Clinical Medicine II
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| What is unique about HIV retrovirus | carry RNA genetic code, but produce reverse transcriptase wihich converts RNA into DNA, and settles into host cell’s where it waits for activation
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| What kills CD4 cells | the “kick out” of the virus from the cell destroys it
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| What HIV test may be positive | gp120 protein on the surface
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| What is significant for gp120 | has a high affinity for the CD4 receptor cells
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| What is the purpose of reverse transcriptase | virus gets in, releases RNA w/ viral enzymes: reverse transcriptase and integrase which reads viral RNA and builds corresponding DNA strands, DNA moves into cell nuclease where cell clones these genes and virus is to be spread when cell divides
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| How is the virus activated | when infected host cell is activated and divides, the proviral DNA is transcribed into RNA which turns into viral proteins and polyproteins
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| What is patho of the HIV virus | 1) many virus replicate in each CD4 cells 2) these cells are getting destroyed
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| Why should post exposure be done w/I 72 hours | want to get it prior to reaching the CD4 cells in blood
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| What does HIV latency time depend on | amount in blood, general health, presence of other illnesses
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| HIV | infected with HIV virus
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| AIDS | acquired immune deficiency syndrome caused by HIV virus
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| The higher the viral load | the ↑ risk of opportunistic infections
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| First antiretroviral approved by FDA | AZT 1987 (5 years post identification)
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| What is the Ryan white care act | provides assistant to pt’s w/o insurance (was a 7-8yo hemophiliac got HIV from transfusion)
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| What is HAART | highly active antiretrovirus therapy
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| Results from the HAART | now a chronic dz NOT a death sentence, LTSE’s for antivirals: renal and other metabolic dz
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| How do we test for HIV | serum ab (Elisa), aliva/urine ab, rapid finger test stick.
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| How do we confirm HIV | western blot assay: identifies positive gp120 protein
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| How long does antibody take to become positive | 22-27days
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| + ELISA and- western blot means | HIV-
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| Pt comes in acute viral sxs, HIV exposure 1-2 weeks ago, what is next test to order | HIV viral RNA load (if present means have virus)
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| Who do we test for HIV | 13-64 in health care settings, based on suspicion
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| Lab markers of HIV infection and monitoring | Viral load, and CD4 count
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| What would classify a false + | viral load <10,000 copies/mL, should be considered “indeterminate” until ruled out
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| When do HIV infected pt’s become infectious | seroconversion (body makes ab for it)
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| What defines AIDS | CD4 <200, and presence of OI’s
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| Primary HIV inx S/S | mononucleosis- like illness 1-4wks post-exposure
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| What viral bacterial, parasitic, and fungal infx are OI’s | V: Kaposi sarcoma, Herpes, flu B: TB, S. pneumo P: pneumocystis carinii F: candida Cryptococcus
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| MC presentation of acute HIV | fever, fatigue, HA, maculopapular rash on face and trunk (rare on extremities)
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| Neuro sxs for HIV | meningitis, neuropathy/radiculopathy, facial palsy, GBS, brachial neuritis, cong impairment, psychosis
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| 5 P’s of HIV during hx | sexual practices, past STDs, preg hx, protection from STDs, partners in last 6m/1yr
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| Neoplastic clues of HIV | kaposi’s, basal ad squamous cell
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| Derm cues | infectious, neoplastic, inflammatory
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| Late-stage presentation of HIV | muscle wasting, lethargy, wt loss, look very sick
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| Why are we concerned about when HIV was contracted | drug resistance, if infected w/I last 2-3 yrs, get resistance testing
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| How can we tell if it is a new or old infx | lab test: absolute CD4, if low, usually older infx
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| What must we test w/ new HIV test | LFT’s, Renal fxn, other OI’s test
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| With a – Hep C ab titer and is a drug user what should we do | HCV RNC PCR viral load test d/t such a correlation b/w HIV and Hep C
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| F/U with HAART pts | 3m w/ labs, utilizing pharm, nutrition, mental health care
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| Vaccines for HIV pts | Hep A, B, pneumococcal, influenza, tetanus
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| What nl test should be looked at d/t SE’s of NRTIs | cholesterol screening d/t its ↑ w/ dyslipidemia
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| Main challenge in tx HIV | raising the immune system values, the drugs can ↓ the viral load significantly, but hard to ↑immune system
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| SE’s with HIV mediciatons | dyslipidemia, glucose metabolism, ↓ bone mineral density, hypogonadism, renal, haptic, psych d/os, neurocog, neuropathy, CAD
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