HIV Overview and Structure Quiz

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Questions and Answers

What is a major receptor through which HIV enters human cells?

Chemokine receptor 5 (CCR5) (correct)

Interleukin receptor

CD8 receptor

CD4 receptor (correct)

Which of the following symptoms are associated with acute HIV infection?

Severe neuromuscular disorders

Sore throat and fever (correct)

Chronic cough

Skin ulcers

What is the hallmark of untreated HIV infection?

Increased CD4 lymphocytes

Stable viral load

Acute opportunistic infections

Profound CD4 T-lymphocyte depletion (correct)

Which test is typically used as the initial screening for HIV infection?

ELISA test Signup and view all the answers

What is one of the primary goals of HIV treatment?

Decrease morbidity and mortality Signup and view all the answers

In what phase of HIV infection is high viral load typically observed?

Acute phase Signup and view all the answers

What is the significance of the HIV RNA test?

It can assess viral load and guide treatment decisions Signup and view all the answers

Which opportunistic condition is most closely associated with severe immunosuppression in HIV?

Opportunistic infections Signup and view all the answers

Which of the following statements about HIV-2 is accurate?

It is primarily found in western Africa Signup and view all the answers

What type of rash may be seen in a patient with HIV clinical presentation?

Morbilliform or maculopapular rash Signup and view all the answers

What is the primary goal of using combinations of antiretroviral agents in HIV treatment?

To achieve undetectable plasma HIV levels and reverse immune deficiency Signup and view all the answers

Which conditions increase the urgency to start antiretroviral therapy (ART)?

Acute opportunistic infections and pregnancy Signup and view all the answers

Which of the following antiretroviral classes is NOT typically included in initial HIV treatment regimens?

NSAIDs Signup and view all the answers

What is a unique consideration when treating HIV-infected children compared to adults?

Children may require different pharmacologic and immunologic evaluations Signup and view all the answers

Which of the following drugs is classified as an Integrase Strand Transfer Inhibitor (INSTI)?

Raltegravir Signup and view all the answers

What is a critical aspect of HIV management that is essential for the treatment's success?

Adherence to prescribed medication regimens Signup and view all the answers

Which of the following antiretroviral classes includes drugs that specifically target the reverse transcriptase enzyme?

Reverse Transcriptase Inhibitors Signup and view all the answers

In the context of HIV treatment, what does ART stand for?

Antiretroviral Therapy Signup and view all the answers

What is the significance of HIV RNA levels being below 100,000 copies/mL when considering treatment?

It suggests a lower risk of transmission and complications Signup and view all the answers

Which of the following is NOT a recommended class of antiretrovirals for treating HIV?

Corticosteroids Signup and view all the answers

Study Notes

HIV Structure

HIV is a retrovirus.
The virus has a capsid containing RNA.
Proteins include p24 (capsid), p7 (nucleocapsid), gp41 (transmembrane glycoprotein), and gp120 (docking glycoprotein).
The virus also has a phospholipid envelope.
Reverse transcriptase is crucial for its replication cycle.
Matrix protein p17
Protease

HIV Overview

HIV is a sexually transmitted infection (STI).
Multiple transmission methods exist.
HIV rapidly spread globally.
Acquired immunodeficiency syndrome (AIDS).
First discovered in Central Africa in 1959.
HIV-1 group M: prevalent in the Western world.
HIV-2: found primarily in Western Africa.

HIV Pathogenesis

HIV attaches to human cells using CD4.
Two chemokine receptors are involved: CCR5 and CXCR4.
The virus replicates inside host cells, and then is released.

HIV Transmission Methods

Sexual transmission
Parenteral exposure to blood
Universal precautions
Perinatal transmission

HIV Clinical Presentation

More common symptoms: Fever, headache, sore throat, fatigue, gastrointestinal upset (diarrhea, nausea, vomiting), weight loss, myalgia, a rash (often maculopapular and on the trunk), lymphadenopathy, night sweats
Less common symptoms: Aseptic meningitis, oral ulcers, leukopenia
Other observations: High viral load (may exceed 1,000,000 copies/mL or 109/L) and persistent decrease in CD4 lymphocytes

HIV Phases

HIV infection progresses through three phases: acute, chronic, and terminal (AIDS).
Untreated HIV infection leads to profound CD4 T-lymphocyte depletion and severe immunosuppression.
Opportunistic infections are a major concern.

HIV Diagnosis

ELISA (initial test)
Western Blot (confirmation)
Rapid HIV tests
HIV RNA (copies/mL)
Signal amplification nucleic acid probe
Reverse transcriptase PCR
Nucleic acid sequence-based amplification

HIV RNA Test Indications

Acute infection
Newly diagnosed
Every 3-4 months (on or off therapy)
2-8 weeks after starting or changing therapy
3-4 months after starting therapy
Following a clinical event or decreasing CD4 count

HIV Treatment Goals

Reduce morbidity and mortality
Enhance quality of life
Preserve immune function
Prevent further transmission

HIV Treatment Principles

Antiretroviral therapy (ART) is recommended for everyone with HIV regardless of CD4 count.
Factors increasing urgent ART initiation include pregnancy, AIDS-defining conditions, acute opportunistic infections, low CD4 counts (<200 cells/mm³), HIV-associated nephropathy, and acute/early infection

HIV Treatment: Drug Classes

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Protease Inhibitors (PIs)
Integrase Strand Transfer Inhibitors (INSTIs)
Entry Inhibitors
CCR5 antagonists

HIV Treatment Regimens

INSTI-based regimens (e.g., dolutegravir + tenofovir)
NNRTI-based regimens (e.g., efavirenz)
PI-based regimens (e.g., darunavir/ritonavir)

HIV Important Management Aspects

Adherence
Efficacy
Resistance

HIV Special Populations: Pregnancy

Dolutegravir should be avoided, if possible, Zidovudine is recommended.
Infants born to HIV-infected mothers should receive Zidovudine or nevirapine prophylaxis for 4-6 weeks after birth.
Breastfeeding is not recommended.

HIV Treatment Failure

Change therapy for toxicity
Significant virologic failure
Immunological failure
Resistance testing
Prior therapy with no resistance (check adherence and address underlying causes, or start a new regimen.)
Intensity or PK boost therapy

HIV Treatment Failure: Resistance Present

New regimen with 2 or more active agents
Extensive therapy with resistance (try to resuppress to prevent progression)
New regimen with 2 active agents not possible (continue current regimen)

HIV Complications & AIDS Development

Uncontrolled HIV leads to opportunistic infections (OIs).
Most OIs are caused by environmental organisms.
OI development is linked to CD4 count.

HIV and AIDS: Specific OIs

Pneumocystis pneumonia (PCP): Primary prophylaxis in patients with CD4 < 200/mm³.
Cryptococcal meningitis: Primary prophylaxis – not indicated
Cytomegalovirus retinitis: Primary prophylaxis with CD4 < 50/mm³, regular retinal examinations.
Mycobacterium avium complex (MAC): Primary prophylaxis with CD4 < 50/mm³. Clarithromycin or azithromycin, or rifabutin treatment.
Toxoplasmosis: Primary prophylaxis with CD4 ≤ 100/mm³. TMP/SMX or dapsone/pyrimethamine.

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Description

Test your knowledge on HIV, its structure, transmission methods, and pathogenesis. This quiz covers key components like the viral capsid, proteins involved, and how HIV interacts with human cells. Gain insights into this critical global health issue.