Human Immunodeficiency Virus Infection
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Questions and Answers

What is the role of antiviral therapy in relation to HHV-8 replication?

Antiviral therapy, particularly zidovudine and nelfinavir, may inhibit HHV-8 replication.

Which antiretroviral therapies are suggested to inhibit HHV-8 replication?

Zidovudine and nelfinavir are suggested to inhibit HHV-8 replication.

What conditions associated with HHV-8 replication may require antiviral therapy?

Antiviral therapy may be more significant in treating MCD (multicentric Castleman disease) and KICS (Kaposi's sarcoma inflammatory cytokine syndrome).

What is the primary type of HIV that is prevalent in the United States?

<p>HIV type 1 (HIV-1)</p> Signup and view all the answers

How can HHV-8 associated malignancies be treated?

<p>HHV-8 associated malignancies can be treated with radiation and cancer chemotherapies.</p> Signup and view all the answers

What defines the advanced stage of HIV infection known as AIDS?

<p>AIDS is defined by specific criteria established by the CDC for children, adolescents, and adults.</p> Signup and view all the answers

What precautions are recommended for hospitalized patients with HHV-8?

<p>Standard precautions are recommended for hospitalized patients with HHV-8.</p> Signup and view all the answers

What percentage of adolescents and adults typically develop acute retroviral syndrome shortly after HIV infection?

<p>50% to 90%</p> Signup and view all the answers

Name two common symptoms of acute retroviral syndrome.

<p>Fever and malaise.</p> Signup and view all the answers

How does acute retroviral syndrome typically present in terms of symptoms?

<p>It presents with nonspecific mononucleosis-like symptoms.</p> Signup and view all the answers

What is the primary mode of HHV-8 acquisition according to epidemiologic data?

<p>Contact with saliva.</p> Signup and view all the answers

Why do some experts recommend that high-risk individuals avoid contact with saliva?

<p>To reduce the risk of HHV-8 transmission.</p> Signup and view all the answers

What criticism has been raised regarding the recommendation to avoid saliva in preventing HHV-8 transmission?

<p>Concerns about the feasibility and efficacy of this strategy.</p> Signup and view all the answers

What current status is mentioned regarding recommendations for HHV-8 transmission control measures?

<p>No recommendations can be made at this time.</p> Signup and view all the answers

What are the clinical manifestations of HIV infection characterized by?

<p>A wide array of clinical manifestations.</p> Signup and view all the answers

What untested strategies are posed for high-risk individuals concerning HHV-8?

<p>Avoiding behavioral practices that expose them to saliva.</p> Signup and view all the answers

What has been the approach of experts toward preventing HHV-8 transmission?

<p>Counseling high-risk persons to avoid saliva contact.</p> Signup and view all the answers

What is lacking in the current guidelines for HHV-8 transmission prevention?

<p>Standardized guidelines and effective strategies.</p> Signup and view all the answers

What organization provides a complete listing of current policy statements regarding HIV and AIDS?

<p>American Academy of Pediatrics</p> Signup and view all the answers

Where can one find the guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and infected children?

<p>Department of Health and Human Services</p> Signup and view all the answers

What is the significance of the link provided by the American Academy of Pediatrics?

<p>It leads to current policy statements on HIV and AIDS.</p> Signup and view all the answers

What panel addresses the guidelines specifically for HIV-exposed and infected children?

<p>Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children</p> Signup and view all the answers

Which two groups are explicitly mentioned in the context of HIV and AIDS in the provided content?

<p>HIV-exposed and HIV-infected children</p> Signup and view all the answers

What were the most common opportunistic infections in children during the pre-cART era?

<p>Invasive encapsulated bacteria, Pneumocystis jirovecii, varicella-zoster virus, and cytomegalovirus.</p> Signup and view all the answers

What does the acronym PCP stand for in the context of HIV-related opportunistic infections?

<p>Pneumocystis carinii pneumonia.</p> Signup and view all the answers

What is immune reconstitution inflammatory syndrome (IRIS)?

<p>A paradoxical deterioration of health occurring soon after starting cART due to restored immune response.</p> Signup and view all the answers

Which organisms are commonly associated with inducing IRIS?

<p>Mycobacteria, herpesviruses, and fungi.</p> Signup and view all the answers

What is the significance of the pre-cART era concerning opportunistic infections?

<p>It illustrates the frequency and diversity of opportunistic infections before the availability of effective antiretroviral therapies.</p> Signup and view all the answers

List two less common opportunistic pathogens observed in the pre-cART era.

<p>Epstein-Barr virus and Mycobacterium tuberculosis.</p> Signup and view all the answers

What prior health conditions may predispose individuals to develop IRIS?

<p>Underlying infections with mycobacteria and herpesviruses.</p> Signup and view all the answers

How did the frequency of opportunistic infections vary in the pre-cART era?

<p>It varied by age, pathogen, previous infection history, and immunologic status.</p> Signup and view all the answers

What types of malignant neoplasms are more commonly seen in children with HIV infection compared to immunocompetent children?

<p>Leiomyosarcomas and non-Hodgkin B-cell lymphomas of the Burkitt type.</p> Signup and view all the answers

How has the incidence of malignant neoplasms in HIV-infected children changed during the cART era?

<p>The incidence has decreased substantially during the cART era.</p> Signup and view all the answers

What is the prognosis for untreated infants who acquire HIV through mother-to-child transmission and have high viral loads?

<p>The prognosis for survival is poor in these infants.</p> Signup and view all the answers

Which neurologic complications are noted in untreated HIV-infected infants and children?

<p>HIV encephalopathy, myelopathy, and peripheral neuropathies.</p> Signup and view all the answers

What is the role of the viral reverse transcriptase enzyme in the HIV lifecycle?

<p>It converts the single-stranded viral RNA genome into a double-stranded DNA copy.</p> Signup and view all the answers

What are the three distinct genetic groups of HIV?

<p>Groups M (major), O (outlier), and N (new).</p> Signup and view all the answers

What are the AIDS-defining conditions during the first 6 months of life for untreated HIV-infected infants?

<p>Pneumocystis pneumonia (PCP), progressive neurologic disease, and severe wasting.</p> Signup and view all the answers

What is the significance of CD4+ T-lymphocyte counts in the prognosis of HIV-infected children?

<p>Severe suppression of CD4+ T-lymphocyte counts indicates a weakened immune system and poor prognosis.</p> Signup and view all the answers

Flashcards

HHV-8 Replication Inhibitors

Drugs that slow or stop the reproduction of Human Herpesvirus-8.

Antiviral Therapy Role

Antiviral drugs may treat diseases with active HHV-8, like MCD and KICS.

HHV-8 Associated Malignancies Treatment

Radiation and cancer chemotherapy are used to treat cancers linked to HHV-8.

Hospitalized Patient Isolation

Standard precautions are necessary for isolating hospitalized patients.

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Antiretroviral Therapy and HHV-8

Some antiretroviral drugs, like zidovudine and nelfinavir, might reduce HHV-8 replication.

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HHV-8 transmission

Primarily through contact with saliva, according to some experts.

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High-risk KS

People at high chance of developing Kaposi's sarcoma (KS).

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Saliva contact

Behavioural practices that involve exposure to saliva.

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Control measures for HHV-8

No recommendations are currently available to control HHV-8 infection.

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HIV infection

Causes a variety of symptoms.

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Kaposi's sarcoma (KS)

A disease related to HHV-8.

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Clinical manifestations

Wide range of symptoms caused by HIV infection.

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Lack of standardized guidelines

No established rules for preventing HHV-8 transmission.

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HIV-1 prevalence

HIV type 1 is more common in the United States than HIV type 2.

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AIDS

Advanced stage of HIV infection, diagnosed based on specific criteria for different age groups by CDC.

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Acute Retroviral Syndrome

Early stage symptom complex in HIV infection, (50-90% of adults/adolescents) within weeks of HIV infection.

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Acute Retroviral Syndrome Symptoms

Includes nonspecific symptoms like fever, malaise, lymphadenopathy, and skin rash.

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HIV

Human Immunodeficiency Virus, a virus that leads to a range of conditions.

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Pediatric HIV/AIDS policy

The American Academy of Pediatrics has a collection of guidelines for treating HIV/AIDS in children.

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Opportunistic Infections

Infections that occur more often in people with weakened immune systems.

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HIV-Exposed Children

Children who have been potentially exposed to the HIV virus.

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HIV-Infected Children

Children who currently have the HIV virus.

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Prevention and Treatment Guidelines

Rules and recommendations for keeping HIV-exposed and -infected children healthy.

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Pre-cART Era Infections

In the time before antiretroviral therapy (cART), common infections in children included those caused by bacteria, Pneumocystis jirovecii (PCP), varicella-zoster virus, cytomegalovirus, herpes simplex virus, Mycobacterium avium complex, and Candida species.

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What is PCP?

Pneumocystis jirovecii pneumonia (PCP) is a lung infection caused by the fungus Pneumocystis jirovecii. It is a severe infection that commonly occurs in people with weakened immune systems, including those with HIV.

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cART

Antiretroviral therapy (cART) is a combination of medications used to treat HIV infection. It helps to suppress the HIV virus and prevent its progression to AIDS.

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IRIS predisposing infections

Infections that can lead to IRIS include those caused by mycobacteria (including Mycobacterium tuberculosis), herpesviruses, and fungi (including Cryptococcal species).

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IRIS Symptoms

IRIS can manifest as local or systemic symptoms, such as inflammation, swelling, and pain. These symptoms develop due to the immune response to a previously dormant infection.

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Post-cART Infections

The frequency of opportunistic infections has decreased since the introduction of effective antiretroviral therapy (cART).

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HIV in Children

HIV infection in children is less common but can lead to specific cancers like leiomyosarcomas and Burkitt's lymphoma.

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Kaposi's Sarcoma in Children

Kaposi's sarcoma, caused by HHV-8, is rare in US children but can occur in those who emigrated from Africa.

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cART and Cancer Rates

Antiretroviral therapy (cART) has significantly reduced the incidence of cancers in children with HIV.

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HIV Encephalopathy

HIV encephalopathy is a brain disorder that commonly affects untreated infants and young children.

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cART Impact on Encephalopathy

cART has significantly lowered the incidence of HIV encephalopathy but other neurological issues can arise.

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Prognosis for Untreated HIV

Untreated HIV-infected infants with high viral loads and low CD4+ T-cell count have a poor prognosis.

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HIV Prognosis Factors

Early PCP, neurological problems, and severe wasting in infants within the first 6 months are poor prognostic indicators.

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HIV: A Retrovirus

HIV belongs to a family called Retroviridae, which is characterized by having a reverse transcriptase (RT) enzyme.

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Study Notes

Human Immunodeficiency Virus Infection

  • HIV-1 is more common in the United States than HIV-2
  • AIDS is an advanced stage of HIV infection
  • Acute retroviral syndrome occurs in 50-90% of infected adults and adolescents in the first few weeks after infection
  • Symptoms include fever, malaise, lymphadenopathy, and skin rash
  • Untreated pediatric HIV infection can lead to unexplained fevers, generalized lymphadenopathy, hepatomegaly, splenomegaly, failure to thrive, persistent or recurrent oral and diaper candidiasis, recurrent diarrhea, parotitis, hepatitis, CNS disease (e.g., encephalopathy, hyperreflexia), hypertonia, floppiness, developmental delays, lymphoid interstitial pneumonia, and recurrent invasive bacterial infections, and other opportunistic infections (OIs)
  • With timely diagnosis of HIV infection in pregnant women, infants, and children, and appropriate treatment, clinical manifestations of HIV infection, including the occurrence of AIDS-defining illnesses, are now rare in industrialized countries
  • In pre-cART era, common OIs in children included infections from encapsulated bacteria, Pneumocystis jirovecii, varicella-zoster virus, cytomegalovirus, herpes simplex virus, Mycobacterium avium complex, and Candida. Less common OIs included EBV, M. tuberculosis, Cryptosporidium, Cystoisospora, other enteric pathogens, Aspergillus, and Toxoplasma gondii
  • Immune reconstitution inflammatory syndrome (IRIS) can occur due to an inflammatory response as cell-mediated immunity is restored
  • Leiomyosarcomas and non-Hodgkin B-cell lymphomas of the Burkitt type can occur more commonly in children with HIV infections
  • HIV-2 is found predominantly in Western Africa
  • HIV-2 is resistant to nonnucleoside reverse transcriptase inhibitors (NNRTIs) and at least 1 fusion inhibitor (enfuvirtide)
  • Human are the only known reservoir for HIV-1 and HIV-2
  • HIV transmission includes sexual contact, percutaneous blood exposure, mucous membrane exposure to contaminated blood or body fluids, MTCT in utero, around the time of labor, and delivery (perinatally), and postnatally through breastfeeding
  • In 2014, most HIV infections in 13-24 year olds were attributed to male-to-male sexual contact in males and heterosexual contact in females.
  • HIV-infected adolescents and young adults are often asymptomatic initially
  • The incubation period for untreated infants and children in the U.S. is usually 12-18 months
  • Acute retroviral syndrome in adolescents/adults lasts 5-7 days and presents 7-14 days after infection
  • HIV-1/HIV-2 immunoassays and antigen assays are used for diagnosis
  • Nucleic Acid Amplification Assays (NAAs) use plasma HIV DNA or RNA testing for diagnosis
  • HIV-infection in children is treated with combination antiretroviral therapy (cART) as soon as possible

Clinical Manifestations

  • HIV infection results in many clinical manifestations varying by age, co-infections
  • Acute retroviral syndrome (ARS). Includes fever, malaise, lymphadenopathy, rash
  • Pediatric HIV infections can have varied symptoms.

Other

  • cART is critical to reduce morbidity and mortality in HIV-infected individuals
  • Prevention and treatment of opportunistic infections is crucial
  • Guidelines for prevention and treatment of opportunistic infections in HIV-exposed and infected children are available
  • Pediatric HIV infections are treated differently than adult HIV infections, especially regarding age-specific guidance on vaccination and medication dosages.
  • Preventing mother-to-child transmission (MTCT) of HIV is crucial in resource-limited settings

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Description

This quiz explores key aspects of Human Immunodeficiency Virus (HIV) infection, including the differences between HIV-1 and HIV-2, the symptoms of acute retroviral syndrome, and the impacts of untreated pediatric HIV. It also discusses the importance of timely diagnosis and treatment in preventing severe manifestations like AIDS in various populations.

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