Repro Buxton Viral Stds: Hiv, Hbv; Kct

Front 1

What are the general characteristics of HIV/AIDS?

Back 1

-RNA, retroviridae
-Infectes CD4, macrophage.
-Genetic variability for immune evasion, ARD resistance (changes its antigen to escape immune response);
-proteins on HIV env

Front 2

What are 4 ways we can inhibit HIV from getting into cells?

Back 2

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.

Front 3

How is HIV transmitted and what are the risk behaviors?

Back 3

Transmission: sex, percutaneous, perinatal (placenta or breast feeding)
Risk Behaviors: hi risk sexual activity, IV drug use.

Front 4

What is the Epi of HIV/AIDS?

Back 4

-@ 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

Front 5

Of males, what is the highest transmission category? Of females?

Back 5

MSM (67%); Heterosexual contact (80%)

Front 6

Highest age group for HIV infection in 2005?

Back 6

males 30-39

Front 7

Describe the patho of HIV.

Back 7

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

Front 8

What do macrophages usually do for our immune response?

Back 8

Present antigens to T cell-->secrete cytokines w/ walling off of pathogen.

Front 9

What are the clinical manifestations of HIV/AIDS?

Back 9

-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

Front 10

What are some opportunistic infections in AIDS?

Back 10

-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

Front 11

How is HIV diagnosed?

Back 11

-Serology (ELISA, Western blot, new rapid pt of care tests available)

Front 12

What should be considered for the prognosis of HIV/AID?

Back 12

viral load (will tell you whether to change drug regimen), CD4 cells cts (<200), resistance testing

Front 13

When should HIV RNA (=viral load) & CD4+ T cells be used?

Back 13

-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.

Front 14

In a chronic infection w/ HIV, what are 2 situations in which treatment must be offered?

Back 14

If pt has is symptomatic w/ AIDS or severe sx's and if they are asymptomatuv but have a CD4 less than 200

Front 15

In which situation w/ HIV should tx offered but pros and cons should be considered?

Back 15

Asymptomatic & CD4 b/w 200-350.

Front 16

W/ asymptomatic HIV pt w/ CD4 >350 and plasma HIV RNA >100,000, should tx be offered?

Back 16

probably defer tx.

Front 17

What are the benefits of deferred therapy for HIV?

Back 17

-Avoid neg effects on QOL
-Avoid drug related toxicity
-Preserve future drug options
-Delay development of drug resistance
-Dec total time on drugs

Front 18

What are the risks of deferred therapy for HIV?

Back 18

-possibility of irreversible immune system depletion;
-inc possibility of progression to AIDS
-Possible inc risk of HIV transmission.

Front 19

What is the drug regimen (initial tx) for someone w/ HIV?

Back 19

NNRTI (Efavirenz), or PI (Atazanavir + rotonavir, Fosamprenavir +ritonavir, lopinavir/ritonavir) + NRTI Options (Tenofovir/ emtricitabine, Zidovudine/Lamivudine)

Front 20

Which Viral Hep can be efficiently transmitted by sexual contact?

Back 20

HBV (Its a DNA virus)

Front 21

What antigens can we test for in diagnosis of HBV?

Back 21

Core, surface, DNA polymerase, ABeAg.

Front 22

Which Hep infection is one more likely to get if they have multiple partners rather than sex w/ an infected partner?

Back 22

HCV

Front 23

What is the tx for HBV?

Back 23

Interferon & Lamivudine

Front 24

What are the prevention methods for HBV?

Back 24

Active vaccine, passive vaccine, screening of donated blood

Front 25

What is the biggest risk factor in the US for HBV?

Back 25

Multiple sex partners (17%)

Front 26

Which should get the hep B vaccine?

Back 26

all infants, high risk groups, adolescents, prevent perinatal infection.

Front 27

What are some behaviors that should be avioded by HBV infected groups?

Back 27

IV drug use, Alcohol, Multiple sex partners, sharing personal items, donation of blood, organs, tissues, semen

Front 28

What is the incubation period for an HBV infection?

Back 28

30-100 days

Front 29

What should be look for in a chronic HBV infection a year post their infection?

Back 29

total anti-HBc, HBsAg, no IgM anti-HBc, anti-HBe

Front 30

Can someone w/ asymptomatic HBV become symptomatic later on in the chronic infection and get cirrhosis and liver cancer?

Back 30

Yes, it just takes a little longer than it would have been if it was symptomatic immediately.

Front 31

In recovery of an acute HBV infection what can use still detect?

Back 31

total anti-HBc