonia
Pnuemocystis jiroveci penumonia
Esophageal candidiasis
Kaposi’s sarcoma
Wasting syndrome
Mycobacterium avium infection
Crytococcal meningitis
Cytomegalovirus retinitis
Toxoplasmosis
