Introduction to HIV and Its Classification

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Questions and Answers

What is the primary body fluid where high titers of HIV are found?

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Which of the following increases the risk of sexual HIV transmission dramatically?

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What percentage of perinatal HIV infections in Africa is attributed to breastfeeding?

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Which of the following is the estimated risk of transmission for healthcare workers after a needlestick incident?

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What is defined as treatment success for HIV regarding viral load?

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What classification of retroviruses is primarily based on genomic sequence and evolutionary relatedness?

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Which of the following statements regarding HIV-1 and HIV-2 is accurate?

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What does the gag gene in the HIV genome encode?

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As of the end of 2022, which region has the highest prevalence of HIV among adults?

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Which of the following best describes the structure of the HIV virion?

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What was the estimated number of people living with HIV globally at the end of 2022?

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Which antiretroviral enzymes are encoded by the pol gene in HIV?

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What was the observed percentage reduction in HIV-related deaths since 2010?

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What best describes the state of latency in HIV infection?

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Which component is essential for the production of infectious HIV?

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Which of the following is considered a cellular reservoir for HIV?

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What is the role of dendritic cells in HIV infection?

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Which cytokines are primarily released by dendritic cells in response to HIV infection?

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What is the main tissue reservoir for HIV in the human body?

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Which immune cells act as cytolytic cells responding to HIV infection?

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What aspect of the provirus ensures that HIV infection remains permanent?

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Which viral characteristic is primarily dependent on the expression of mRNA?

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What best describes low-level chronicity in HIV infection?

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What is the primary function of HIV-specific CD8+ CTLs?

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What role do INF-γ and chemokines play in the immune response to HIV?

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What is a significant reason for the failure of the immune system to eliminate HIV despite a robust response?

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How do HIV envelope glycoproteins complicate the immune response?

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What effect does the infection with HIV have on CD4+ T-lymphocytes?

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Which factor contributes to the establishment of persistent HIV infection?

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What leads to impaired functions of T- and B-lymphocytes in response to HIV?

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Which statement best describes the role of B lymphocytes in response to HIV?

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What is the impact of cell-to-cell spread of HIV on the immune response?

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What is a consequence of high mutation rates in HIV?

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What are the roles of the env gene in HIV?

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Which receptor is primarily used by HIV-1 to enter T lymphocytes?

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What is the significance of the coreceptor in HIV entry into cells?

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What effect do homozygous deletions in the CCR5 gene have on individuals?

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In which part of the cell does the HIV RNA get integrated into the host DNA?

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What role does reverse transcriptase play in HIV infection?

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Which coreceptor is associated with macrophage-tropic strains of HIV-1?

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What triggers membrane fusion during HIV entry into the host cell?

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What is the role of integrase in HIV replication?

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How does HIV initially interact with host cells?

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Flashcards

Retroviruses

A category of viruses characterized by their ability to integrate their genetic material into the host cell's genome.

Reverse Transcription

The process of copying RNA into DNA.

Reverse Transcriptase

The enzyme responsible for converting RNA into DNA in retroviruses.

Lentiviruses

A specific group of retroviruses known for their ability to cause long-term infections and immune deficiency.

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HIV (Human Immunodeficiency Virus)

A type of lentivirus that causes AIDS in humans.

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Integrase

A viral protein that allows the HIV genome to integrate into the host cell's DNA.

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Protease

A viral protein that breaks down the HIV genome into smaller pieces, allowing it to be packaged into new virions.

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HIV Replication Cycle

The process of how HIV replicates and spreads within a host.

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How other STDs increase HIV risk?

The presence of other sexually transmitted diseases, such as syphilis, gonorrhea, or herpes simplex type 2, increases the risk of sexual HIV transmission as much as a 100-fold because the inflammation and sores facilitate the transfer of HIV across mucosal barriers.

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What is perinatal HIV transmission?

The process of transmitting HIV from a mother to her child during pregnancy, childbirth, or breastfeeding.

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What is a high maternal viral load?

High levels of HIV in the blood are associated with a higher risk of transmission, especially during breastfeeding.

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How is HIV transmitted through parenteral exposure?

HIV can be transmitted through contact with contaminated blood or blood products.

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What is the viral load (VL)?

The amount of HIV in the blood is measured to assess the effectiveness of treatment.

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Viral integration

A permanent state where the virus's genetic material becomes integrated into the host cell's DNA. This means the infected cell will continuously produce new viral particles unless a cure is found.

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Latency (HIV)

A form of a virus that exists within a host cell but is not actively replicating. It can remain dormant for years, waiting for the right conditions to reactivate.

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Chronic HIV infection

The ability of a virus to persist in the body for a long time, often causing recurring symptoms or disease.

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Full blown viral expression

The complete and active reproduction of a virus within a host cell, leading to the release of new viral particles and potentially cell death.

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Viral Reservoir

A group of cells or tissues where a virus can reside and replicate, allowing it to persist in the body.

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CD4+ T cells

A key type of immune cell that is targeted by HIV. It helps to fight off infections by helping coordinate the immune response.

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Innate immunity

The body's initial line of defense against pathogens. This includes cells like macrophages and NK cells that can directly attack invaders.

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Adaptive immunity

The adaptive immunity triggered by exposure to a specific pathogen. It involves cells like T lymphocytes (T cells) that can recognize and destroy specific invaders.

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Antigen-presenting cells (APCs)

Special cells that present pieces of pathogens to T lymphocytes, triggering the adaptive immune response.

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T lymphocytes (T cells)

A type of immune cell responsible for killing infected cells and activating the adaptive immune response.

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What are CD8+ CTLs?

A type of white blood cell that directly kills HIV-infected cells.

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What is INF-γ?

A protein produced by CD8+ T-lymphocytes that creates an antiviral state.

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What are CTL escape mutants?

Mutations in HIV that allow it to escape recognition by the immune system.

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What are neutralizing antibodies?

Antibodies that neutralize HIV by binding to the virus and preventing it from infecting cells.

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What is the HIV envelope glycoprotein?

A key protein on the surface of HIV that helps it enter cells, and is a target for neutralizing antibodies.

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What are CD4+ T-Lymphocytes?

Special white blood cells that help other immune cells fight infection by producing substances called cytokines.

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How does cell-to-cell spread contribute to HIV persistence?

HIV can spread directly from one cell to another, avoiding detection by antibodies.

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How does HIV's high mutation rate contribute to its persistence?

HIV's high mutation rate allows it to constantly change its appearance, evading the immune system’s memory.

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How does HIV disrupt cytokine production?

HIV can interfere with the production of important signaling molecules (cytokines) that help the immune system function.

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How does HIV integration into host DNA contribute to its persistence?

HIV can hide within the host's DNA, making it difficult for the immune system to eliminate it completely.

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HIV Receptor: CD4

Virus uses CD4 molecule found on macrophages and T lymphocytes as a receptor for entry into cells.

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HIV Coreceptor

A second receptor besides CD4 is required for HIV to fuse with the cell membrane and gain entry. This protein is important for the fusion process.

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HIV Coreceptor: CCR5 and CXCR4

HIV uses chemokine receptors as the second receptor for entry. CCR5 is the main receptor for macrophage-tropic HIV strains, while CXCR4 is the coreceptor for lymphocyte-tropic strains.

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HIV Entry Mechanism

The viral envelope glycoprotein gp120 binds to CD4, and this binding triggers conformational changes in the envelope, activating the gp41 fusion peptide which leads to membrane fusion and entry of the virus.

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HIV Entry: gp120 and CD4 binding

The HIV envelope protein gp120 binds to CD4, a receptor found on the surface of immune cells. This sets off a chain of events allowing the virus to enter the cell.

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HIV Entry: Coreceptor Role

After binding to CD4, HIV uses another receptor called a coreceptor, typically CCR5 or CXCR4, to further activate the fusion process and enter the cell.

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HIV Reverse Transcription and Integration

HIV reverse transcriptase creates a DNA copy of the viral RNA genome, which is then integrated into the host cell's DNA through the action of integrase.

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HIV Replication: RNA to DNA

The HIV RNA genome is released into the cytoplasm after the virus enters. Reverse transcriptase, an enzyme carried by the virus, creates a DNA copy of the viral RNA genome.

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HIV Replication: DNA integration

The newly formed DNA copy is then integrated into the host cell's DNA by integrase, an enzyme that helps the viral DNA become part of the host's genetic material.

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HIV Replication: Provirus

The provirus, the integrated viral DNA, can now direct the host cell to produce new HIV particles, continuing the cycle of infection.

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Study Notes

Introduction to HIV

  • HIV is a retrovirus, a spherical, enveloped RNA virus
  • Its genome contains three structural genes (gag-pol-env)
  • Gag encodes structural proteins (matrix, capsid, nucleocapsid)
  • Pol encodes protease, reverse transcriptase, and integrase
  • Env encodes the two membrane glycoproteins (SU gp120 and TM gp41)
  • There are two main types: HIV-1 (most common) and HIV-2, which is less virulent
  • HIV-2 is primarily found in West Africa

HIV Classification

  • Classification is based on genomic sequencing, grouping by evolutionary relatedness
  • This method is currently the most widely accepted classification system

HIV Epidemiology

  • Globally, approximately 39 million people lived with HIV in 2022
  • 1.5 million children are living with HIV (0-14 years)
  • In 2022, 630,000 people died from HIV-related causes globally, a 51% decrease since 2010.
  • 84,000 children died from HIV in 2022
  • The WHO African region is significantly affected (3.6% of adults have HIV)
  • The majority of people living with HIV globally live in this region

HIV Replication Cycle

  • HIV replication starts with binding to the CD4 receptor and a coreceptor (CCR5 or CXCR4).
  • The viral RNA is then released into the cytoplasm
  • Reverse transcriptase makes a DNA copy of the RNA
  • The DNA is integrated into the host's chromosomal DNA, becoming a provirus
  • The provirus is duplicated with the host cell's DNA, so it's a permanent infection
  • The process produces more viral RNA and proteins that assemble into new viruses, which bud from the cell.

HIV Receptors

  • HIV uses the CD4 molecule and a coreceptor (CCR5 or CXCR4) for entry into cells.
  • CCR5 is the predominant coreceptor for macrophage-tropic HIV-1 strains
  • CXCR4 is the predominant coreceptor for lymphocyte- tropic HIV-1 strains

HIV Reservoir

  • HIV reservoirs include memory CD4+ T cells, macrophages, brain microglia, and astrocytes, the most commonly occurring in the gut-associated lymphoid tissue.

Immune Response to HIV

  • Early HIV infection is controlled by innate immunity (cytokines, phagocytes, NK cells)
  • Adaptive immunity involves CD8+ T cells (cytotoxic T lymphocytes) to control viral replication and B cells to produce neutralizing antibodies
  • Viral variability (mutation) allows HIV to evade the immune response, causing chronic infection.
  • CD4+ T-lymphocytes are critically important but are often infected and killed by HIV

HIV Transmission

  • High viral loads increase transmission risk
  • Transmission occurs through sexual contact, blood exposure, or mother-to-child transmission.
  • Sexual transmission risk is exacerbated by other STIs
  • Health care workers are at risk through needlestick injuries

Pathogenesis and Course of HIV Infection

  • Acute HIV infection is characterized by a flu-like illness, followed by a period of clinical latency which leads to chronic infection
  • cART treatment reduces viral load, which slows progression
  • People with cART can stay in chronic HIV infection stage for several decades before AIDS.

Opportunistic Infections

  • AIDS patients are vulnerable to opportunistic infections due to immune deficiency.
  • Many infections are typically harmless to healthy individuals but can be life-threatening in people with AIDS
  • AIDS patients are at a higher risk of developing certain cancers, due to immune deficiency.
  • Kaposi sarcoma is a notable example

HIV Diagnosis

  • Testing methods include antibody tests, antigen/antibody combinations, and nucleic acid tests (NATs) for viral RNA.
  • The window period between HIV infection and antibody detection can vary, impacting test results.

HIV Treatment/Care

  • Anti-retroviral therapy (ART) is a standard approach to treat HIV infection.
  • Treatment aims to reduce viral load, improve CD4 T-cell counts, and prevent opportunistic infections.
  • Treatment timing and strategies are important, and adherence to the treatment regiment is vital.
  • Periodic viral load and CD4+ T-cell counts are tracked and monitored to assess treatment efficacy.

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