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HIV
Human Immunodeficiency Virus (dropped image link (*Diagnosis of HIV
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HIV
- Human Immunodeficiency Virus
HIV *Drugs
HIV - Reverse Transcriptase Inhibitors
- "HAVE YOU DINED with my NUCLEAR family yet?"
- efaviirenz, tenofovir, lamivudine
-
HIV - anti- Docking and Fusion
- "mavaric blocks CCR5 jet from DOCKING"
--> maraviroc
- "enfuvirtide blocks FUSION"
HIV - Protease Inhibitors
- "NAVIR TEASE a Protease!"
- navir's are protease inhibitors
-proteaase needed to break up the HIV viral protein
- saquinavir, ritonavir
HIV - Integrase Inhibitors
- "Raltegravir RNA HALT on integration"
- Raltegravir
*Common infections in HIV
- depends on CD 4+ counts for Helper T cells
--> 5,2,1 rule
--> < 500, < 200, < 100
--> starts with common herpes viruses and HPV
--> then AIDS defining pneumocystis
--> finally more basic fungi = Candiidiasis and CMV
- < 500 = EBVs, HPVs and HHVs
--> tounge (top and side/scrapable and non-scrapable)
--> HPVs in the anus and cervix
- < 200 = AIDS defining pneumonia = pneumocystis jirovecci
- < 100 = Candida moves from tongue to esophagitis + other esophagitis causes (including CMV)
--> AIDS defining CMV = CYTO - MEG MEGALO
-
*HIV Esophagitis
- 3 causes, 2 are HHV family
- 1 = Candida Albicans
--> most common cause in HIV patients
--> pseudomembranes
- C diff CAP = CYTOskeleton B toxin , A toxin cAMP, pseudomembranes
- note that both normal flora of mouth and anus (Candida and C Diff) have pseudomembrane formation
- 2 = CMV = Cytomegalovirus
--> linear ulcers in the distal part of esophagus
- 3 = HSV1
--> punched out ulcers
-
AIDS / HIV Defining Illnesses
HIV CD4+ count < 200
- pneumonias
--> Pneumocystis Jirrovecci
- Watery diarrhea
--> cryptosporidium
- Mycobacterium Avium
--> only affects HIV people with CD < 50
HIV CD4+ < 100AIDS / HIV Defining Illnesses
- CMV HIV retinitis
--> this is a key HIV defining illness
--> only affects HIV people with CD < 50
--> presents as cotton wool spot hemorrhages in the eyes
- Watery diarrhea
--> cryptosporidium
- Mycobacterium Avium
--> only affects HIV people with CD < 50
*Cryptosporidium
- "CRYPT KEEPER" for HIV patients
- protozoa that lives in contaminated water
- cause non-inflammatory watery dirrhea
- usually self limiting in healthy people
- AIDS definging illness that is life threatening for AIDS HIV patients
--> excessive water loss and dehydration is life threatening
Cryptosporidium - small cysts on the brush border of GI
- they are hard to find and diagnose
- appear as very small cysts on the brush border of GI
-
HIV CD4+ < 50AIDS / HIV Defining Illnesses
- CMV HIV retinitis
--> this is a key HIV defining illness
--> only affects HIV people with CD < 50
--> presents as cotton wool spot hemorrhages in the eyes
- Mycobacterium Avium
*CMV HIV retinitis
- HIV CD4+ < 50
--> this is a key HIV defining illness
--> only affects HIV people with CD < 50
--> presents as cotton wool spot hemorrhages in the eyes
*Mycobacterium Avium
- HIV CD4+ < 50
- Mycobacterium avium has very low virulence but can infect HIV people with CD4 < 50
- Myco Avium is the reason you need to treat HIV people with CD4 < 50 with Azithromycin
-
HIV CD4+ < 200AIDS / HIV Defining Illnesses
- HIV specific pneumonias
--> Pneumocystis Jirrovecci
*Pneumocystis jirovecii and HIV pneumocystis pneumonia
- pneumocystis pneumonia characteristic in HIV AIDS
- "PNEUMO Jirovecci = NEW JURY IS OUT" = AIDS defining disease
- see other notes
-
*HIV Diarrhea
- CMV is the major cause of HIV diarrhea
--> worse since it forms ulcers and ivades the mucosa
- Creeping Sporidium and small sporidium are non-invasive dirrhea in HIV
- CryptoSporidium = CREEP on the SURFACE
- MicroSporidium MICRO on the SURFACE
CMV diarrhea in HIV patients
- happens when CD 4 counts are in the lowest bracket = < 100
-
*Diagnosis of HIV
- 1 = first use ELISA kit for antigens to rule out the virus (may get a false positive though)
--> highly sensitive
--> low specificity
- 2 = next you rule in the virus with a WESTERN blot for proteins
--> "SNW DRP"
*Diagnosis of AIDS
- there are 3 separate ways to diagnose AIDs in someone with HIV
--> AIDS diagnosis is based on the CD4+ counts in your blood or getting the "AIDS defining illness"
- 1 = < 200 =
- 2 = AIDS defining pneumonia = pneumocystis jirovecci
--> can diagnose AIDS based on this infection since usually only happens if the CD4+ count is below 200 anyways
- 3 = CD4+ % of all WCC < 14%
*Time course of HIV
- 4 F stages of HIV
- F1 = FLU like symptoms
- F2 = Feeling Fine = latency stage
- F3 = FALLING counts = of CD4+ from 500,200,100
- F4 = FINAL crisis = die from HIV complications +/- other infections
*window phase of HIV
- right after you get infected you can have a viral load and test positive for HIV RNA
- but you don't develop antibodies until about 2-3 months after infection starts
- you are highly infective at this stage since you have a spike in the viral load since there are no antibodies against the HIV envelope yet
-
*Docking and fusion of HIV
- Docking subtypes of HIV
- either CCR5 = Macrophage primary target
--> CCR5 = chemo-kine receptor
--> CCR5 ~ CKR5
- or X4 = T cell primary target
-
*TORCHES infections and HIV passed to Children
- pregnant women need to be taking ART during pregnancy and while breastfeeding infants
-
*HIV2
- endemic to Western Africa
- it is a slower and milder form of HIV
-
*HIV complications and sequelae
*HIV dementia
- infects microglial cells int he CNS
--> first gains access to the CNS by infecting macrophages through their CCR5
--> then they move on to infect the CNS macrophages = microglia
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