Modern Pandemic

Question 1

What are our big three modern pandemics?

Answer 1

HIV, influenza, and SARS-CoV-2

Question 2

What is an endemic?

Answer 2

normal level of infection/spread in certain area among people there

Question 3

What is an epidemic?

Answer 3

increased levels of infection typically occurs over a large geographic area and generally result of new strain of virus in immunologically naive population

Question 4

What is a pandemic?

Answer 4

worldwide epidemic, usually from introduction of new virus

Question 5

Who decides when level of infection goes from endemic to epidemic to pandemic?

Answer 5

depends on agency, WHO declares pandemics

Question 6

What is a retrovirus?

Answer 6

enveloped, positive sense, single-stranded RNA virus that converts RNA to DNA through reverse-transcription (via reverse transcriptase)

Question 7

What does HIV bind to?

Answer 7

CD4 cells; and coreceptor CCR5

Question 8

What are the two forms/states HIV?

Answer 8

metabolically active or dormant; active = productive infection, dormant = long-lived in person

Question 9

What happens to host cells of HIV?

Answer 9

HIV is cytotoxic to it’s host cells; number of CD4 cells will decrease over time

Question 10

When does HIV progress to AIDS?

Answer 10

when the person becomes immunocompromised

Question 11

What actually kills HIV patients?

Answer 11

secondary/opportunistic infections

Question 12

Where did HIV come from?

Answer 12

they came from ancient world monkeys that humans had crossover events with

Question 13

How is an HIV molecule structured?

Answer 13

genome in middle, proteins (reverse transcriptase and integrase), capsid, envelop (host derived membrane), more proteins on outside

Question 14

What do the proteins outside HIV do?

Answer 14

recognize and bind to CD4 cells

Question 15

What is the HIV virus’ life cycle?

Answer 15

1) binding
2) fusion
3) reverse transcription
4) integration
5) replication
6) assembly
7) budding

Question 16

Which step in the life cycle is prone to error/mutations?

Answer 16

the reverse transcription stage

Question 17

How can HIV escape our treatment/intervention?

Answer 17

it rapidly changes due to mutation

Question 18

What happens in integration?

Answer 18

double-stranded DNA entered into host cell which is IRREVERSIBLE; genome is now a provirus; determines dormant vs active status

Question 19

What are symptoms of HIV at first?

Answer 19

cold/flu-like symptoms

Question 20

What is clinical latency?

Answer 20

HIV and our immune system fighting to reach equilibrium

Question 21

What is AIDS?

Answer 21

having CD4 count < 200 cells/mm OR having an AIDS defining condition (invasive cervical cancer, HIV-related encephalopathy)

Question 22

What is the stigma around HIV?

Answer 22

one of the most heavily stigmatized such as refusal to interact, refusal of services, loss of relationships; leads to social isolation

Question 23

What is a problem with HIV stigma?

Answer 23

people become hesitant to disclose/seek help for their HIV status

Question 24

What is the HIV prevalence 1990-2017?

Answer 24

number of new infections and deaths have decreased while number of people living with HIV has increased

Question 25

How do you require HIV? (highest to lowest risk)

Answer 25

blood transfusion, receptive anal sex, needle-sharing during injection drug use, percutaneous (needle-stick), insertive anal sex, receptive vaginal sex, insertive vaginal sex

Question 26

What can increase risk of HIV infection?

Answer 26

higher viral load, other STIs, tearing and abrasions, menstruation, and some vagial conditions

Question 27

What can decrease risk of HIV infection?

Answer 27

lower viral load, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), circumcision, lubrication, and condom use

Question 27

What age group makes up HIV diagnoses?

Answer 27

people 25-34 account for most infections (younger people)

Question 28

What populations see HIV infection the most?

Answer 28

2/3 of infections among men who have sex with men, 24% heterosexual sexual conduct, 10% drug users (higher among men)

Question 29

What race is most affected by HIV?

Answer 29

about half of HIV infections are related with black people

Question 30

What is the HIV care continum?

Answer 30

new HIV diagnosis/late HIV diagnosis, linkage to care, receipt of HIV care, and viral suppression

Question 31

How do we commonly test for HIV?

Answer 31

4th generation amino assay (recommended); start with screening test, antibody differentiation test (determines HIV 1 or 2), HIV 1 RNA test (gold standard, definitive HIV test)

Question 32

What other methods do we use to diagnose HIV?

Answer 32

oraquick point of care testing and nucleic acid amplification testing (viral load monitoring)

Question 33

What is the influenza virion structure?

Answer 33

orthomyxoviridae, spherical virions

Question 34

What two glycoproteins does influenza have?

Answer 34

hemagglutinin (HA) and neuraminidase (NA)

Question 35

What are two important transmembrane proteins for influenza virions?

Answer 35

M1 (anchors) and M2 (proton channel)

Question 36

What is the influenza life cycle?

Answer 36

across animals as well as humans

Question 37

What is antigenic drift?

Answer 37

small changes/mutations over time of an endemic strain circulating the human population (less dramatic)

Question 38

What is antigenic shift?

Answer 38

recombination even in another host (birds,swine), leading to a novel influenza shift (more dramatic, pandemic strains)

Question 39

What is endemic influenza?

Answer 39

yearly circulation, normal (not increased amount of infection), if there is outbreak it's considered epidemic, antigen drift

Question 40

What is pandemic influenza?

Answer 40

caused by recombination of influenza (novel strain), humans are naive to it, increase in mortality and infection rate, antigenic shift

Question 41

How do we strain type influenza?

Answer 41

by the glycoproteins present on virus surface

Question 42

What are the strain types?

Answer 42

hemagglutinin (HA) which activates fusion and neuraminidase (NA) which allows new virions to be released

Question 43

What are the symptoms of influenza?

Answer 43

respiratory illness involving fever, chills, headache, muscle aches, malaise, dry cough, sore throat, and rhinorrhea (runny nose)

Question 44

What can influenza become?

Answer 44

pneumonia or secondary bacterial pneumonia

Question 45

How do we detect influenza?

Answer 45

lateral flow POC, PCR, viral culture and serologic diagnosis

Question 46

What is the spike glycoprotein on SARS-CoV-2?

Answer 46

specific for ACE-2 (on lung and intestine)

Question 46

What are the variants of concern (VOC) for SARS-CoV-2?

Answer 46

alpha, beta, delta, omicron (current major circulating variant)

Question 47

What is COVID-19 transmitted by?

Answer 47

respiratory droplets/aerosoles, fomite transmission by pre-symptomatic/symptomatic/asymptomatic individuals

Question 47

What is the primary COVID-19 infection? Who does it affect?

Answer 47

symptoms range from mild cold to viral pneumonia; affects elderly mainly

Question 48

What can COVID-19 lead to?

Answer 48

cytokine storm, blood clots, organ damage, and MIS-C (children)

Question 48

What are the long-term effects of COVID-10?

Answer 48

new/ongoing symptoms, chronic fatigue, "brain fog", shortness of breath, lung damage, heart damage, development of type 2 diabetes

Question 49

How do we test for COVID-19?

Answer 49

direct detection (NAAT, rapid antigen), indirect detection

Question 50

What is flurona?

Answer 50

coinfection = new virus created from SARS-CoV-2 and influenza