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34 year-old male with AIDS; unsure of progression from HIV to AIDS…
34 year-old male with AIDS; unsure of progression from HIV to AIDS
HIV progresses to AIDS
Didn't receive proper medical attention with drugs that could have slowed down progression of HIV to AIDS
Use of hypodermic needles, unprotected sex, breastfeeding infant with someone infected with HIV
Perinatal transmission of HIV
Not spread by kissing, sharing eating utensils, public restrooms, or casual physical contact
If caught before 10 weeks of infection, can be functionally cured (HIV present in body, but at such low levels blood tests don't detect it).
Didn't refrain from behaviors that allowed for virus transmission
Contraceptives, oral, do not protect against HIV
Help T-Lymphocytes destroyed by HIV infection
T-Lymphocytes produce HIV RNA at rapid rate, causing cell lysis
Helper T-Lymphocytes targeted & destroyed by other immune cells (macrophages or cytotoxic T-lymph.)
Helper T-Lymph. level drops dangerously low; loss of normal immune function
T-Lymph cell drops below 200 cells per cubic millimeter
Develops opportunistic infection or illness
Background Information
Immune Cells & "Organs"
Leukocytes: defend body against pathogens; formed in red bone marrow
Neutrophils: phagocytize bacteria to prevent bacterial infections
Eosinophils: phagocytize antigen-antibody complexes and allergens
Basophils: release histamine and heparin during inflammatory reactions
Macrophages: phagocytize bacteria, viruses, cell fragments
Lymphocytes: phagocytize viruses/viral infections; produce antibodies
T-Lymphocytes: manage direct immune response
B-Lymphocytes:humoral immunity; matures into plasma cell to produce antibodies
Natural Killer Cells: attack abnormal and infected tissue cells
Secondary Lymphatic Structures: where T-cells & B-cells are housed
Tonsils, spleen, lymphatic nodules, & MALT (mucosa-associated lymphatic tissue)
Immune System is comprised of cells instead of organs, although uses certain organs to house cells
Difference Between HIV & AIDS
HIV: Human Immunodeficiency Virus; attacks cells that help the body fight infection (T-Lymphocytes; TH-1 & TH-2 cells depleting); Still have >200 count of CD4 cells
AIDS: Acquired Immunodeficiency Syndrome; late stage of HIV; CD4 Cell count <200 cells/mm3; develop opportunistic infections
TH-1 & TH-2 cells almost completely gone; gives rise to deadly infections
Extensive damage from HIV
Initial virus infection; not necessarily exhibiting symptoms
Innate & Adaptive Immune System
Cytosines: small proteins that regulate & facilitate immune system activity
Produced in both innate & adaptive immune system
Serve as communication btwn cells; control dev. & behavior of immune cells; regulate inflamm. response of innate system; destroy cells
Cytosine Categories
Interleukin: regulate immune cells
Tumor Necrosis Factor: destroy tumor cells
Colony-Stimulating Factor: stimulates lekopoiesis in bone marrow of specific type of leukocyte
Interferon: pro-inflammatory agent
Innate Immune System
Mult. components that protect against wide array of substances, born with it
Do not require exposure to a foreign substance, respond immediately to pathogens
Skin & mucosal Membranes
Skin: Epidermis & Dermis; exfoliation; normal flora (non-pathogenic bact.); hyaluronic acid; sebaceous gland secretions; sweat glands;
Mucous Mem: Epithelial & conn. tissue; mucus,
Internal Defenses: cells, chemicals, & physiological responses
Phagocytic Cells: neutrophils, macrophages, & dendritic cells
Respiratory Burst: destruction of bact. by reactive oxygen-containing molecules
Proinflammatory Chemical-Secreting Cells: basophils & mast cells
Chemotaxic Chemicals: attract immune cells as part of the inflammatory response
Apoptosis-Initiating Cells: NK Cells
Immune Surveillance: detect unhealthy cells & destroy them by release of cytotoxic chemicals
Parasitic-Destroying Cells: eosinophils
Degradation of pathogens by release of enzymes
Adaptive Immunity
Lymphocytes that are activated to replicare and respond when stimulated by a specific antigen
T-Lymphocytes; cell mediated immunity
T-Natural Killer Cells: serves as a pathway for NKT cells to fight against infections and enhance the humoral immunity
T-Gamma Delta Cells: regulate immunosuppressive functions of IELs and play role in development of tolerance
TSIR Cells: waits to suppress immune cells once immune reaction is complete
T-Alpha Cells: coordinators of the immune response
CD8 Cells: cell killer w/ specific markers; needs instruction from TH-1 to attack cells
CD4 Cells: T-Helpers; activate B cells to secrete antibodies and macrophages to destroy ingested microbes; activate cytotoxic cells
TH-1: activates CD8 cells for immune response
Th-2: activates B-Memory cells
T-Memory Cells: antigen specific cells that recognize presence of pathogen it has seen before to know how to attack it
B-Lymphocytes; humoral immunity
Plasma cells (synthesize & release antibodies
B-Memory Cells: recognizes pathogen it has seen before to initiate immune reaction
Interferon Defense
Body cell infected w/ virus
Virus infected cell releases IFN-alpha & beta
IFN alpha & beta bind to receptors of neighboring bodies; causes synthesis of enzymes that destroy viruses DNA & RNA
IFN cells stimulate NK cells to destroy virus-infected cells
NK cells release IFN cells to stimulate macrophages to destroy virus cells
Complement System: array of proteins produced by liver into the blood
10% of blood serum proteins
Compliment activation occurs when pathogen enters the body
Classical Pathway: complement protein binds to an antibody that attached to a foreign substance, prior
Antibody required for activation
Alternative Pathway: where polysaccharides bind w/ complement protein
Antibody not required for activation
Opsonization: binding of a protein to portion of bacteria to enhance phagocytosis
Inflammation: activation of mast cells and basophils, attracts neutrophils & macrophages
Cytolysis: membrane attack complex kills the cells by compromising cell's integrity
Elimination of Immune Complexes: links complexes to RBC's to be transported to the liver or spleen
Viral & Bacterial Infections
Viral Infections
Require a living host cells to survive & use your cell's makeup to its own advantage
Can alter the DNA sequencing & cause deficient proteins or alter certain aspects of transcription & translation for own adv.
Capsids made from proteins translation makes; virus takes over these DNA forming processes
Non-living/acellular; comprised of nucleic acids & proteins
Bacterial Infections
Living; can survive w/ or w/o a host
Most common bacteria contain gram + or - cell walls; determines type of antibiotics, based on the thickness of peptidoglycan
Multiplies less efficiently as viruses
Treatment: Antibiotics based on composition of cell wall
Treatments: Antivirals, NSAIDS
Preventative: vaccines
Lytic & Lysogenic Stages
Lytic Cycle of a Virus
Penetration: virus attaches ti cell & injects genetic material; host = infected
Cell can be targeted for destruction by immune system
Biosynthesis: Virus uses host cell to make viral proteins
Maturation & Lysis: viral components complete & turns into complete viruses; enzyme breaks down cell wall, water enters, cell bursts & many viruses are free to infect other cells
Lysogenic Cycle of a Virus
Fusion of genetic Material: viral nucleic acid fuses w/ host cell
Replication of Prophage: new prophage passed onto daughter cells in cell division; can replicate many times
Prophage Leaves Host DNA: dissociates from host DNA & enters lytic cycle to infect a human
Viral genes are not expressed until lytic cycle which creates more viruses
T-Helper Cells Destroyed by Macrophages or Cytotoxic T-Lymphocytes
CD4 Cells (TH-1 & TH-2) cannot initiate an immune reaction/response to pathogens
CD8 Cells are unable to destroy pathogens w/o signaling from TH-1
Leads to opportunistic infections from other bacteria or viral infections which can be life-threatening
TH-2 cannot activate B-Memory cells
B-Memory cells will not recognize any prior pathogen & therefore cannot alert other antibodies & cells to destroy any disease/infection causing agent
T-Lymphocytes produce HIV RNA
HIV RNA produced at such rapid rate = cell undergoes lysis/ bursts from the amount of genetic info.
Completely inhibits CD4 Cell function
Indirect Effects of AIDS
Aging
Antiretroviral Therapy Complications
Diabetes
Increase insulin resistance
High glucose lvls
Increased risk for heart disease & stroke
Kidney Dysfunction
Build up of fluids in body
Increased risk of heart attack
Kidney failure
Bone Loss
Osteomalacia associated w/ renal tubulopathy & urine phosphate wasting
Increase risk of fractures
Bone marrow suppression
Anemia
Fatigue & diziness
Shortness of breath & chest pain
General weakness
Headaches
Neutropenia
Increased risk for bacterial infection
Inability to fight off infection
Sepsis
Kidney failure
Lung damage; ARDS
Tissue necrosis
Endocarditis
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Weight Gain
ART Toxicity
Abacavir Hypersensitivity Reaction
EFV Neuropsychiatric Toxicity
ATV-Associated Hyperbilirubinemia
Without Treatment & Current Immune System
Infections due to Suppressed Immune System
Pneumocystis Pneumonia
Pleural Effusion
Collapsed Lung
Empyema
Pulmonary Fibrosis
Pneumothorax
Hypoxemic Respiratory Failure
Cardiac Arrest
Pulmonary Edema
Fistula
Pneumopericardium
Pleural Empyema
Respiratory Failure
Death
Permanent lung damage; failure to thrive
Candidiasis
Sepsis
Weight loss, malnourishment from swallowing dysfunction
Spread of infection to lungs, liver, heart valves, intestines
Tuberculosis
Spinal pain & joint damage
Swelling of membranes that cover brain = meningitis
Impairs liver & kidney
Cardiac Tamponade
Cryptococcal Meningitis
Seizures
Hearing loss
Brain Damage
Excess fluid on the brain
Recurrent infections of cryptococcal bacteria
Cancer
Lymphoma
Infections from chemotherapy
Infertility
Heart Disease
Diabetes
Thyroid Disease
Kidney or lung Disease
Kaposi's Sarcoma
Bleeding of skin, mucous membranes, GI Tract
Hemoptysis
Respiratory Failure
Anemia
Wasting Syndrome
Diarrhea causing weight loss
Chronic Weakness
Recurrent Fever
Neurological Complications
Forgetfulness; depression; anxiety; Difficulty walking
Kidney Disease
Inflammation of filters in kidneys
Inability to filter waste from kidneys
Fluid build-up
HIV Associated Neuropathy
Liver Disease
Ascites
Hepatic Encephalopathy
Portal Hypertension
Hepatorenal syndrome
Current Immune System
Due to the loss of CD4 cells, immune system is unable to activate CD8 cells to kill pathogens & unable to activate B-Memory cells which allows for the signaling of recognition & fighting off pathogens (through other associated antibodies)
His immune system is almost non-functional in the progression of AIDS to where it completely diminishes