HIV/AIDS Past Paper PDF

 What does HIV/AIDS stands for? H –Human ………………..only infect human beings I - Immunodeficiency …↓body's immune system V –Virus …………“obligate intracellular pathogen” A -Acquired ……….Not hereditary I - Immune …. Affects the body's immune system D-Deficiency ………….. Not function properly S- Syndro...

 What does HIV/AIDS stands for? H –Human ………………..only infect human beings I - Immunodeficiency …↓body's immune system V –Virus …………“obligate intracellular pathogen” A -Acquired ……….Not hereditary I - Immune …. Affects the body's immune system D-Deficiency ………….. Not function properly S- Syndrome ………….. Experience a wide range of  What is HIV? is a member of retroviruses that causes AIDS A retrovirus has an RNA genome and a reverse transcriptase , integrase & protease enzyme. By the help of the enzyme the virus uses its RNA as a template for making cDNA, which can integrate into the DNA of the host organism.  Binding Fusion/entry/uncoating Reverse transcription Translation of viral RNA Assembly Release  1-Unprotected Sexual Activity 2-Sharing Needles or Syringes/drug abuse 3-Receiving infected blood or blood products 4-Mother-child during delivery or breast feeding >25% Body fluids, (low conc of HIV ↓incidence).  Medical history information, signs or symptoms suggest presence of HIV in a patient? http://t3.gstatic.com/images?q=tbn:ANd9GcTqlGA80txiBSC5CFwm5WQQw3vTEb3A5dlEyKWDnLZghlq6zkRu5R9Qt6I O.Is SPUR infection PCP IF unttt HIV Salmonella, CMV S&S …. HSV &TB 4 stages http://t0.gstatic.com/images?q=tbn:ANd9GcTg1LpwhCd0qdTs9xE3MzM7cMENcbNqOgxG74Fruw59-m7dwgnR4UxgDJM http://t2.gstatic.com/images?q=tbn:ANd9GcQBY-Ik5h2fPjTCgiHNgsDNqv5R9Fwv9lVEa6qL-2UI7iGZEagNUPN1VSM Kaposi’s sarcoma DIAGNOSIS laboratory test that confirm diagnosis are: 1. Detection of anti-HIV antibody…. 3 months post infection…… ELISA, IFA < 350 cells/mm3 2. CD4 count: 500 -1500 cells/ mm3 < 200 cells/mm3 < 50 cells/mm3 3. Viral load (HIV RNA)…PCR What is the importance of CD4 count? A-it confirms diagnosis of HIV B-it allows starting of ARVs before symptoms CD4 appearance in asymptomatic pt count C- It detects immunological failure earlier than clinical failure D-Monitor effectiveness of therapy the goals of HIV treatment A- Lowering the viral load B- Restore immune status C- Relieve symptoms/Improve quality & duration of life. D- Treat and/or prevent opportunistic infections.  What is HAART ? -Highly Active Anti-Retroviral Therapy, 2 drugs of NRTIS + 1 drug of PIs or nNRTIs Adult 1st line regimen. Zidovudine or Stavudine + lamivudine +neverapine or efavirenz Adult 2nd line regimen. Didanosine + abacavir +lopinavir or retonavir  The possible side effects of HAART ? liver problem, diabetes, abnormal fat distribution (lipodystrophy syndrome) high cholesterol ↑bleeding in patients with hemophilia ↓ bone density or skin rash pancreatitis (e.g. Didanosine) fever nausea, fatigue  Differences Differencesin in mech actionbet mech of action betNRTIs NRTIs&&nNRTIs nNRTIs? ? A- NRTIs B- nNRTIs A- Are phosphorylated A-Not need phosphorylation inside cells inside cells B- Act as false substrate But for reverse transcriptase B-Bind non-competitively to incorporated into viral RT enzyme DNA…..chain termination E.g. zidovudine, Lamivudine, Stavudine E.g. delavirdine, ,Didanosine, Zalcitabine nevirapine, & abacavir efavirenz  NRTIs nNRTIs Zidovudine Didanisine Nevirapine: thymidine analogue Adenine analogue Rash, Hepatitis, BMD, Anemia pncreatitis.↑Amylase Nausea , Headache & Periph. neuropathy Sedation and Fatigue Protease inhibi Saquina & Indinavir Lipodystrophy syndrome Disturb lipid and glucose metabolism Haemolytic anaemia Give an example of fusion inhibitor, explain how it acts? Enfuvirtide [fuzeon.injection] approved in 2003 as first fusion inhibitor Mechanism: binds to the gp41 subunit of the viral envelope glycoprotein, preventing the conformational changes required for the fusion of the viral and cellular membranes. Uses: in combination with other drugs for adult & children > 6 years with advanced Infection ,who are resistant to other drugs what is raltegravir? What is maraviroc? Raltegravir Maraviroc integrase inhibitor CCR5 blocker -approved by FDA in Blocks chemokine co- October 2007 only for receptor that used by HIV peoples whose infection to enter the cell resistant to other HAART drugs Side effects: Nausea, Headache and Diarrhea when the CD4 count dropped below 200/ μl, what infections might pt suffer and which drugs might prevent them? Co-trimoxazole ? ? ? PCP Fluconazole not Candidiasis ketoconazole? Why? HSV Acyclovir Which other drugs were likely to have been administered when The CD 4 count dropped below 50/µl? Why might they be needed? Gancyclovir CMV Clarithromycin, azithro- M. bact.avium mycin  Co-trimoxazole used by all HIV +ve people regardless of level of their CD4 count? A-to prevent O.Is in HIV/AIDs pts Co-trimoxazole B-inexpensive , easy to take & has low side effects C- prolong survival & time before ARVs are needed D-has high value in pt with CD4 < 200 , it can prevent or delay signs of : Acute PCP, pneumococcal pneumonia Salmonellosis, cerebral toxoplasmosis  Case 1 A 43-year-old male hospitalized AIDS patient developed progressive weakness, abdominal cramping, fevers, poor appetite, nausea and vomiting. He had a CD4+ lymphocyte count of 150/μl and "high" HIV-1 viral load. He was being treated with anti-HIV drug (cocktail) composed of didanosine, zidovudine and indinavir. Other drugs being administered include trimethoprim/sulfamethoxazole for secondary Pneumocystis carinii pneumonia (PCP) prophylaxis. Current laboratory values included amylase 240 units/L (Normal 35-110) and creatinine 1mg/dl (Normal 0.5-1.3). At this time, didanosine therapy was discontinued and his HAART regimen was switched to lamivudine, zidovudine and indinavir. The patient’s gastrointestinal symptoms resolved but several months later the patient complained of feeling weak and presented with symptoms of thrush.  In the previous case why was Didanosine discontinued & replaced by Lamivudine When the pt complained of abdominal pain? Because of didanosine cause peripheral neuropathy & pancreatitis Where GI symptoms & ↑amylase level [N 35-110 unit /l] are reasons for stopping didanosine & replacing it by another NARTIs like lamivudine what drug class theses anti-HIV drugs represent? Explain their mechanism Of action? I.e. Lamivudine & Didanosine, indinavir Class: NRTIs, protease inhibitor Mechanism: phosphorylated, act as false substrate →inhibit reverse transcriptase enzyme → No reverse transcription of RNA to DNA Act as chain terminating drugs protease inhibitor: inhibit protease which cleaves Gag- pol polyprotein lead to production of immature, non-infectious viral particles how should the therapy recommended for this patient be monitored for efficacy and adverse effects ? Treatment Adverse Efficacy effects measuring blood level of CD4 count, lactic acid, glucose, viral load amylase & lipids Is treatment afforded to this pt an example of highly active antiretroviral therapy? Why? yes, because HAART is combination between 2 drugs of NRTIs & 1 PIs or nNRTIs Afforded treatment for this pt includes didanosine, zidovudine (2NRTIs) and indinavir (1PI). What type of drug is indinavir &what are its anticipated side effects? protease inhibitor disturb lipid, glucose metabolism lipodystrophy thrombocytopenia, Nephrolithiasis, hyperbilirubinemia give an example of nucleotide analogue reverse transcriptase inhibitors [NtRTIs]? Tenofovir, inhibit both HIV & HBV, be effective in persons resistant to NRTIs, Side effects: → N, V, Diarrhea, sever liver damage like any other RTI Case 2 A patient has sputum –positive pulmonary tuberculosis. An HIV rapid test was positive, should the pt begin treatment for TB & HIV at the same time? Why?. can the immune status of this pt be expected to improve with TB therapy alone? -TB therapy start at least 2 months before starting ARV, As delaying ARV for 2months→ Will simplify the ttt regimen & will not slow recovery or compromise pt immune status -Yes, Control OIs like TB in HIV +ve pt → will rise CD4 count (Or at least slow its decline) this phenomenon is the reason for using co-trimoxazole In all HIV pt ? to slow the decline in immunity by prevention of many OIs.  Recommendations for post-exposure HIV prophylaxis Wash the wound with water , soap after needle stick One combo. tablet of AZT + lamivudine HIV –ve→ Find & test HIV rapid test on needle HIV +ve →Send him to source person stick victim HIV clinic for cure HIV –ve ……..Reassure the victim HIV +ve or unknown …….Start ARV prophylaxis immediately or with in 72 hrs 3 Months ? after exposure HIV –ve …Reassure re-test the victim HIV +ve...Send him the victim to HIV clinic  How can one prevent infection of HIV from mother to child? -Nevirapine to mother at onset of labor & to her baby with in 3days After birth →↓risk of transmission from 30 % >>>>>>>>>>> 12-15% -If AZT [zidovudine] is used from week 28 of pregnancy the risk of transmission ↓to < 10%  prevention ✓ Avoid sexual contact with anyone has AIDS. ✓ Avoid contact with contaminated blood. ✓ Don't share toothbrushes, razors or others. ✓ Avoid acupuncture, tattooing, ear piercing, etc., ✓ Do not share needles or syringes. ✓ Clean the needle before using.