BIO 307D Biology of AIDS Study Guide

Talaro Ch. 13: Microbe-Human Interaction

Multiple Choice 1. The best descriptive term for the resident flora is - commensals 2. Resident flora is commonly found in the - salivary glands 3. Resident flora is absent from the - lungs 4. Virulence factors include - toxins, enzymes, and capsules 5. The specific action of hemolysins is to - damage red blood cells 6. The __ is the time that lapses between encounter w/ a pathogen and symptoms - incubation 7. A short period early in a diseases that manifests with malaise is - prodomal period 8. The presence of a few bacteria in the blood is termed - septicemia 9. A __ infection is acquired in a hospital - nosocomial 10. A __ is a passive animal transporter of pathogens - mechanical vector 13. The occurrence of Lyme disease mainly in areas where certain species of ticks live would define it as a ___ disease - endemic 14. A positive antibody test for HIV would be a __ of infection - sign 15. Which of the following is not a portal of entry - the meninges Writing to Learn 1. a. Differentiate between contamination (colonization), infection, and disease colonization - when normal resident flora engage in commensal relationships infection - when a microbe has penetrated host defenses, invaded sterile tissues, and multiplied. disease - any deviation from health

b. What are the possible outcomes in each? colonization - prevent outgrowths of harmful microorganisms, can attack host infection - may establish a presence in the host and produce toxins disease - besides causing harm to their host they can be communicable 2. How are infectious diseases different from other diseases? The disruption of internal organs and tissues results from microbe activity 3. a. Name the general body areas that are sterile Internal organs, tissue, & their fluids b. Why is the inside of the intestine not sterile? Because part of it (anus) is technically an external organ 4. a. Explain the differences between transient and resident flora transient - those organisms that occupy the body for short periods of time residents - microbes that become more established, live in the body b. What causes variations in the flora of newborn intestine? If the baby is bottle or breast fed 5. Explain several ways that true pathogens differ from opportunistic pathogens. pathogens - capable of causing disease in healthy persons w/ normal immune systems opportunistic - cause disease to a host with a compromised immune system, not considered pathogenic to a normal healthy person. 6. a. Distinguish between pathogenicity and virulence. Pathogenicity - an organism's potential to cause infection or disease Virulence - relative severity of the disease, describes the degree of pathogenicity b. Define virulence factors and give examples of them in gram- and gram+ bacteria, viruses, and parasites. virulence factors - natural traits the microbe uses to invade and establish itself exoenzymes - secreted by bacteria, fungi, & protozoa, break down tissues exotoxin - released by bacteria, affect cells by damaging cell membrane, causes lysis 7. Describe the course of infection from contact to exit 1) Portal of entry - skin, gastrointestinal, respiratory, urogenital, pregnancy 2) Invasion - adhesion to host, surviving host defenses 3) Multiplication - use host cell (virus) or replicate extracellularly 4) Infection of target - incubation period > prodromal > invasion >

convalescent 5) Disease - signs & symptoms indicate, some infections are asymptomatic 6) Portal of exit - respiratory & salivary, epithelial, fecal, urogential, bleeding 8. a. Explain why most microbes are limited to a single portal of entry. The microbes have adapted so much yo our bodies that they are not infectious except under a few entry methods. b. Examples of each Skin - staphylococcus aureus attach to membranes or burrow their way through Gastrointestinal - salmonella, E. coli Respiratory - streptococcus pneumoniae Urogenital - STD's, HIV, Hepatitis B Pregnancy - STORCH (syphilis, toxoplasmosis, other [Hep B, AIDS, chlamydia], rubella, cytomegalovirus, herpes c. Explain how the portal of entry could differ from the site of infection Most viruses have a specific area of the body to target, so they must travel away from the portal of entry to the site of infection (ex: rabies travels to the brain) 9. Differentiate between exogenous and endogenous exogenous - infection originating from a source outside the body endogenous - already existing in or on the body 12. a. Explain what is happening during each stage of infection Incubation - the agent is multiplying at the portal of entry, does not elicit symptoms, can last from hours to years Prodromal - earliest notable symptoms like discomfort, head & muscle aches, fatigue, upset stomach, malaise Invasion - multiplies at high levels, exhibits greatest toxicity, establishes in target tissue. Convalescent - if the infection is not terminal, the symptoms decline b. Compare and contrast - systemic & local, primary & secondary, infection & intoxication systemic - when an infection spreads to the bloodstream local - when infection remains confined to specific tissue primary - the initial infection secondary - another infection subsequent to the primary, complicates infection infection (focal) - when an infectious agent breaks loose from local area and is

disseminated into other tissues intoxication (toxemia) - the infection itself remains local, but its toxins are carried by blood to the target tissue 13. Differences between signs and symptoms signs - any objective evidence of disease as noted by a physician (ex: inflammation, edema, granulomas, abscesses, lymphadenitis) symptoms - any subjective evidence as sensed by the patient (ex: sore throat) 16. Explain what it means to be a carrier a person or animal who inconspicuously shelters a pathogen and spreads it to others b. Describe four was humans can be carriers asymptomatic - are infected but show no symptoms incubation carriers - act as carries while the infection incubates (ex: HIV) convalescent - recovered from an infection but are still shedding (ex: diphtheria) chronic - recovers and carries for a long period c. What is epidemiologically and medically important about carriers? screening is very difficult to find them, carriers allow a pathogen to continue to exist, creates potential for epidemics. 21. Distinguish the primary differences between mechanical and biological vectors biological - actively participates in a pathogen's life cycle. Communicates the agent to a human host by biting, aerosol formation, or touch. mechanical - are not necessary to the life cycle of the pathogen, merely transport it without being infected. Communicated indirectly (food) or directly (touch, bite)

Weeks Ch. 3 - Immune System

2. Large, amoeboid cells that function as phagocytes to initiate the immune process macrophages 3. Type of immunity resulting from activity of B-lymphocytes - antibody-mediated immunity 6. Products of B-lymphocytes and plasma cells - antibodies

8. Immunity involving a direct assault on microorganisms by body cells - cell-mediated immunity 9. Site where T-lymphocytes and B-lymphocytes are found - spleen 10. General class of body cells to which lymphocytes belong - white blood cells 13. Also called a CD4+ cell - Helper T-lymphocyte (CD4+ Th cell) 14. Type of immunity resulting from activity of CD8+ Tc cells - cell-mediated immunity 16. Composed of four chains of amino acids - antibodies 17. Organ in which cells are modified to form T-lymphocytes - thymus 18. Type of T-lymphocyte unaffected by HIV - Tc cell 19. A substance, usually a protein or polysaccharide, that stimulate the immune system antigen 20. Located on the surface of unstimulated B-lymphocytes - MHC proteins 22. White blood cells that specialize in engulfing and destroying - phagocytes 23. First lymphocyte encountered by an antigen-presenting cell - Helper T cell 24. Highly reactive proteins from helper T-lypmhocytes that stimulate other lymphocytes - cytokines 25. Type of immunity involving activity of antibodies - antibody-mediated immunity

Weeks Ch. 4 - Recognizing AIDS

1. __ is the name of the brain disorder commonly occurring in roughly 1/3rd of persons with AIDS AIDS - dementia complex 3. __ is the cancer of the skin often observed in AIDS patients - Kaposi's sarcoma 5. __ is the name of the protozoan that causes lung disease as an opportunistic disease Pneumocystis carinni (PCP) 7. __ is the name assigned to the condition where a patient harbors HIV but has no symptoms HIV infection

8. __ is the term given to the swollen lymph nodes commonly associated with HIV infection & AIDS lymphadenopathy 10. __ is the normal count of T-lymphocytes per microliter of blood - 800-1,000 11. __ is the yeast-like fungus that causes thrush - Candida albicans 12. __ is the system of the body attacked by the opportunistic microorganism Cryptosporidium gastrointestinal system 13. __ is the name given to the chronic diarrhea and dramatic weight loss associated with AIDS HIV-wasting syndrome 15. __ are the animals that harbor Toxoplasma and should be avoided by AIDS patients - cats

Weeks Ch. 7 - HIV Testing & Diagnosis

1. __ is the acronym used for the laboratory test most widely used to detect HIV antibodies ELISA 2. __ characterizes the result of an HIV antibody test when the person is infected but does not have sufficient antibodies to give a positive test false-negative 3. __ is the technique in which an electric current is used to separate HIV proteins (antigens) used in in the Western blot analysis eletrophoresis 6. __ is the name given to any test that determines the presence of antibodies serological 7. __ is the validation test most frequently used when the ELISA test is positive Western blot analysis 8. __ is the result that can occur if an uninfected person has antibodies that react with HIV antigens in a laboratory test false positive

13. __ is the material obtained from the patient to perform an ELISA test - serum (liquid blood) 14. __ is the source of the antibodies in a newborn's blood that makes an HIV antibody test insufficient the mother 16. __ is the approximate time after exposure to HIV required for a person's immune system to make enough antibodies to test positive on an ELISA test 6 to 10 weeks 17. __ is the level of specificity and sensitivity exceeded by both ELISA and Western blot analysis .99 percent 18. __ is the material other than polymerase enzymes and nucleotides that must be added to DNA to carry out the PCR primer DNA 19. __ is the serologic test in which a color change indicates HIV antibodies - ELISA test 20. __ is the one group for which HIV testing is mandatory in the U.S. - military

Lecture - HIV Infection (10/24, 10/28, 10/31)

HIV in vivo - in the body simians only get infection. humans get AIDS (due to HIV/SIV differences) How does HIV leave the body? frequency blood breast milk semen cervical saliva** 100% 30-40% 30-70% 20-40% 20-50% virus per mL 10^2 - 10^6 10^2 - 10^3 10^2 - 10^4 10^2 - 10^3 10^2 - 10^3

**likely reflects blood contamination in the saliva How does HIV enter the body? direct exposure transmucosal membrane

rectal vaginal ulceration injection of contaminated fluid / blood vertical transmission (mother > baby) in uteri (fetus), peri (birth) or post natal (breast feeding) amount of virus and or number of exposures contributes to risk of infection infectious dose is <10 virus particles HIV exposure > infection > disease exposure (minutes) infection (hours to days) virus moves through the body (days to weeks) long-lives Th memory cells express the receptors that HIV needs (CCR5 and CD4)

founder population of HIV travels through lymph, goes to lymph nodes (to find Th cells), infected lymph goes into cardiovascular system, blood becomes infected = systemic HIV Acute HIV Infection (early phase) incubation period - days to weeks (average 11-14 days), no signs, no symptoms some infections are asymptomatic (25-30%) symptomatic infections (acute_ - resembles "flu-like" illness, aka malaise, aka prodromal most common signs & symptoms fever - 80% malaise - 68% loss of appetite - 54% arthralgia (joint pain) - 54% rash - 51% other signs and symptoms - myalgia, pharyngitis, swollen lymph nodes Stages of HIV infection / disease (without antiretrovirals) -dramatic reduction in blood CD4+ cells - partial recovery of CD4+ T cell levels - persistent production of HIV - persisten decline in CD4+ T cells

Specific Immune Response to HIV as HIV levels decrease in blood, CD4+ Th cells gradually increase - the appearance of HIV-specific CTL's correlates with decline of HIV in bloody - HIV-specific antibody produced within 1st month after infection, fails to neutralize HIV

Since HIV is an RNA virus, it can mutate easily. This means that prognoses can vary widely. (A person infected with HIV can die in a few years instead of a few decades). "A Tale of Two Infections" Acute phase - mucosal, CD4+ Th cell depletion**, occurs within two weeks Chronic phase - takes years, gradual depletion of peripheral CD4+ cells, persistent activation of immune system (which loses its regenerative capacity) ** - killed by direct replication of HIV, CD8+ Tc cells, or uninfected CD4+ commit apoptosis exposure does NOT equal infection HIV exposure can be cleared by the body viremia - condition in which virus particles are circulating in the body peripheral CD4+ T cells rebound form HIV infection by mucosal cells do not (before AIDS develops) the immune system loses regenerative capacity over the chronic stage of infection because it has been constantly activated for years. Immunologic Abnormalities of AIDS dichotomy - sustained and dramatic immune activation - profound immunodeficiency (because of Th cell loss) lymph node structure - destruction of dendritic APC's -tissue necrosis, destruction of lymph node regions Th cells - decrease in number - loss of ability to respond to antigens antibody production - production of nonspecific IGG, IGA - no proliferation of B cells, loss of HIV-specific antibody production Tc cells - normal reactivity early in disease - late in disease, reduction of CTL activity ('Tc cell fatigue')

HIV disease does NOT equal AIDS - HIV disease is everything leading up to AIDS - AIDS is a medical definition, set by arbitrary observational diagnoses - AIDS appears when HIV count goes up and CD4+ goes down

Testing for AIDS 1) Test positive for HIV (antibody or/and virus detection) AND 2) CD4+ count drops below 200 cells per microliter OR 3) CD4+ count is <14% of blood lymphocytes OR 4) diagnosis of AIDS-defining disease AIDS-defining Disease - Any of >24 diseases - examples of infections: Pneumocystis pneumonia (PCP) - fungi, affects lungs Toxoplasmosis - protozoa, affects brain Candidiasis albicans (thrush) - fungi, affects mouth Tuberculosis - bacteria, affects lungs Herpes virus - cytomegalovirus retinitis (eye) or shingles - examples of cancers Kaposi's sarcoma (caused by herpes virus-8) Lymphoma Evolution of AIDS definition 1981 - (not called AIDS yet), patients suffering form rare cancer or infectious disease associated with immunodeficiency, no other underlying cause 1982 - CDC publishes term AIDS 1987 - without lab evidence of HIV = no other cause found, definitive diagnosis of 12 cancers/ infections || with lab evidence of HIV = definitive diagnosis of 23 cancers/infections 1993 - test positive for HIV, CD4+ count below 200, diagnosis of any 26 infectious cancers / infections

Guest Lecture - STI Prevention by Guli Fager

Student Sexual Behavior 67% of students sexually active - high risk behavior - 4% use condoms every time (including oral) - 37% use condoms every time (up to vaginal, not including oral) - 17% use condoms every time (anal) In the 30 days before the survey 41.5% had oral 43.5% had vaginal

4.1% had anal No Sex 30.9% never oral 36.5% never vaginal 77.5% never anal 25% of seniors have never had sex Prevention 33% pull out 24% HIV test (probably over-reported) 23% discuss getting tested before sex 49% keep condoms at home 10% keep condoms in a wallet, backpack 2 Types of STI Bacterial - curable gonorrhea chlamydia syphilis Viral - treatable HPV HIV HSV (herpes) All STI's are preventable!

Guest Lecture - AIDS & HIV in Travis County by Ella Puga

Epidemiology surveillance - ongoing and systematic analysis of pop. based info about persons infected with HIV or diagnosed with AIDS collected by active reporting (contacting hospitals & clinics) - demographics (age, sex, race, etc) - mode of exposure - opportunistic illnesses, immunological status - supplemental info - antiretrovirals, prophylactics? - use of substance abuse services? - health insurance? confidentiality - names of patients and physicians not reported to the CDC limitations - can only be seen in those tests, government policy influences

uses of data - monitor HIV & AIDS in population - identify changes in trends of HIV infection - target prevention interventions - allocate funds for social & health services, morbidity & mortality US #'s 1,178,350 people age 13+ diagnosed with HIV infection, est. 20% are undiagnosed by race in numbers: white non-hispanic black non-hispanic hispanic by race in rates (more accurate) black hispanic white by gender: more male than female AIDS cases: MSM (men who have sex with men) most heterosexual | MSM & IDU | IDU (injection drug use) least pediatric cases black white hispanic

most | least

most | least

61.3% 22.6% 16.9%