Blood And Lymph - Hiv - Blue

Front 1

How does HIV replicate that's unique?

Back 1

Single stranded RNA that encodes reverse transcriptase = strand converted to DNA = made into DS DNA (=why its called a retro-virus)

DS DNA Then integrates into our DNA = then you're infected for life. I can't make new virus until it does this...Ie it makes mRNA and viral transcripts and we get death of the cell

Front 2

T/F: There has likely been several chimp-human HIV crossovers

Back 2

TRUE

Front 3

Define Mutant swarm in terms of HIV

Back 3

Mutant swarm is a survival tactic used by HIV in which it undergoes rapid antigenic variation due to mistake-prone reverse transcriptase

Front 4

What are the 3 major targets of anti-retroviral drugs?

Back 4

Integrase

Reverse Transcriptase

Protease

Front 5

What types of cells does HIV infect?

Back 5

CD4 Helper T cell

Macrophage

Glial cell

Front 6

Define rapid antigenic variation

Back 6

What reverse transcriptase does to stay ahead of the immune system

Front 7

What happens eventually as HIC continues to deplete CD4 cells?

Back 7

eventually your immune system will fail

Front 8

Whats an alternate route (besides CD4, macrophages, and glial cells) of HIV infectivity

Back 8

Mucosal dendritic cells --> dendrites pick up HIV --> take to lymph node to present to CD4 cells --> this secures HIV infectivity

Ex = oral sex

Front 9

If you see HIC infecting glial cells, what stage of the disease is the pt likely in?

Back 9

end stage (glial cell infection can lead to dimentia)

Front 10

Whats the initial cell infected with HIV?

Back 10

Macrophage (=usually first cell in which replication occurs)

Front 11

What does HIV need to infect a CD4 cell?

Back 11

CD 4 receptor and 2 co-receptors, which are chemokines

Dual binding property = virus can invade cell

Front 12

How does HIV escape from immunity and anti-retrovirals?

Back 12

reverse transcritase' inefficneicy = constant mutations = immune system and anti-retrovirals don't work.

Front 13

What are the mechanisms of HIV transmission?

Back 13

Needles
Sexual Transmission (ANY type of sex)

Front 14

Whats the most common HIV passed from person to person?

Back 14

M=Tropic (=most usual one passed from person to person)

Front 15

T/F: Most people don't know they're infected with HIV

Back 15

TRUE

Front 16

Why are T cells more prone to HIV infection than other cells?

Back 16

They have two spots where HIV can bind instead of just one

Front 17

Group M HIV includes what and how many clades?

Back 17

9 clades

A, B, C, D, F, G, H, J, K, CRFs

CFR = circulating recombinant form

(In what clades has genetic recombination been documented in? A --> G)

5 Group O clades

Front 18

What are the four major groups of HIV?

Back 18

MNOP

Front 19

In what clades has genetic recombination been documented in?

Back 19

A --> G

Front 20

Which is more pathogenic, HIV1 or HIV2?

Back 20

HIV 1

Front 21

What type of HIV do we have in the US?

Back 21

Group M type B

Front 22

CD4 cells are rapidly depleted from where first?

Back 22

GI tract

THEN

Lymph nodes

Front 23

Loss of what cell after loss of CD4 cells after HIV infection leads to reduced antibody production

Back 23

CD8

Front 24

What protects HIV from immune and anti-retroviral effetcs?

Back 24

The fact that the virus can remain dormant IN T cells = these systems can't find it.

Additional cell sanctuaries = macrophages, glial/Astrocyte cells

Front 25

T/F: Host genetic can enhance/diminish effects of HIV infection

Back 25

TRUE

Host genetics play a big role in whether HIV infection is bad or not

Front 26

Average pt with untreated HIV will live how long?

Back 26

8-9 years

= time until immune system completely wiped out

Front 27

Which decreases more rapidly after HIC Infection: Blood CD4 T cells r Body CD4 T cells?

Back 27

Body CD4 T cells

Front 28

What HIV strain is associated with a rapid progression?

Back 28

CXCR4 Syncytial strain

Front 29

What HIV strain is associated with a slow progression?

Back 29

gp120 or nef (-)

Front 30

Mutations in what part of the HIV molecule can make a pt. have a rapid or slow disease progression?

Back 30

RAPID: CXCR4, CCR5 = inc. binding affinity

SLOW: Minor or Heterozygous mutation in CCR5 CCR2 = Dec. binding affinity

Front 31

At what CD4 T cell count will a pt start to show signs of Bacterial skin infections?

Back 31

500

Front 32

At what CD4 T cell count will a pt start to show signs of Kaposi's Sarcoma?

Back 32

400

Front 33

What does the CDC recommend in terms of HIV screening?

Back 33

Routine, Voluntary screening for all ages 13-64

Front 34

How many people are HIV+ and have never been tested?

Back 34

150,000-200,000 (almost 1/4 million people)

Front 35

What groups does the CDC recommend get screened for HIV annually?

Back 35

Injected drugs/steroids/shared drug equipment like needles

Anyone who has had unprotected sex with men who have sex with men, anonymous partners, or multiple partners

Have sex exchanged for drugs or money

Dx'd with hepatitis, TB, sexually transmitted infection

All pregnant women

Front 36

How do we test for HIV? ie what lab tests are done?

Back 36

ELISA and Western Blot

Front 37

When will the ELISA and western blot be positive after infection with HIV?

Back 37

1-2 months

Front 38

When will PCR be positive after infection with HIV?

Back 38

1-2 weeks

Front 39

Define Rapid screening tests (POC)

Back 39

Blood, serum and or oral test to determine if pt is HIV+

Front 40

Whats the benefit of the Rapid Screening test for HIV (POC)?

Back 40

Results are immediate, so pt is in office when results are read = reduces amt. of shady pts who don't show up to get HIV test results from ELISA or western blot

Front 41

Do both the ELISA and western blot need to be positive to Dx HIV?

Back 41

YES

Front 42

In HIV positive pts., what do we monitor?

Back 42

CD4 Count

Viral Load

Viral resistance testing (genotypic and phenotypic) = aids in determination of initial antiviral treatment

Front 43

At what amt of CD4 cells is an HIV positive pt still considered healthy?

Back 43

Over 500

Front 44

How is most HIV transmitted?

Back 44

Heterosexual Sex

Front 45

If a pt is treated EARLY with the anti-retroviral HAART agents, what is their outlook for survival long term?

Back 45

GOOD...50% chance they'll live into their 60s or 70s even if they were infected in their 20s

Front 46

Whats the change a person treated with HAART, the anti-retroviral therapy late in the disease progression will live to be 50?

Back 46

Not good -

There's a 50% chance they'll only live to be about 40

Front 47

Homosexual sex accounts for what percent of HIV transmission?

Back 47

15%

(Heterosexual = 75%)

Front 48

What body fluids contain HIV at high concentrations such that there is a HIGH probability of infection from them?

Back 48

Blood
Semen
Vaginal fluid
Breast milk

Front 49

What body fluids contain HIV at a LOW concentration such that there is a low chance you'll get HIV from them?

Back 49

Saliva
Urine
Tears
Sweat
CSF

Front 50

More than 97% of HIV infections occur where?

Back 50

Low and middle income countries

Front 51

Where is the highest percentage of people living with HIV?

Back 51

Sub-saharan Africa (69%!)

Front 52

T/F: The global number of people living with HIV is leveling off

Back 52

TRUE