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31 Cards in this Set

  • Front
  • Back
What are the general characteristics of HIV/AIDS?
-RNA, retroviridae
-Infectes CD4, macrophage.
-Genetic variability for immune evasion, ARD resistance (changes its antigen to escape immune response);
-proteins on HIV env
What are 4 ways we can inhibit HIV from getting into cells?
1. Fusion inhibitors (inhibits HIV from getting into cells)
2. Protease inhibitors (when virus is produced, makes a long strand of polypeptide to make mature virus but protease inhibitor blocks this capsid from going around virus so it'll escape but its not virulent)
3. Nucleoside Reverse Trascriptase Inhibitors
4. Nonnucleoside Reverse transcriptase inhibitors.
How is HIV transmitted and what are the risk behaviors?
Transmission: sex, percutaneous, perinatal (placenta or breast feeding)
Risk Behaviors: hi risk sexual activity, IV drug use.
What is the Epi of HIV/AIDS?
-@ end of 2003, 1-1.2 mil in US living w/ age & 25% of AIDS pts don't know they have it.
-40,000 newly diagnosed in 2005.
-74% male, 49% AA
Of males, what is the highest transmission category? Of females?
MSM (67%); Heterosexual contact (80%)
Highest age group for HIV infection in 2005?
males 30-39
Describe the patho of HIV.
HIV transmitted-->goes to CD4 or macrophages-->
1. CD4-->will affect T cell dysfxn and T cell death-->cytokine dysregulation-->inability to activate & regulate immune responses-->inc infections
2. macrophage dysfxn-->poor T cell activation-->t cell dysfxn-->cytokine dysregulation-->inc infections
What do macrophages usually do for our immune response?
Present antigens to T cell-->secrete cytokines w/ walling off of pathogen.
What are the clinical manifestations of HIV/AIDS?
-Acute retroviral syndrome: mono-like or flu-like illness, 1-3 wks post infection;
-Chronic: lasts for yrs, slow decline in immune fxn, skin & mucus membrane dz's common, latent TB can recur.
-Crisis-->AIDS: opportunistic infections, unusual cancers, AIDS dementia (abnl cytokine secretion), primary lymphomas of CNS, KS
What are some opportunistic infections in AIDS?
-Bacterial infections: bacterial resp & enteric diseases, syphilis, bartonellosis;
-Mycobacterial infections: MTB, MAC;
-Fungal infections: Pneumocystis jiroveci pneumonia, Candida, cyptococcosis, histoplasmosis, coccidiomycosis, aspergillosis.
-Parasitic infections: toxo, crypto, microsporidiosis
-Viral: CMV, HSV, HZV, HHV-8 (kaposi's sarcoma), HPV, HCV, HBV
How is HIV diagnosed?
-Serology (ELISA, Western blot, new rapid pt of care tests available)
What should be considered for the prognosis of HIV/AID?
viral load (will tell you whether to change drug regimen), CD4 cells cts (<200), resistance testing
When should HIV RNA (=viral load) & CD4+ T cells be used?
-in suspected acute HIV infection in seronegative individual;
-initial eval of newly diagnosed pt
-every 3-4 mos in untreated pt.
-immediately prior to initiating therapy
-every 3-4 mos in pts on therapy
-as indicated.
In a chronic infection w/ HIV, what are 2 situations in which treatment must be offered?
If pt has is symptomatic w/ AIDS or severe sx's and if they are asymptomatuv but have a CD4 less than 200
In which situation w/ HIV should tx offered but pros and cons should be considered?
Asymptomatic & CD4 b/w 200-350.
W/ asymptomatic HIV pt w/ CD4 >350 and plasma HIV RNA >100,000, should tx be offered?
probably defer tx.
What are the benefits of deferred therapy for HIV?
-Avoid neg effects on QOL
-Avoid drug related toxicity
-Preserve future drug options
-Delay development of drug resistance
-Dec total time on drugs
What are the risks of deferred therapy for HIV?
-possibility of irreversible immune system depletion;
-inc possibility of progression to AIDS
-Possible inc risk of HIV transmission.
What is the drug regimen (initial tx) for someone w/ HIV?
NNRTI (Efavirenz), or PI (Atazanavir + rotonavir, Fosamprenavir +ritonavir, lopinavir/ritonavir) + NRTI Options (Tenofovir/ emtricitabine, Zidovudine/Lamivudine)
Which Viral Hep can be efficiently transmitted by sexual contact?
HBV (Its a DNA virus)
What antigens can we test for in diagnosis of HBV?
Core, surface, DNA polymerase, ABeAg.
Which Hep infection is one more likely to get if they have multiple partners rather than sex w/ an infected partner?
What is the tx for HBV?
Interferon & Lamivudine
What are the prevention methods for HBV?
Active vaccine, passive vaccine, screening of donated blood
What is the biggest risk factor in the US for HBV?
Multiple sex partners (17%)
Which should get the hep B vaccine?
all infants, high risk groups, adolescents, prevent perinatal infection.
What are some behaviors that should be avioded by HBV infected groups?
IV drug use, Alcohol, Multiple sex partners, sharing personal items, donation of blood, organs, tissues, semen
What is the incubation period for an HBV infection?
30-100 days
What should be look for in a chronic HBV infection a year post their infection?
total anti-HBc, HBsAg, no IgM anti-HBc, anti-HBe
Can someone w/ asymptomatic HBV become symptomatic later on in the chronic infection and get cirrhosis and liver cancer?
Yes, it just takes a little longer than it would have been if it was symptomatic immediately.
In recovery of an acute HBV infection what can use still detect?
total anti-HBc