AIDS

Question 1

HIV primarily targets

Answer 1

CD4+ lymphocytes, which are critical to proper immune system function.
diagnosis: depletion of CD4+ cells to** ≤200 cells/mL** or because of the development of new opportunistic infections

Question 2

modes of transmission

Answer 2

Sexual: if unprotected
Parenteral:
Injectable drug use OR Receiving contaminated blood products
Perinatal: Mother-to-infant transmission during gestation, delivery, or breast-feeding
Occupational exposure via needle stick or exposure to eyes, nose, or open wound
Organ donation from an HIV infected donor

Question 3

hiv is not transmissited by:

Answer 3

• Working or playing with an HIV positive person
• Closed mouth kissing
• Shaking hands
• Public pools
• Hugging
• Public toilet

Question 4

Risk factors for HIV/AIDS infection

Answer 4

1. Men who have sex with men (MSM)
2. Unprotected sex with high-risk individuals
3. History of or current IV drug use (needle or equipment sharing)
4. Presence of other sexually transmitted infections (e.g., Chlamydia trachomatis or Neisseria gonorrhoeae)
5. Persons with coagulation / hemophilia disorders
   Previous blood product recipients

Question 5

Pathophysiology

Answer 5

HIV is RNA virus, its contents include single-stranded RNA, reverse transcriptase and other enzymes.

Question 6

types of hiv

Answer 6

There are two molecularly and serologically distinct but related types of HIV: HIV-1 and HIV-2.

HIV-1 is a retrovirus and member of the genus Lentivirus.

HIV-2 is a less common cause of the epidemic and is found primarily in West Africa.

These viruses have a prolonged latency period.

Question 7

HIV lifecycle

Answer 7

1. Binding
2. Fusion
3. Reverse transcriptase
4. Integration
5. Replication
6. Assembly
7. Budding

Question 8

Q: Why is it so hard to cure AIDS completely?

Answer 8

A: The viral RT enzyme is highly error-prone, and many mutations occur in the conversion of RNA to DNA. This inefficient RT activity is responsible for HIV’s ability to rapidly mutate and develop drug resistance.

Question 9

HIV infection stages

Answer 9

• The initial immune response against HIV is relatively effective, but it is unable to completely clear the infection
• Patient enters a latent, asymptomatic, or mildly symptomatic stage lasting 5 - 15 years (some references: 10 years).During this time, a high rate of viral replication can be seen in the lymph nodes.
• immune deficiency occurs when the body is no longer able to produce helper T cells at a rate equal to that at which HIV is destroying them.

Question 10

acute HIV

Answer 10

rapid production of hiv
some poeple develope flu like symptoms

Question 11

stage 2 chronic hiv

Answer 11

• asymtomatic
• slow reproduction of hiv
• gradual reduction of cd4 cells
• no symptoms

Question 12

stage 3 aids

Answer 12

• symptomatic
• low levels of cd4 cells in the body
• appearance of oppurtunistic infection

Question 13

Clinical presentation

Answer 13

Acute retroviral syndrome:
When the patient is present within (fever, myalgia, lymphadenopathy, pharyngitis, or rash)
Occur 2-6 weeks after initial infection and the symptoms last 2-4 weeks.

Question 14

Diagnosis of HIV is made by either:

Answer 14

Positive HIV ELISA (enzyme linked immunosorbent assay)

Rapid test (e.g. OraQuick ADVANCE)

Diagnosis needs to be confirmed by a +ve HIV WB (Western Blotting) technique

Question 15

A diagnosis of AIDS is made when an HIV positive patient has:

Answer 15

CD4 count ˂ 200 or 14% or the patient diagnosed with an AIDS indicating condition (pulmonary TB, recurrent pneumonia or cervical cancer)

Question 16

Treatment response & disease progression is determined by:

Answer 16

CD4+ lymphocyte count (CD4+ count) and percentage
HIV RNA (viral load).

Question 17

Treatment of efficacy and safety can be monitored by:

Answer 17

CD4+ lymphocyte count (CD4+ count) and percentage
HIV RNA (viral load)
Basic blood chemistry tests (U & E)
LFTs
CBC
Lipid profiles

Question 18

Maximal suppression of viral replication

Answer 18

Maximal suppression of viral replication is defined as HIV RNA concentrations undetectable by the most sensitive assay available.
Combination antiretroviral therapy has increased both the length and quality of life of HIV-infected patients

Question 19

Nucleoside \ nucleotide RT inhibitor (NRTI+NtRTI)

Answer 19

1. Abacavir
2. Lamivudine

Question 21

Non-nucleoside RT inhibitor (NNRTI)

Answer 21

1. Efavirenz
2. Nevirapine

Question 21

Protease inhibitor (PI)

Answer 21

1. Atazanavir
2. Indinavir

Question 22

• Integrase strand transfer inhibitors (INSTI)
• Fusion inhibitors
• CCR5 inhibitors

Answer 22

raltegravir
Enfuvirtide
Maraviroc

Question 23

Highly active antiretroviral therapy (HAART)

Answer 23

2 nucleoside \ nucleotide RT inhibitors
ONE NNRTI OR PI OR INSTI Abacavir and lamivudine

Question 24

Causes of virologic failure should be identified if possible. These could be:

Answer 24

Poor compliance / adherence which might be due to medication SE / intolerance Pharmacokinetic issues Presence of drug resistance

Question 25

HIV Treatment failure

Answer 25

Never add a new drug to a failing regimen to prevent the development of resistance, try to not initiate the regimen that failed in the past.If an agent in a given regimen must be stopped, it is recommended that all agents in the regimen be stopped and restarted simultaneously to prevent development of resistance.

Question 26

Considerable cross resistance

Answer 26

can occur between medications within an antiretroviral class. Using drugs to which the patient has not been exposed may be insufficient

Question 27

Complete cross-resistance

Answer 27

occurs within the first generation of NNRTIs, whereas the NRTIs and PIs have variable overlapping resistance patterns.

Question 28

failure therapy Adherence and Resistance Testing

Answer 28

Question Adherence: Assess the patient’s adherence to the regimen and address any barriers. Confirm Sample Adequacy: Ensure the plasma HIV RNA concentration in the resistance sample is adequate to accurately detect resistance mutations.

Question 29

HIV Prophylaxis

Answer 29

1. Tenofivir \ emtricitabine fixed-dose combination with safe sex.

Question 30

Post-exposure prophylaxis

Answer 30

after exposure should contain 3 or more active ARVs and should continue for 4 weeks.

Question 31

non-occupational post-exposure prophylaxis

Answer 31

s recommended for individuals seeking care within 72 hours to blood, genital secretions, or other infectious fluids from a known infected person.