AIDS Policy History Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What was the initial budget announced by George W. Bush for AIDS relief under PEPFAR?

$25 billion

$10 billion

$20 billion

$15 billion (correct)

In what year did President Obama sign the Affordable Care Act, which included protections for patients with chronic infections like HIV?

2011

2009

2012

2010 (correct)

What percentage of Americans believed in 2012 that HIV could be contracted by sharing a drinking glass?

20.7

10.5

35.2

25 (correct)

What significant achievement was announced due to PEPFAR since 2003?

1 million babies born HIV-free Signup and view all the answers

What was the finding of the START study regarding HIV-positive patients?

Early ART initiation decreases AIDS-related risks Signup and view all the answers

What percentage of new HIV infections could potentially be prevented according to the CDC in 2015?

90% Signup and view all the answers

What is the estimated overall lifetime risk of an HIV diagnosis in the US as of 2016?

1 in 99 Signup and view all the answers

What was one outcome for 'the Mississippi baby' mentioned in 2014?

Had detectable levels of HIV Signup and view all the answers

How did scientists believe HIV initially made the jump to humans?

Infected blood contact while hunting chimpanzees Signup and view all the answers

As of 2023, what proportion of persons living with HIV are women and girls?

53% Signup and view all the answers

What was the total number of HIV infections globally since 1981 as of 2023?

88.4 million Signup and view all the answers

What is the primary characteristic that differentiates HIV-2 from HIV-1?

HIV-2 is less transmissible than HIV-1. Signup and view all the answers

Which of the following conditions is NOT used to confirm an HIV positive status?

HIV positive status with symptoms of fever Signup and view all the answers

How many people have reportedly died from HIV/AIDS since 1981?

40.4 million Signup and view all the answers

Which cell type is primarily affected by HIV and is critical for immune response?

CD4 cells Signup and view all the answers

What significant event regarding HIV/AIDS occurred in 1981?

CDC published a report on rare infections in gay men. Signup and view all the answers

What distinguishes post-exposure prophylaxis (PEP) from pre-exposure prophylaxis (PrEP)?

PEP is taken only after potential exposure, whereas PrEP is taken beforehand. Signup and view all the answers

Which syndrome is caused by Human Immunodeficiency Virus?

Acquired Immunodeficiency Syndrome Signup and view all the answers

What is a key feature of HIV as a virus?

It is a retrovirus that transcribes RNA to DNA. Signup and view all the answers

In what year was the first drug to treat HIV/AIDS, zidovudine (AZT), approved?

1986 Signup and view all the answers

What event in 1987 highlighted public reaction to HIV-positive individuals returning to school?

A federal judge's ruling Signup and view all the answers

Which year did AIDS become the leading cause of death for all Americans aged 25-44?

1994 Signup and view all the answers

Which significant policy was enacted in 1990 to support those living with AIDS?

Ryan White CARE Act Signup and view all the answers

What was the main focus of the CDC reports in 1983 regarding the population at greatest risk for AIDS?

Homosexual males, IVDAs, Haitians, and hemophiliacs Signup and view all the answers

By which year did the US estimate 792,000 people were living with HIV?

1997 Signup and view all the answers

What was established in 1996 regarding treatment effectiveness for HIV/AIDS?

HAART effectiveness was established Signup and view all the answers

What significant recommendation did the US government make in 1994 regarding pregnant women with HIV?

They should take AZT to reduce transmission Signup and view all the answers

In 1998, what was a notable statistic reported by the CDC regarding mortality in African Americans with AIDS?

Higher mortality than Whites and Hispanics Signup and view all the answers

What viral test was approved in 1996 that contributed to HIV treatment monitoring?

Viral load test Signup and view all the answers

Which medication is absolutely contraindicated when taken with rilpivirine?

Proton Pump Inhibitors (PPIs) Signup and view all the answers

What is the recommended administration condition for doravirine?

With or without food Signup and view all the answers

Which of the following statements about Atazanavir is correct?

It can have decreased concentrations due to H2 blockers. Signup and view all the answers

What is the recommended separation time for taking antacids with rilpivirine?

2 hours before or 4 hours after Signup and view all the answers

What is a common adverse effect associated with protease inhibitors?

Endocrine disturbances Signup and view all the answers

Which integrase strand transfer inhibitor is known for having a lower genetic barrier?

Raltegravir Signup and view all the answers

How do H2 receptor antagonists interact with rilpivirine?

They decrease rilpivirine concentrations. Signup and view all the answers

Which of the following adverse drug events is NOT commonly associated with integrase inhibitors?

Gastrointestinal intolerance Signup and view all the answers

Which of the following factors contraindicates the use of rilpivirine?

Viral load greater than 100,000 copies/mL Signup and view all the answers

What is the primary mechanism of action of protease inhibitors?

Inhibition of the viral maturation process Signup and view all the answers

What is the main function of Lenacapavir in HIV treatment?

Inhibits HIV RNA and enzyme transport into the cell nucleus Signup and view all the answers

Which of the following is a known adverse effect associated with the use of Enfuvirtide?

Injection site reactions Signup and view all the answers

Which statement about Maraviroc is accurate?

It requires a tropism test to determine its effectiveness Signup and view all the answers

What is the route of administration for Ibalizumab?

Intravenous infusion Signup and view all the answers

What role does Fostemsavir play in HIV treatment?

It acts as a prodrug of temsavir Signup and view all the answers

What is a contraindication when using strong 3A4 inducers with Lenacapavir?

Decreased effectiveness of other ARTs Signup and view all the answers

Why is the therapeutic approach of using stem cell transplants considered for HIV patients?

To eliminate HIV by altering immune receptor genetics Signup and view all the answers

Patients taking statins alongside ART should consider which of the following considerations?

Monitoring is essential when using atorvastatin Signup and view all the answers

What is a common adverse effect associated with Ibalizumab?

Nausea and diarrhea Signup and view all the answers

Which patient population is specifically indicated for the use of Fostemsavir?

Heavily treatment-experienced patients failing current therapy Signup and view all the answers

Study Notes

Human Immunodeficiency Viruses and Acquired Immunodeficiency Syndrome (AIDS)

HIV-1 and HIV-2 are causative pathogens for AIDS
HIV-2 is less virulent, transmissible, and prevalent than HIV-1
HIV is a retrovirus (RNA virus that is transcribed to DNA)

Objectives

Define the etiology and epidemiology of HIV
Illustrate the life cycle of HIV
Describe the pathophysiology of AIDS
Compare and apply the pharmacology of antiretroviral therapy
Classify the toxicities and adverse effects of antiretroviral therapy
Describe the drug-drug interactions of antiretroviral therapy
Identify recommended and non-recommended vaccines for patients living with HIV
Summarize preferred starting regimens for patients with HIV/AIDS
Define prophylactic regimens for post-exposure prophylaxis (PEP) or pre-exposure prophylaxis (PrEP)

Epidemiology

Three primary modes of transmission:
- Sexual transmission (primarily anal and vaginal intercourse; condom use reduces risk by 80%)
- Parenteral transmission (sharing contaminated needles/syringes, rare with today's screening, healthcare workers from accidental needle sticks)
- Perinatal transmission (mother to baby, most common cause of pediatric HIV infection, can also be transmitted by breast milk)
People Living with HIV/AIDS (PLWHA)
- Since 1981, 85.6 million people have become infected with HIV
- 40.4 million have died
Diagnosis:
- Positive HIV status
- AIDS defining illness
- CD4 cell count less than 200

HIV/AIDS Timeline

1981: CDC reports 5 previously healthy gay men in Los Angeles with Pneumocystis carinii.
1982: Term "Acquired Immunodeficiency Syndrome (AIDS)" is coined.
1983: First reports of transmission to female sexual partners of males with AIDS.
1986: First drug to treat HIV/AIDS (zidovudine, AZT) approved.
1987: Federal judge ordered 3 HIV-positive brothers back to school.
1990: First report of HIV transmission through dental procedure.
1992: AIDS became the #1 cause of death for US men aged 25-44.
1993: Female condom approved, "Philadelphia" released
1994: AIDS leading cause of death for all Americans aged 25-44, pregnant women given AZT to reduce perinatal transmission.
1995: First protease inhibitor approved.
1996: Highly Active Anti-Retroviral Therapy (HAART) effectiveness established, new cases decline.
1997: HAART becomes standard of care; UN estimates 30 million people worldwide have HIV.
1998: First HAART guidelines published; CDC reports differences in mortality rates among racial groups living with AIDS.
1999: WHO notes AIDS as the 4th leading killer worldwide.
2002: 961,000 people living with HIV in the US.
2003: CDC reports 27,000 new HIV infections from people who don't know they're infected.
2007: CDC reports over 565,000 people have died from AIDS in the US since 1981.
2008: PEPFAR re-authorized.
2009: 100th ART drug released.
2010: Obama signs Affordable Care Act; NIH study shows HIV drug reduces risk of infection in MSM.
2011: CDC announces HIV drug trials reduce heterosexual risk of transmission.
2012-2015: various updates on HIV awareness, testing, treatments, and prevention in these years
2015: CDC reports that more than 90% of new HIV infections could be prevented, lower AIDS risk in patients starting ART earlier.
2016: Overall lifetime risk of HIV diagnosis in the US is 1 in 99.
2018: Various data on perinatal HIV transmission
2022: The South accounted for more than 50% of HIV diagnoses.
Data on HIV globally and in the US in 2023 showing 39.9 million people with HIV globally, 30.7 million were accessing antiretroviral therapy.

HIV Origins

HIV mutated from Simian Immunodeficiency Virus (SIV) in chimpanzees in Central Africa.
Humans contracted SIV from hunted chimpanzees through contact with infected blood.
Possibly started in the late 1800s.
First verified case was documented in 1959 in the Democratic Republic of Congo.

Prevention

Safe sex practices (condoms) greatly reduce risk.
Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP)

Vaccine Recommendations

Live vaccines contraindicated at low CD4 counts.

Diagnosis

All patients ages 13-64 should be screened for HIV risk.
Testing recommended using a 3-step process using fourth-generation HIV antigen/antibody test.
Confirm HIV 1/2 if positive
Viral load measurement if indeterminate.

Typical Course of HIV Infection

A graphic demonstrates the decline in CD4+ T-lymphocyte cell count over time with the increase in HIV RNA copies per ml of plasma.

HIV Life Cycle (Diagram)

A diagram of HIV structure and components labels HIV Envelope, HIV RNA, HIV capsid, HIV enzymes, and HIV glycoproteins.

Antiretroviral Therapy (ART) Classes

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Protease Inhibitors (PIs)
Integrase Strand Transfer Inhibitors (INSTIs)
Capsid Inhibitors
Fusion Inhibitors
CCR5 Antagonists
Examples and details for each class provided.
Importance of medication adherence.

Vaccines for PLWHA

Live vaccines are contraindicated for patients with low CD4 counts.
Other vaccines are recommended based on individual patient factors and risk.

Therapy Goals for HIV/AIDS

Undetectable viral loads is a key goal in treatment as it prevents transmission.
CD4 counts should be sustained and increase.

Pregnancy Considerations

Pregnant women with HIV should receive ART early in pregnancy.
Drug dosing, potential teratogenicity, prevention of vertical transmission, cobicistat regimens, and first trimester initiation of treatment.

Intrapartum Considerations

Reduces transmission risk to less than 0.5%
Continuing ART, except ZDV, if viral load is below 50 copies/mL
If VL is between 50-999 copies/mL, consider IV ZDV.

Adolescent Considerations

Adolescents may require additional psychological support during HIV treatment.

HIV/HCV/HBV Co-infections

Treatment recommendations for co-infections. Co-infection treatment should address both viral infections.

Treatment as Prevention (TasP)

PEP and nPEP for high-risk individuals.
Rapid testing and prompt treatment.

Chemoprophylaxis Regimens

TDF/FTC + RAL or TDF/FTC + DTG.
Start treatment ASAP, ideally within 72 hours if exposed.

PrEP

Preferred combinations for PrEP.
Important considerations for PrEP regimens and patient monitoring.

PrEP Testing Recommendations

Assess baseline CrCl and lipid panels before starting PrEP (especially for TAF/FTC).

PrEP Counseling

High-risk subgroups.
Considerations for pregnant women.
Screen for STIs.

U=U (Undetectable = Untransmittable)

The concept of viral suppression as preventing HIV transmission to sexual partners
Adherence is a key element in successfully implementing U=U.

Science Behind PrEP Studies

iPrEX, PROUD, and Bangkok Tenofovir studies
Key findings and results.

Case Studies

Detailed case study presentations.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on the history of AIDS policy in the U.S. with questions about PEPFAR, the Affordable Care Act, and public perceptions of HIV. Explore key events and statistics that have shaped the fight against HIV/AIDS.