Hiv And Aids Test 2

Front 1

What was the first FDA approved anti-HIV drug?

Back 1

AZT in 1987 (zidovudine)

Front 2

Describe the 3 phases of the FDA drug approval process:

Back 2

Phase 1: 20-80 healthy volunteers test the drug's safety.

Phase 2: 100-300 patients with the disease assess the drug's effectiveness and identify side effects.

Phase 3: 1000-3000 patients verify effectiveness and identify adverse reactions.

Front 3

About _____ drugs that begin a clinical trial is approved for consumer use.

Back 3

1 in 5

Front 4

List the 4 classes of drugs currently in use:

Back 4

1. Reverse Transcriptase Inhibitors
a. non-nucleoside analogs
b. nucleoside analogs
2. Protease Inhibitors
3. Integrase Inhibitors
4. Entry and Fusion Inhibitors

Front 5

What are the current standards of HIV therapy?

Back 5

-All anti HIV drugs must be used in combination.
-Antiretroviral Therapy (AVT) includes 3 or more drugs: 2 RT & PI
-It is more difficult for viruses to develop that are resistant to several drugs.
-The drugs slow replication of virus and slow mutation rate.

Front 6

Salvage Therapies

Back 6

New treatment regimens for patients with resistant HIV.

Front 7

Cross Resistance

Back 7

When HIV becomes resistant to one drug, it may easily become resistant to other drugs which function in the same manner.

Front 8

What are the 2 markers used to evaluate effectiveness of anti-HIV drugs?

Back 8

1. T4 and CD4+ cells
Important because they need to be up to prevent opportunistic infection.
2. Viral load

Front 9

Current guidelines for starting anti-viral therapy:

Back 9

-If T cell count is 350 or higher, don't start medication unless viral load is 55,000 or higher.
-If T cell count is between 200-349, treatment should be considered.
-If T cell count is below 200, treatment is indicated.

Front 10

Phenotypic

Back 10

Drug resistance testing where drug is added to a sample of the patients virus to see if the drug can stop the growth of HIV.

Front 11

Genotypic tests

Back 11

Drug resistance testing which sequences the virus and looks for known resistant mutations in the reverse transcriptase and protease genes. This is cheaper and faster.

Front 12

Can HIV be cured?

Back 12

No, because there is no way to remove the provirus from the cell's DNA.

Front 13

List important side effects:

Back 13

-liver damage/failure
-diabetes
-lipodystrophy (abnormal accumulation of fat in back and abdomen)
-high cholesteral
-high triglycerides
-heart disease
-bone loss
-kidney stones

Front 14

Current problems using HIV therapy:

Back 14

1. Duration: for life
2. Adherence or compliance: taking all drugs at the scheduled times.
3. Cost - $19000-150000 per year
4. Side effects can be severe

Front 15

How could HIV drugs make things worse?

Back 15

-Antibiotics help spread and strengthen bacteria which cause STDs.
-When penicillin became available, STD edu ended.
-The sexual rev was spurred on by a belief STDs were curable.
-HIV mutates quicker than any other virus and strains have evolved to evade every drug.
-New combination therapies are expensive and difficult to take (non-compliance increases number of resistant strains)
-Apathy & a false sense of security - AIDS prevention efforts have faltered. Infection rates have remained high and unsafe sex practices low.

Front 16

What is a surrogate marker?

Back 16

A physiological measurement that serves as a substitute for a major clinical event.

Front 17

After starting antiretroviral therapy, what is an acceptable target for virus load that indicates therapy is effective?

Back 17

5000 copies/mL

Front 18

When your virus becomes resistant to a drug in your drug combination, your viral load may go up. Resistance is an all or nothing deal - the drugs work perfectly or not at all.

Back 18

False

Front 19

Functions of the immune system:

Back 19

1. Distinguish between self and non-self.
2. Filter out foregin substances.
3. Destroy and remove pathogens.
4. Control normal flora & prevent from overgrowth.
5. Remove damaged and dead cells.
6. Destroy mutant and cancer cells.

Front 20

Without an immune system:

Back 20

1. Any microbe can grow to high numbers in the body and cause disease.
2. Microbes normally found in a healthy body are in a large number and cause disease.
3. Antimicrobial drugs help stop microbes from growing, but ultimately the microbes become resistant and cause disease.
4. Higher risk of cancer.

Front 21

Antigen

Back 21

(foregin invader) anything that is recognized as foregin or nonself by the immune system.

Front 22

Antibody

Back 22

(defensive weapon) a Y-shaped protein which is produced and secreted by B cells in response to a specific antigen. Antibodies bind to and contribute to the destruction of antigens.

Front 23

Characteristics of T cells

Back 23

-Derived from bone marrow and mature in the thymus.
-Make 70-80% of circulating lymphocytes.
-Each T cell has a T cell antigen receptor which recognizes a peptide bound to a self MHC molecule
-Do not recognize soluble antigen
-Antigen must be displayed on surface of an antigen presenting cell like a B cell or macrophage.

Front 24

Two types of T cells and their functions:

Back 24

1. Helper T4: conductor of the immune system. Activates other cells of the immune system. Target of HIV.
2. Cytotoxic T8: Destroy target cells on contact.

Front 25

How does the immune system distinguish between self and non-self?

Back 25

-All body cells have class 1 MHC proteins on their surfaces that mark the cells as self.
-Immune system tries to destroy anything that does not have class 1 proteins because they are nonself or antigens.

Front 26

What cells does HIV infect?

Back 26

-T4 cells
-Macrophages, dendrite cells, scavenger white blood cells that digest antigens.

Front 27

What percent of HIV is in lymph nodes?

Back 27

98%

Front 28

What percent of HIV is in blood?

Back 28

2%

Front 29

What happens as a HIV infection progresses?

Back 29

-HIV replicates rapidly in lymph nodes and generates lots of mutant strains.
-B cells produce antibodies against each new variant of HIV until they are overwhelmed.
-Viral load relates to production rates: clearance is constant.

Front 30

How does HIV infection lower the number of T4 cells?

Back 30

1. Directly-HIV replication sometimes kills cells
2. HIV can fill CD4 receptors with free gp 120, cell cannot function and will be destroyed.
3. HIV can cause syncytia formation - T4 cells fuse together.
4. HIV can produce superantigens - cause loss of response.
5. HIV can trigger apoptosis (cell suicide)
6. Autoimmune mechanisms - HIV may trick the immune system into attacking itself.
7. Cofactors help deplete T cells
- poor nutrition, stress drugs, other infections.
8. HIV may cause less T cells to be produced

Front 31

Opportunistic Infections

Back 31

-Disease caused by microorganism that normally live in or on the body without causing disease in people with normal immune systems.
-Suppression of the immune system allows for harmless to become harmful.
-Caused by viruses, bacteria, fungi and protozoa that are kept in check by an intact immune system.
-Caused by over 100 microbes
-Can become disseminated (systemic)

Front 32

Cause of death related to HIV:

Back 32

-90% opportunistic infection
-7% cancer
-3% others

Front 33

Why did opportunistic infections decrease in 1997?

Back 33

Due to use of protease inhibitors

Front 34

Six most common opportunistic infections:

Back 34

1. Bacterial pneumonia - numerous causes
2. Mycobacterium avium - complex disease
3. Mycobacterium tuberculosis
4. Pneumocystis carnii - pneumonia
5. Candida albicans - esophagitis
6. Herpes simplex virus

Front 35

Worldwide, ________ is the leading cause of death in HIV infected people.

Back 35

tuberculosis

Front 36

List 4 fungi and the diseases they cause:

Back 36

1. Pneumocystis carinii - pneumonia
2. Candidias - oral thruch, esophagitis, vaginitis
3. Histopiasmosis - Histoplasma capsulatum
-inhaled spores, pneumonia, dissemination to other organs
-flu like symptoms, shortness of breathe
4. Crytococcus neoformans - meningitis, pneumonia

Front 37

Herpesviruses are a big problem for AIDS patients.

Back 37

True

Front 38

List 4 Herpesviruses and the diseases that they cause:

Back 38

1. Herpes Simplex (HSV 1 & 2)
-mouth, genital, rectal
2. Cytomegalovirus (CMV)
-fever, hepatitis
3. Varicella zoster virus (VZV)
-shingles, encephalitis
4. Epstein-Barr (EBV)
-oral hairy leukopiakia, B cell lymphoma

Front 39

List 2 non-herpes viruses:

Back 39

1. Human papilloma virus (HPV)-warts
2. Hepatitis C (HCV) - hepititis

Front 40

Nairobi prostitude study:

Back 40

-Repeated exposure to HIV - 25% or more of clients are HIV+
-Free of disease for more than 12 years and completely resistant to infection
-Association between their resistance to infection and their class 1 and class 2 MHC.
-This particular class of 1 MHC
--may allow very high efficent cytotoxic T cell responses.
--may present highly conserved parts of different HIV strains
-The key epidemiologic correlate of late seroconversion was a reduction in sex work over the preceeding year.
-In persistently uninfected controls, a break from sex work was associated with a loss of HIV- specific CD8+ responses.
-May relate to the waning of HIV- specific CD8+ responses due to reduced antigenic exposure

Front 41

Kaposis's sarcoma is caused by HIV

Back 41

False - HIV has not been found in KS lesions. There is a Kaposis's sarcoma virus aka HH8 that grows and causes cancer when the immune system is suppressed.

Front 42

Neuropathis

Back 42

Functional changes in the PNS. Nerve damage characterized by sensation of pins and needles, burning, stiffness or numbness.

Front 43

Window period

Back 43

Time before seroconversion, anti HIV antibodies are not detectable.
-Give a false negative HIV test
-High viral replication
-May infect others

Front 44

Clinical latency

Back 44

Period from infection until expression of opportunistic infection; may last 1-20 years, average is 10 years.

Front 45

Four Stages of HIV Disease:

Back 45

1. Acute or Primary Infection Stage
2. Asyptomatic HIV disease stage
3. Chronic Symptomatic HIV disease stage
4. Advanced HIV disease stage: AIDS

Front 46

Acute of Primary Infection Stage - Acute retroviral syndrome

Back 46

2-8 weeks after infection
70% of people have brief flu like illness
High levels of HIV in organs
- Very infectious

Front 47

Asyptomatic HIV disease stage

Back 47

6 months to 11 years
Set point: steady state of HIV replication
T4 cells constantly destroyed and replaced.
-Infectious to others

Front 48

Chronic Symptomatic HIV disease stage

Back 48

Last months - years
T4 cells drop to 200 or less per mL of blood
Fever, weight loss, loss of appitite, night sweats, etc.
Destruction of lymph nodes
Onset of opportunistic infection and cancer

Front 49

Advanced HIV disease stage: AIDS

Back 49

Final stage of HIV infection
T4 cell count below 200 per mL of blood

Front 50

Long term non-progressors (with out drugs)

Back 50

0.8% of people infected by HIV don't develop AIDS
- About 1 in 3000 people can maintain no more than 50 copies of HIV/mL of blood over a period of at lease 1 to 2 years despite never having taken antiviral meds

Front 51

Six causes of long term non-progressors:

Back 51

1. High level of responsive cytotoxic T8 cells
2. Defective viruses
3. HIV specific neutralizing antibodies
4. Increased numbers of CD4 T cells specific for p24, HIV viral capsid protein.
5. Low levels of spontaneous lymphocyte apoptosis (programmed cell death) compared to progressor
6. Mutant CoKR5 coreceptor gene - more common in caucasians of European decent.

Front 52

HIV infection of the CNS:

Back 52

-O.I. malignancies and HIV infection of CNS causes neurological dysfunction.
-HIV invades brain within a few weeks after HIV enters the body.
-HIV infected macrophages migrate to brain
-HIV does not infect neurons
-HIV in the CNS may evolve independently from HIV in the blood
-Progressive dementia due to HIV in the CNS develops in 55-65% of AIDS patients.
-Mental impairment begins after HIV infection becomes symptomatic.

Front 53

Four types of cancer common in AIDS:

Back 53

1. Kaposis's sarcoma - linked to HHV8 outgrowth of blood vessels
-disseminated lesions involving skin, lymph nodes and organs
-more common in homosexual men
2. Lymphoma - generalized lymphadenopathy, site of growth at brain, heart and anorectal area.
3. Progressive multifocal leukoenphalopathy (PML) - caused by Papovavirus JCV - 4% of AIDS patiets, fatal, no treatment
4. Squamous cell carcinoma - anal, oral

Front 54

How is HIV transmitted?

Back 54

1. Sex - anal, oral, vaginal
2. Parenteral - IV drug users, blood transfusions.
3. Perinatel - mother to fetus, in utero, during delivery

Front 55

HIV is NOT transmitted by:

Back 55

Insects
Toliet Seats
Casually by household contact
Kissing, hugging, etc
Urine
Saliva

Front 56

_________ percent of untreated HIV+ pregnant women pass the infection to their babies.

Back 56

25-33%

Front 57

____ percent of treated HIV+ pregnant women pass the infection to their babies.

Back 57

3%

Front 58

What is the most common route of HIV transmission?

Back 58

unprotected sex

Front 59

The proportion of AIDS cases among black Americans doubled between 1985 and 2006, a sharp increase compared to the other most populous ethnic groups.

Back 59

True

Front 60

HIV is found in almost all body fluids EXCEPT:

Back 60

Sweat and bronchial fluids

Front 61

Where is HIV found in greatest number?

Back 61

Within T4 cells, macrophages of blood, vaginal fluid and semen.
- Low levels of cell free HIV is found in these fluids.

Front 62

Among hetrosexuals, HIV transmission from male to female and from female to male are equally efficent.

Back 62

False - HIV is more efficently transmitted to females

Front 63

Unprotected receptive anal intercouse the the sexual activity with the greatest risk of HIV transmission.

Back 63

True