IMMUNODEFICIENCY 1.2

Question 1

ASSESSMENT AND DIAGNOSTIC METHODS

Answer 1

1. Enzyme immunoassay (EIA)
2. Western Blot
3. Viral Load Test
4. OraSure Saliva Test
5. OraQuick Rapid HIV-1 antibody test

Question 2

ASSESSMENT AND DIAGNOSTIC METHOD:

• Formerly enzyme-linked immunosorbent assay [ELISA]
• One of the most commonly used tests to screen for HIV antibodies. This test detects antibodies that the body produces in response to HIV infection

Answer 2

Enzyme Immunoassay (EIA)

Question 2

ASSESSMENT AND DIAGNOSTIC METHOD:

• A blood sample is taken from the individual, and the test is performed in a laboratory. The test uses antigens from HIV to capture any antibodies present in the blood.
• If the test detects antibodies, it produces a positive result.
• However, because this is a screening test, any positive result must be confirmed by a more specific test, such as the Western blot assay.

Answer 2

Enzyme Immunoassay (EIA)

Question 3

ASSESSMENT AND DIAGNOSTIC METHOD:

FALSE POSITIVE RESULT OF Enzyme Immunoassay (EIA)

Answer 3

• Cross-Reactivity
• Recent Vaccination
• Technical Errors
• Biological Factors

Question 3

ASSESSMENT AND DIAGNOSTIC METHOD:

FALSE NEGATIVE RESULT OF Enzyme Immunoassay (EIA)

Answer 3

• Window Period
• Test Sensitivity
• Genetic Variants of HIV

Question 3

FALSE POSITIVE RESULT:

Improper handling, contamination, or incorrect interpretation of the test results

Answer 3

Technical Errors

Question 3

FALSE POSITIVE RESULT:

Can sometimes react with antibodies produced in response to other infections or conditions such as autoimmune disorders or other viral infections (EBV)

Answer 3

Cross-Reactivity

Question 4

FALSE POSITIVE RESULT:

Rarely, individuals may naturally produce proteins that mimic HIV antibodies

Answer 4

Biological Factors

Question 4

FALSE POSITIVE RESULT:

Can sometimes trigger the production of antibodies that cross-react with HIV antigens

Answer 4

Recent Vaccination

Question 4

FALSE NEGATIVE RESULT:

The time between initial HIV infection and the point when the body produces enough antibodies to be detected by the EIA.

Answer 4

Window Period

Question 5

FALSE NEGATIVE RESULT:

Antibody levels are very low in cases of early HIV infection and advanced HIV infection.

Answer 5

Test Sensitivity

Question 5

ASSESSMENT AND DIAGNOSTIC METHODS:

• The confirmatory test for HIV.
• It is more specific than the EIA and is used to confirm the presence of HIV antibodies after a positive EIA test.

Answer 5

Western Blot

Question 6

FALSE NEGATIVE RESULT:

Incorrect sample handling, dilution errors

Answer 6

Technical Errors

Question 6

FALSE NEGATIVE RESULT:

While rare, certain genetic variants of HIV might not be detected by the antigens used in the standard EIA

Answer 6

Genetic Variants of HIV

Question 7

ASSESSMENT AND DIAGNOSTIC METHODS:

Target Amplification Methods of Viral Load Test

Answer 7

• Polymerase Chain Reaction (PCR)
• Branched DNA (bDNA) Test

Question 7

ASSESSMENT AND DIAGNOSTIC METHODS:

• The test separates viral proteins by size using gel electrophoresis, and these proteins are then transferred to a membrane where they are exposed to the patient’s serum.
• If HIV antibodies are present, they will bind to the viral proteins, confirming the infection.

Answer 7

Western Blot

Question 8

ASSESSMENT AND DIAGNOSTIC METHODS:

The test is highly specific and is used to avoid false positives that might occur with the EIA.

Answer 8

Western Blot

Interpretation: A positive Western blot test confirms an HIV infection.

Question 8

ASSESSMENT AND DIAGNOSTIC METHODS:

• Viral load tests measure the amount of HIV RNA in the blood, rather than antibodies.
• These tests are often used to monitor the effectiveness of antiretroviral therapy (ART) and to determine the stage of the infection.

Answer 8

Viral Load Test

Question 8

Target Amplification Methods of Viral Load Test

Detects HIV RNA by amplifying small amounts of viral RNA to detectable levels.

Answer 8

Polymerase Chain Reaction (PCR)

Question 9

Target Amplification Methods of Viral Load Test

Measures the amount of HIV RNA in a sample using a signal amplification method.

Answer 9

Branched DNA (bDNA) Test

Question 10

ASSESSMENT AND DIAGNOSTIC METHODS

Low or undetectable levels suggest effective suppression of the virus

Answer 10

Viral Load Test

Interpretation: High viral load levels indicate active viral replication and a higher risk of disease progression.

Question 11

ASSESSMENT AND DIAGNOSTIC METHODS

• A non-invasive method that uses a saliva sample to detect HIV antibodies.
• It is useful for individuals who are reluctant to provide a blood sample.

Answer 11

OraSure Saliva Test

Question 12

ASSESSMENT AND DIAGNOSTIC METHODS

A special collection device is used to obtain a saliva sample from the gums and inner cheek. The sample is then tested in a laboratory.

Answer 12

OraSure Saliva Test

Interpretation: A positive result indicates the presence of HIV antibodies and should be confirmed with a blood-based test, such as the Western blot.

Question 13

ASSESSMENT AND DIAGNOSTIC METHODS

A rapid point-of-care test that provides results within 20-40 minutes. It can be performed using a blood sample or an oral fluid sample.

Answer 13

OraQuick Rapid HIV-1 antibody test

Question 14

# **ASSESSMENT AND DIAGNOSTIC METHODS** For the oral test, the device is swabbed along the gums, and the sample is placed in a solution. For the blood test, a small blood sample is taken from the finger.

Answer 14

OraQuick Rapid HIV-1 antibody test

Question 15

# **ASSESSMENT AND DIAGNOSTIC METHODS** The rapid test is widely used for its convenience, especially in settings where quick results are needed.

Answer 15

OraQuick Rapid HIV-1 antibody test ## Footnote **Interpretation**: A positive result on the OraQuick test should be confirmed with a follow-up laboratory test.

Question 16

MEDICAL MANAGEMENTS FOR AIDS

Answer 16

1. Antiretroviral Therapy (ART) 2. Treatment of Opportunistic Infection

Question 17

# **MEDICAL MANAGEMENTS FOR AIDS:** A combination of medications that target the HIV. ITS GOAL INCLUDES: * To reduce the viral load in the body to undetectable levels * To maintain or increase the number of CD4+ T cells * To prevent the progression of HIV to AIDS * To manage or prevent opportunistic infections and complications.

Answer 17

Antiretroviral Therapy (ART)

Question 17

Examples of Opportunistic Infection

Answer 17

* Pneumocystis Pneumonia * Mycobacterium Avium Complex * Cryptococcal Meningitis * CMV Retinitis * Other Infections: * *- Herpes simplex or herpes zoster* * *- Esophageal or oral candidiasis*

Question 18

# **CMV Retinitis:** Adverse reaction to Ganciclovir:

Answer 18

Severe Neutropenia

Question 18

* Treatment of choice for Pneumocystis Pneumonia (PCP) * Adjunctive corticosteroids should be started as early as possible (and certainly within 72 hours).

Answer 18

Trimethoprim-sulfamethoxazole (TMP-SMZ)

Question 18

# **MEDICAL MANAGEMENT:** * A synthetic analog of somatostatin * Shown to be effective in managing chronic severe diarrhea

Answer 18

Octreotide acetate (Sandostatin) | **Antidiarrheal Therapy**

Question 19

# **CMV Retinitis:** Adverse reactions to Foscarnet:

Answer 19

* Nephrotoxicity * Electrolyte imbalances -*life threatening*.

Question 19

# **MEDICAL MANAGEMENT:** **Treatment Goals:** * reduce symptoms by decreasing the size of the skin lesions * reduce discomfort associated with edema and ulcerations * control symptoms associated with mucosal or visceral involvement.

Answer 19

Chemotherapy | **Kaposi’s Sarcoma**

Question 20

# **MEDICAL MANAGEMENT:** Radiation therapy is effective as a palliative measure; alphainterferon can lead to tumor regression and improved immune system function.

Answer 20

Chemotherapy | **Kaposi’s Sarcoma**

Question 20

# **MEDICAL MANAGEMENT:** Treatment of depression involves psychotherapy integrated with pharmacotherapy antidepressants and possibly a psychostimulant

Answer 20

Antidepressant Therapy

Question 20

# **MEDICAL MANAGEMENT:** For patients with severe depression who do not respond to pharmacologic interventions.

Answer 20

Electroconvulsive therapy

Question 20

# **MEDICAL MANAGEMENT:** * Calorie counts should be obtained to evaluate nutritional status and initiate appropriate therapy for patients experiencing unexplained weight loss. * Appetite stimulants can be used in patients with AIDS related anorexia. * Oral supplements may be used to supplement diets that are deficient in calories and protein.

Answer 20

Nutrition Therapy

Question 21

What kind of diet should a patient with diarrhea consume?

Answer 21

A diet low in fat, lactose, insoluble fiber, and caffeine and high in soluble fiber