MicroBio 160 1st Edition Lecture 25 Outline of Last Lecture I Transmission of HIV II How HIV enters the body III HIV Transmission Trends IV Modes of Transmission in Adults V Documented Cases VI Routes of Exposure VII Condom Use and HIV Transmission VIII Drug Use Alcohol and HIV Infection IX X XI Criminal Deliberate and Reckless HIV Transmission People who attempt to contract HIV HIV Transmission Risk and Sexual behaviors Outline of Current Lecture I II Testing for HIV What do CD4 Cell Counts Mean III Purpose of Viral Load Tests IV Routine Tests V VI VII VIII Interventions Against HIV Goals of HIV Treatment Major Classes of Anti retroviral Drugs Combination Therapy These notes represent a detailed interpretation of the professor s lecture GradeBuddy is best used as a supplement to your own notes not as a substitute IX HAART Combinations X XI XII XIII Atripla Mother to Child Transmission MTCT Goals Quality of Life Issues When is it time to Change Therapies Current Lecture Testing for HIV Get physical exam women Gyn Pap Get key tests CD4 cell count viral load Get other blood tests as needed Maximize your health support Consider your treatment options Early Stage CD4 cell counts above 500 Viral load below 5 000 Middle Stage CD4 cell counts 200 500 Viral load 5 000 100 000 Advanced Stage CD4 cell counts below 200 Viral load above 100 000 Get CD4 cell and viral load test done every three months o Starting HIV medicines is recommended for everyone with HIV regardless of CD4 count talk with your healthcare provider about all the factors to consider before startingHIV medicines o In addition to CD4 and viral load tests general health evaluative tests are performed such as CBC Chemistry panel liver and kidney function tests What do CD4 Cell Counts Mean Above 500 CD4 cells No unusual conditions likely Emphasize good health habits and health care maintenance including vaccines and nutrition 200 500 CD4 cells Increased risk for shingles zoster thrush candida skin infections bacterial sinus and lung infections and TB o Life threatening OIs such as PCP pneumocystis pneumonia MAC micobacteriumavium and CMV cytomegalovirus are rare o Anti HIV therapy is generally recommended when CD4 cell counts are in the 200 to 350 range 50 200 CD4 cells Increased risk for PCP and other opportunistic infections o Preventive treatment for PCP is indicated o If counts are below 100 consider preventive treatment for MAC CMV and invasive fungal infections Below 50 CD4 cells Increased risk for opportunistic infections including MAC and CMV o Continue preventive medication Purpose of Viral Load Tests Establish baseline 2 tests should be taken 2 4 weeks apart then every 3 4 months Avoid viral load tests during active infection a cold after a vaccination or during flareups of infections like a cold sore Can cause HIV levels to briefly increase but return to normal in a few weeks Test 3 4 weeks after starting or changing therapies Trend of viral loads over time is the most important and not an individual result Low stable and decreasing viral load good High or increasing levels call for attention as it may point to the failure of a regimen Women may have a naturally lower viral load than men especially in early HIV infection Therefore women should be aware that a viral load above 30 000 or even 60 000 might indicate a high viral load for them People with undetectable viral load should remember that it does not mean that their HIV is gone HIV may actually be there but just in too small of a quantity to detect These are routine in people living with HIV but do not need to be done as often as CD4 cell counts and viral load tests PPD Skin Test and Chest X Rays o Tuberculosis If you ve been exposed the PPD causes a bump to appear within several days at the site of the test A positive or inconclusive PPD is followed up by a chest x ray and sputum culture to determine active TB disease Pap Smears Women living with HIV may need to get a Pap test done more often than every 3 years based upon your health and risk factors Anal Pap This test can be done in the anus to look for damage caused by HPV human papillomavirus High rates of anal HPV occur in HIV positive men and women including those who do not report having anal intercourse Hepatitis Serology Liver function tests can show hepatitis infection o Other tests can be done to find antibodies to hepatitis B HBV and C HCV diseases that affect the liver These tests should be done after first learning your HIV status if you have not been tested before Toxoplasmosis Serology This test may be done to detect antibodies to the toxoplasmosis toxo cat scratch organism Toxo can cause problems in the brain and central nervous system A positive test result may help to decide on preventive therapy Interventions Against HIV General Health Maintenance lab work eat healthy exercise Supportive Therapies complementary and alternative therapies Anti HIV Treatment Strategy meds specialists Immune Therapies enhance or inhibit immune function Opportunistic Infection Strategy safe sex food prep good hygiene Goals of HIV treatment to reduce your viral load and increase your T cell count HIV therapy should Prolong life and improve quality of life Suppress HIV levels viral load below the limit of detection 50 copied HIV RNA or as low as possible for as long as possible Optimize and extend the use of current therapy Minimize drug toxicity and manage side effects and drug interactions Major Classes of Anti retroviral Drugs Reverse transcriptase RT inhibitors interfere with the critical step during the HIV life cycle known as reverse transcription During this step RT an HIV enzyme converts HIV RNA to HIV DNA o There are two main types of RT inhibitors Nucleoside nucleotide RT inhibitors or analogues NRTIs are faulty DNA building blocks When these faulty pieces are incorporated into the HIV DNA during the process when the HIV RNA is converted to HIV DNA the DNA chain cannot be completed thereby blocking HIV from replicating in a cell Non nucleoside RT inhibitors NNRTIs bind to RT interfering with its ability to convert the HIV RNA into HIV DNA Protease inhibitors PI interfere with the protease enzyme that HIV uses to produce infectious viral particles Entry and fusion inhibitors FI interfere with the virus ability to fuse with the cellular membrane thereby blocking entry into the host cell Integrase inhibitors II block integrase the enzyme HIV uses to integrate genetic material of the virus into its target
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