HIV VIRUS HIV has a diploid genome meaning it is composed of 2 molecules of RNA.

This rna is enclosed by a conical capsid composed of viral protein p24. Aorund this layer is the lipid bilayer called the viral envelope. Embedded in the viral envelope are proteins that are used for attachment and reproduction. This envelope has GP 120 and GP41. GP120 is the grabber protein. It grans on to the CD4 of t helper cells and the macrophages. Once it has made that connection, GP120 changes its confirmation and allows it to bind to another cell receptor (a co-receptor) called CCR5 or CXCR4. This concept is called tropism. All tropism means is that some HIv viruses like to bind to 1 co receptor over the other coreceptor. Sometimes they can use either and thats called dual tropism. The 1st cell that is infected is a macrophage or dendritic cell that is in the exposed mucosal surface of the sexual site. The macrophages and dendritic cells have the CCR5 receptors, so many of the early infections have CCR5 tropism. However, many of the Cd4 positive t-cells have the CXCR4 receptor. So later in the infection there may be a tropism switch or dual tropism that is seen. HIV viruses that use only the CXCR4 receptor is called X4 virus, and those that use the ccr5 virus is called the R5 virus. Some people are immune to HIV if they are homologous for the CCR5 deficiency, and those that are heterozygous have a slower course than the normal population. Other envelope protein is gp41 which is responsible for the fusion and entry. When the HIV infects it releases proteins into the cell. These proteins include: Reverse transcriptase- Synthesizes dsDNA from the HIV RNA! Remember that HIV is an RNA virus that need dsDNA to intergrate itself in the genome. HIV Intergrase- incorporates the dsDNA in to the Host DNA HIV Testing: Screening test is the ELISA test( high sensitivity). Next step is the Western Blot. Also helpful is the viral load (PCR), which determines the effectiveness of the drug therapy. It lets you know if the HIV is reacting to the medications. Viral can also be used for diagnosis. ELISA and Western Blot looks for the antibodies toward HIV BUT there may be false negative results in the 1st 2 months of infection and thats BC you are in the window period where the body has not made enough Ab to the HIV( enough to be detected). You can also get False positive in babies because the antibodies of the HIV moms cross over to the child during the fetal development and reside for the 1st 6 months of life. Two good uses of the viral load are to see if the person who is recently exposed to HIV has an acute infection or if a newborn baby of an infected mom became infected during the peripartum period.

Diagnosis of AIDS <200 CD4+ T+Cells. % of CD4/all lymphocytes.- Below 14% Aids defining illnesses- Pneumocystis Jiroveci. Timeline. 1st month- asymptomatic After 1 month- you get mononucleosis type syndromes that last for 1-2 weeks and then they get better. Then you have an asymptomatic stage that lasts a long time Then the CD4 count drops and you get opportunistic infections. W/o rx. You get wasting, infection and death W/ therapy you get a normal life span .. compliance and good therapy needed.

Diseases Histoplamosis C- Pulmonary Dz in CD4 <100. Fever, cough, hepatosplenomegaly

Dermatologic Conditions GI CNS AIDS pts w meningitis- Cryptococcus meningitis AIDS and ring enhancing lesion- toxoplasmosis AIDS dementia PML- JC VIRUS CMV retinitis when CD4 <50! Cotton wool spots on retina and treated with gancyclovir Cryptosporidiosis- watery diarrhea! Significant Wasting! Bacillary Angiomatosis- Bartonella Henslea. Results in superficial vascular lesions. Looks like cherry angiomas on exam. Usually a large crop of them Canadida Albicans- Oral and Esophageal Candidiasis- like thrush.. cheesy white lesions in tongue and esophageal candidiasis.

Oncologic Kaposis Sarcoma- HHV8- Increased blood vessel forming. Lesions are purple on skin. Seen in mucus membranes and sometimes in the lung. Invasive cervical carcinoma or Anal Carcinoma Primary CNS lymphoma

Non-hodgkins lymphoma Squamous Cell carcinoma of the cervic and anus- a/w HPV infections types 16 and 18. Oral Hairy Leukoplakia, Primary CNS lymphoma, and NHL of the lare type associated with EBV

Respiratory Dz Pneumocystic Jiroveci- Especially if CD4 <200 and interstitial infiltrates. Mycobacterium Avium Complex- CD4 <50 TB

HIV Oppurtunistic infections and prophylaxis <200- TMP-SMX is DOC, but if sulfa allergy then Dapsone,(BUT WATCH OUT FOR G6PD w/ dapsone) aerosolized pentamidine. <100 TMP- SMX is used to cover toxoplasmosis(only if they have a + IgG titer for toxo) but if sulf allergy then give dapsone, leucovorin, and pentamidine. <50- Mycobacterium Avium Intracellulare-Azithromycin Once a week

HIV DRUGS! Anyone with aCD4 count less than 350 be on antiretroviral therapy or AIDS diagnosis! Protease inhibtors (-navir tease a protease) Prevent the new viruses from forming