PATHO CH. 12

T helper death

"what chance does the 'little guy' stand if the big brother isnt able to respond?"

STUDY GUIDE QUESTIONS

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interactive review questions

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The ELISA test enzyme-linked immunosorbent assay

To diagnose HIV infection, laboratory tests such as the enzyme-linked immunosorbent assay (ELISA) and the Western blot are used to detect the presence of HIV antibodies. blood test for aids

Children with HIV have

growth and development problems, including impaired physical growth, intellectual development, and motor functioning.

The finding that Ken's CD4 lymphocyte count is 198 cells/μl means that

his diagnosis is changed from HIV disease to AIDS.

In order to avoid transmitting HIV to his girlfriend, Ken is taught to practice safe sex, which includes all of the following except A. abstinence. B. using condoms. C. using spermicidal ointments. D. maintaining a low viral load.

using spermicidal ointments

Gynecologic manifestations include

persistent monilial vaginitis, cervical dysplasia, and pelvic inflammatory disease.

she wont go into detail about the diseases in the systems of aids but just know these....and of course systems that are affected.

peyers patches diarreah/ candidisis malabsorption weight loss pneumonia - big player in pulmonary system

Ken's laboratory report today shows that his CD4 lymphocyte count is 198 cells/l, which is down from his last count 3 months ago. The physician suggests that Ken begin a protease inhibitor medication. The purpose of this medication is to

prevent the release of functional virus from infected cells. -Protease inhibitors must be used in combination, or resistance will develop.

After significant accidental exposure to HIV-infected blood or body fluids, it is recommended that health care workers

receive postexposure antiretroviral medication as soon as possible after exposure and as needed for 4 weeks following the incident.

. Most of the signs and symptoms related to this type of hypersensitivity are attributable to

release of inflammatory mediators from mast cells.

Macrophages serve as both targets and_________ for HIV.

reservoirs

The HIV virus is known to mutate frequently within an infected individual. This is because

reverse transcriptase has poor fidelity and makes errors in transcription

The category C phase is

severely symptomatic with AIDS

HIV is acquired primarily through

sexual transmission via semen and vaginal and cervical secretions; through parenteral transmission via blood, blood products, and contaminated needles/syringes; and through perinatal transmission from an infected mother to her infant antepartum, intrapartum, and postpartum via breast milk.

Prevention of transmission

stick to standard precautions

The vast majority of HIV/AIDS cases in the world today are found in

sub-Saharan Africa

Virions

the assembly of new virus particles at the cell membrane

HIV primarily infects T helper cells and macrophages because

they have CD4 receptors on their cell surfaces

Some people are resistant to HIV infection because

they lack one or more necessary coreceptors for viral binding and insertion.

TREATMENT HIV is a retrovirus

treat with anti-retrovirus meds it interferes with replications - deals with RNA processes ex: fusion inhibitors CCR5 antagonist *can also treat for symptoms: ex- anti diahreal meds don't have to memorize any drugs.

jane is 12 she is allergic to bee stings she has epi pen with her at all times last time she was stung she developed wheezing and severe urticaria

type I hypersensitivity

Cachexia

wasting away - malnutrition

Syncytium

uninfected cells fuse, then die together *cardiac muscle operates in syncytium- they all act together*

An HIV-positive individual is diagnosed with AIDS if the CD4 lymphocyte count falls below _____________cells/μl or if a category C AIDS indicator condition is present.

200

is the primary risk factor for health care workers:

Exposure to blood and body fluids of infected individuals through skin, mucous membranes, and accidental needle sticks .The universal use of standard precautions decreases the risk of infection.

An effective vaccine is available to prevent HIV infection in humans.

FALSE

With appropriate highly active antiretroviral therapy, HIV can be eradicated from the body and cure is likely.

FALSE

what does AIDS stands for

acquired immunodeficiency syndrome

HTLV-I is the cause of

adult T-cell leukemia

Management of HIV and AIDS includes the use of

antiretroviral medications, including NRTIs, NNRTIs, PIs, fusion inhibitors, INSTIs, CCR5 antagonists.

Seroconversion to AIDS

apoptosis continues to ocurr CD4s keep depleting until u get to a point where CD4 is less than 200 S of aids = cluster of signs/symptoms

HTLV-IV

associated with chronic lymphomas.

HIV gains access to CD4+ cells by

attaching to the CD4 receptor on the cell surface. Viral envelope protein gp120 and coreceptor chemokines such as CCR5 or CXCR4 mediate attachment

The purposes of the epinephrine injection include all of the following except- A. stabilizing mast cell membranes. B. relaxing bronchial smooth muscle. C. supporting arterial blood pressure. D. blocking histamine receptor

blocking histamine receptors

Mucocutaneous symptoms occur

both early and late in the course of HIV infection. One of the first symptoms is the viral exanthem that occurs during the primary infection. Other manifestations may be allergic; infectious, such as candidiasis or herpes, human papillomavirus, and Epstein-Barr virus infections; or neoplastic, such as Kaposi sarcoma.

HIV virus is called a retrovirus because it

contains the enzyme reverse transcriptase

In addition to avoiding bee stings and immediately treating those that do occur with epinephrine, Jane might benefit from

desensitization therapy.

HIV can be transmitted by

-Breast milk -A mother, to the fetus, during delivery -Sharing a hypodermic needle

Three categories of drugs commonly are used to inhibit HIV replication in cells. These are

-Nucleoside reverse transcriptase inhibitors, -non-nucleoside reverse transcriptase inhibitors, -protease inhibitors

Which statement(s) are true regarding post-exposure prophylaxis?

-Prophylaxis for a significant exposure should be started immediately. -Postexposure medication treatment last at least 4 weeks, or even longer. -Two or more medications may be included in the medication regimen. -Exposure, sexual or otherwise, requires similar medication protocols.

Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS)

-are acquired immunodeficiency disorders resulting in defective immune functioning.

Human immunodeficiency virus (HIV)

-considered to be a primary immunodeficiency disease -HIV infection triggers chronic widespread and diverse organ involvement with varying signs and symptoms. -caused by the retroviruses HIV type 1 and HIV type 2. They attack the CD4 cells and CD8 cells (T helper Cells) CD stands for cluster of differentiation

The hallmark of HIV infection is

-defective cell-mediated immunity, especially the decrease in CD4+ or T helper/inducer lymphocytes.

All body systems are affected by HIV.

.

Aggressive treatment of opportunistic infections with appropriate antibiotics and antivirals is a large part of the treatment regimen.

/

TRUE/FALSE

/

More than one genotype of HIV virus has been identified; however, the great majority of HIV-infected individuals in the United States, Europe, Australia, and Central Africa have HIV type____________________

1

What term refers to a cell's decreased ability to fight new infections?

Anergy

. Stan undergoes a bone marrow biopsy the result of which reveals an abnormally high percentage of plasma cells. This means that his disease is a cancer of

B cells.

Which type of cell does not contain the CD4 receptor? A. Langerhans B. Cervical C. Vaginal D. T

C. Vaginal

Apoptosis is the major mechanism of

CD4 cell depletion - due to error of crosslinking

Which is important for cell attachment?

CD4 receptor CXCR4 gp120 CCR5

Langerhans cells, cervical cells, and T cells contain

CD4 receptors.

Which statement is true regarding HIV in children?

Category N is an asymptomatic phase.with no signs or symptoms of the disease.

difference b/w these 2 tests

ELISA test is slightly more likely to give u a false positive result its also cheaper they do the other test if you are positive

What are the common modes of HIV transmission and how can infection be prevented?

HIV is acquired primarily through sexual transmission via semen and vaginal and cervical secretions; through parenteral transmission via blood, blood products and contaminated needles/syringes; and through perinatal transmission from an infected mother to her infant antepartum, intrapartum, and postpartum via breast milk. HIV infection can be prevented with the use of safe sex practices, such as condoms, the use of safe parenteral practices, such as sterile needles/syringes, and the use of standard precautions in handling body secretions/liquids

3. How does infection with HIV lead to progressive immunodeficiency and AIDS?

HIV virions are attracted to cells with CD4 receptors and cause a high level of CD4+ cell death. The lack of CD4+ cells leads to progressive immunodeficiency, with the hallmark of AIDS being a decrease in CD4+ cells, including T-helper lymphocytes and macrophages

Which statement regarding either HIV-1 or HIV-2 is true?

HIV-1 is the causative organism for most AIDS diagnosed in the United States. Both HIV-1 and HIV2 are similar in structure and function. HIV-2 produces a milder form of the disease than HIV-1. Both HIV-1 and HIV-2 are found worldwide.

Ocular manifestations include

HIV-associated retinopathy, CMV retinitis, malignancy, and a variety of infectious causes.

Which retrovirus is associated with hairy cell leukemia?

HTLV-II

Children with a diagnosis of HIV are prone to problems involving which of the following?

Height Weight Math skills Motor function

Which statement is true regarding HIV?

Homosexual men constitute the largest population with AIDS. * Males had a higher rate of diagnoses (21.9 per 100,000 in 2007) than females (7.6 per 100,000 population). *Women are most likely exposed via heterosexual contact. *Heterosexual contact accounts for about 15%. *IV drug users contact accounts for about 13%.

What condition is associated with initial HIV infection?

Initial HIV presents like a flulike illness, including fever, chills, headaches, nausea, vomiting, fatigue, weakness, arthralgias, and sore throat. The number of white cells is decreased, although an increase of CD8 T cells is noted.

GOAL OF TREATMENT

Keep CD4 levels elevated retroviral medications

Which of the following findings would help confirm this diagnosis?

Monoclonal antibody spike on electrophoresis

Which of the following HIV-positive individuals would appropriately be given the diagnosis of AIDS? A. One who developed oral candidiasis B. One with a CD4 count of 250 cells/μl C. One with Pneumocystis jiroveci pneumonia D. One with a herpetic outbreak on the genitalia

One with Pneumocystis jiroveci pneumonia

58 yr old man- back pain- reduced bone density and compression fracture of vertebra *elevated serum calcium level

Plasma cell myeloma

Seroconversion occurs between

Seroconversion occurs between 3 weeks and 6 months after exposure. The CD4 count is greater than 400 per µL.

GI symptoms occur frequently in patients with HIV.

Symptoms include diarrhea caused by Cryptosporidium or other agents, ulceration, and candidiasis, as well as multiple opportunistic infections.

A high maternal viral load of HIV increases the risk of transmission to the fetus

TRUE

Condoms and abstinence are the only contraceptive methods that are effective in preventing transmission of HIV.

TRUE

Heterosexual contact with infected partners is the most common route of HIV transmission in Africa and Southeast Asia.

TRUE

How are CD4+ cell counts and various clinical findings used to classify the stages of HIV disease and AIDS?

The CD4+ counts are linked with clinical symptomatology in a simple matrix classification system. Clinical categories range from asymptomatic (a), symptomatic (b), to conditions indicative of AIDS, or AIDS indicators (c); a lower CD4+ cell count with AIDS indicator(s) signify the most severe category

Which statement is true regarding HIV testing?

The new rapid finger stick test can provide results in 20 minutes.The initial test is ELISA All positive tests are followed up with the Western Blot test.

What is the scope of the HIV/AIDS epidemic in the United States and the world?

The scope of the HIV/AIDS epidemic in the United States continues to increase with an estimated 1 million persons diagnosed since the beginning of the epidemic. The epidemic continues to increase worldwide, particularly in third-world countries, with sub-Saharan Africa accounting for more than two-thirds of all cases. Globally, there are more than 38 million persons diagnosed with HIV/AIDS

Which of the following exposures represents the greatest risk for acquiring HIV? A. A blood splash from an HIV-infected individual onto intact skin B. Perinatal transmission from an HIV-infected mother to her fetus C. Receiving a blood transfusion from a U.S. blood bank D. Heterosexual contact using latex condoms

[B] Perinatal transmission from an HIV-infected mother to her fetus

Long-term survival of individuals with HIV infection is associated with all of the following except A. inheriting a mutant CCR5 gene. B. increased CD8 cell function. C. increased antibody production. D. low viral load.

[C] increased antibody production.

Category A

a mildly symptomatic phase, with two or more associated conditions that include otitis media and upper respiratory infections.

Category B

a moderately symptomatic phase in which the child exhibits some opportunistic infections as a result of impaired cell-mediated immunity or impaired bone marrow function

Neurologic manifestations

include peripheral neuropathy, encephalopathy with dementia, headache, apathy, and focal deficits.

Protease inhibitors work by

inhibiting protein splicing, viral assembly, and maturation.

HIV

is an RNA virus -(retrovirus) that primarily infects and destroys the immune system.In so doing, it destroys one of the basic foundations of human regulation and protection. HIV decreases the body's ability to fight organisms, opens the door to opportunistic infections, and allows neoplasms to emerge. HIV can infect anyone of any age. The ultimate intracellular pathogen, it slowly destroys the host while manufacturing billions of copies of itself. Study of this virus has improved our understanding of the immune system as well as of cellular function.

HIV

is an RNA virus known as a retrovirus. It must undergo reverse transcription within infected cells to form viral DNA.

During the________________ period, a person with HIV has few clinical manifestations but can transmit the infection to others.

latency

An HIV-infected person is not diagnosed with AIDS until the CD4+ T-cell count is

less than 200/μL. and people have 2 opportunistic infections

The most significant systemic symptom is

malnutrition or wasting, which is due to a combination of factors, including an elevated metabolic rate, chronic inflammation, malabsorption, anorexia, and the effect of multiple opportunistic insults.

Syncytium

mass of cells.

Pulmonary symptoms include

opportunistic pneumonias (particularly PCP), tuberculosis, and adult respiratory distress syndrome.

fecal incontenence bags -

painful, bloody - --common in aids population