Causes of Bone marrow suppression in HIV infection

General causes :


1. HIV infection itself
2. Mycobacterial infections
3. Fungal infections
4. B19 Parvovirus infection
5. Lymphoma 


Drugs used in HIV patient which cause Bone marrow suppression :


1. Zidovudine
2. Dapsone
3. trimethoprim/sulfamethoxazole
4. Pyrimethamine
5. 5-Flucytosine
6. Ganciclovir
7. Interferon-alpha
8. Trimetrexate
9. Foscarnet 

Part 14 HIV Multiple choice questions

66q: what is most common manifestation of pulmonary disease in HIV infected patients ?


a. pneumonia
b. carcinoma
c. bronchiectasis
d. asthma

answer a . pneumonia, mostly caused by pneumococcus and H.influenza and P. Jiroveci

67q: what is the treatment of choice for severe pneumocystis carinii disease in a patient unable to tolerate TMP/SMX ?


a. intravenous pentamidine
b. intravenous dapsone
c. intravenous clindamycin
d. intravenous primaquine

answer a, intravenous pentamidine

68q: what is the most common presentation of syphilis in HIV-infected patient ?


a. lues maligna
b. condyloma lata
c. neurosyphilis
d. none

answer b . condyloma lata

69q: all of the following are causes of bone marrow suppression in patients with HIV infection except ?


a. HIV infection itself
b. Mycobacterial infections
c. Fungal infections
d. B19 parvovirus infections
e. Lymphoma
f. All the above

answer f . all the above

70q: all of the following medications used in an HIV patient cause bone marrow suppression except ?


a. zidovudine
b. tenofovir
c. ganciclovir
d. interferon-alpha
e. foscarnet

answer b . tenofovir has the potential for renal toxicity but does not cause bone marrow suppression

Lues maligna

While most HIV-infected individuals with syphilis have a typical presentation, a variety of formerly rare clinical problems may be encountered in the setting of dual infection .

Among them are lues maligna , an ulcerating lesion of the skin due to necrotizing vasculitis; unexplained fever; nephrotic syndrome and neurosyphilis . 

Part 13 HIV Multiple choice questions

61q: in the absence of prophylactic antiretroviral therapy to the mother during pregnancy, labor and delivery and to the fetus following birth , the probability of transmission of HIV from mother to infant/fetus in industrialized countries is ?


a. 15-25 %
b. 25-35 %
c. 50-60 %
d. 100 %

answer a . 15-25 %

62q: in the absence of prophylactic antiretroviral therapy to the mother during pregnancy, labor and delivery and to the fetus following birth , the probability of transmission of HIV from mother to infant/fetus in developing countries is ?


a. 15-25 %
b. 25-35 %
c. 50-60 %
d. 100 %

answer b . 25-35 %

63q: find the false statement ?


a. mother to child transmission before birth is 23-30 %
b. mother to child transmission during birth is 50-65 %
c. mother to child transmission by breast feeding is 12-20 %
d. maternal transmission of HIV to fetus occurs most commonly during perinatal period
e. all are true

answer e . all are true

64q: which of the following is a mode of transmission of HIV ?


a. tears
b. saliva
c. urine
d. human bite

answer d . human bite . Though rare human bite has been known to transmit HIV

65q: what is the average CD4+ T cell count of an HIV infected patient at the time of death ?


a. just over 200 cells/microliter
b. just over 300 cell/microliter
c. just under 200 cells/microliter
d. just over 100 cells/microliter

answer b . just over 300 cells/microliter

Part 12 HIV Multiple choice questions

56q: itraconazole is used as a first choice for prophylaxis of which of the following opportunistic infections in a HIV infected patient ?


a. Cryptococcus neoformans
b. Histoplasma capsulatum
c. Coccidioides immitis
d. Pencillium marneffei
e. Both b and d

answer e . both b and d .

57q: what is the drug used as a first line prophylaxis for the prevention of Cytomegalovirus infection in a HIV infected individual ?


a. fluconazole
b. ceftriaxone
c. ganciclovir
d. formivirsen

answer c . ganciclovir

58q: a CD4 T cell percentage of how much is comparable to a CD4+ T cell count of 200/microliter ?


a. 10 %
b. 15 %
c. 20 %
d. 25 %

answer b . 15 %

59q: patients with CD4+ T cell counts of less than 200/microliter are at high risk for which of the following opportunistic infections ?


a. Pneumocystis jiroveci
b. Mycobaterium Avium Intracellulare ( MAC )
c. Toxoplasmosis
d. CMV

answer a . Pneumocystis jiroveci

60q: patients with CD4+ T cell counts less than 50/microliter are at high riks for which of the following opportunistic infections ?


a. CMV
b. MAC
c. Toxoplasmosis
d. Only a and b
e. All the above

answer e . all the above

Part 11 HIV Multiple choice questions

51q: which of the following is not a NNRTI drug ?


a. delaviridine
b. nevirapine
c. efavirenz
d. etravirine
e. all are NNRTIs

answer e . all are NNRTIs . etravirine is also a NNRTI .

52q: the drug COMBIVIR is a combination of which retroviral drugs ?


a. zidovudine and lamivudine
b. zidovudine and abacavir
c. zidovudine , lamivudine and abacavir
d. tenofovir and emtricitabine

answer a . zidovudine and lamivudine . option b is EPZICOM option c is TRIZIVIR option d is TRUVADA

53q: Globally which is the most common opportunistic infection in HIV-infected individuals ?


a. mycobacterium tuberculosis
b. pneumocystis carinii
c. mycobacterium avium intracellulare
d. toxoplasmosis

answer a . Mycobacterium Tuberculosis

*Ref: Chapter-182-Harrison's17th-edition: Under the heading 'Cellular activation and Pathogenesis'- second paragraph. 


54q: first choice for the prophylaxis of pneumocystis jiroveci in HIV patient ?


a. sulfadiazine
b. fluconazole
c. ciprofloxacin
d. trimethoprim/sulfamethoxazole

answer d . trimethoprim/sulfamethoxazole ( TMP/SMZ )

55q: fluconazole is used as a first choice for prophylaxis of which of the following opportunistic infections in a HIV infected patient ?


a. Cryptococcus neoformans
b. Histoplasma capsulatum
c. Coccidioides immitis
d. Pencillium marneffei
e. Both a and c

answer e . both a and c

R5X4 HIV viruses

HIV-1 utilizes two major co-receptors along with CD4 to bind to, fuse with, and enter target cells; these co-receptors are CCR5 and CXCR4, which are also receptors for certain endogenous chemokines.

Strains of HIV that utilize CCR5 as a co-receptor are referred to as R5 viruses.

Strains of HIV that utilize CXCR4 are referred to as X4 viruses.

Many virus strains are dual tropic in that they utilize both CCR5 and CXCR4; these are referred to as R5X4 viruses.

Part 10 HIV Multiple choice questions

46q: all of the following drugs used in the treatment of HIV are reverse transcriptase inhibitors except ?


a. delaviridine
b. efavirenz
c. zalcitabine
d. indinavir
e. abacavir

answer d . indinavir is a protease inhibitor

47q: what is the mechanism of action of maraviroc , a drug used in the treatment of HIV?


a. integrase inhibitor
b. CCR5 antagonist
c. CXCR4 antagonist
d. Reverse transcriptase inhibitor

answer b . CCR5 antagonist . CCR5 is the co-receptor which helps in attachment of HIV to the host cell

48q: what is the mechanism of action of Raltegravir , a drug used in the treatment of HIV?


a. integrase inhibitor
b. CCR5 antagonist
c. CXCR4 antagonist
d. Reverse transcriptase inhibitor

answer a . integrase inhibitor .

49q: which of the following is an entry inhibitor used in the treatment of HIV ?


a. enfuviritide
b. maraviroc
c. raltegravir
d. both a and b

answer d . both a and b .

50q: all of the following are non nucleoside reverse transcriptase inhibitors ( NNRTI ) except ?


a. delaviridine
b. efavirenz
c. nevirapine
d. zalcitabine

answer d . zalcitabine is a NRTI ( nucleoside reverse transcriptase inhibitor )

Part 9 HIV Multiple choice questions

41q: infusion of which of the following has the least chance of transmitting HIV infection?


a. whole blood
b. packed RBC
c. platelets
d. leucocytes
e. plasma
f. clotting factor concentrates

answer f . clotting factors . the chance of infection of a hemophiliac via clotting factor concentrates has essentially been eliminated because of the added layer of safety resulting from heat treatment of the concentrates

42q: It is currently estimated that the risk of infection with HIV in the united states via transfused screened blood is approximately how much ?


a. 10 in 1.5 million donations
b. 20 in 1.5 million donations
c. 5 in 1.5 million donations
d. 1 in 1.5 million donations

answer d . 1 in 1.5 million donations

43q: despite the best efforts of science, among the approximately 15 million donations collected in the united states each year , about 10 HIV infectious donations are available for transfusion . why does this happen ?


Answer: This happens because the current technology cannot detect HIV RNA for the first 1-2 weeks due to low levels of viremia .


44q: Large, multi-institutional studies have indicated that the risk of HIV transmission following skin puncture from a needle or a sharp object that was contaminated with blood from a person with documented HIV infection is ?


a. Approximately 0.3 %
b. Approximately 0.09 %
c. Approximately 1 %
d. Approximately 0.01 %

answer a . approximately 0.3 %

45q: Large, multi-institutional studies have indicated that the risk of HIV transmission after a mucous membrane exposure to HIV infected blood is ?


a. Approximately 0.3 %
b. Approximately 0.09 %
c. Approximately 1 %
d. Approximately 0.01 %

answer b . approximately 0.09 %

Part 8 HIV Multiple choice questions

36q: Usually the heterosexual transmission of HIV is rare when the infected partner has a plasma level of _____________ copies of HIV RNA per milliliter ?


a. less than 1000
b. less than 1500
c. less than 2000
d. less than 2500

answer b . less than 1500 copies of HIV RNA per milliliter

37q: the rate of HIV transmission per coital act was highest during ?


a. early stage of HIV infection
b. advanced stage of HIV infection
c. both early and advanced stages
d. in the middle stages of HIV infection

answer c . both early and advanced stages of HIV infection

38q: find the false statement ?


a. male circumcision is associated with a lower risk of HIV infection among men
b. use of oral contraceptives is associated with increased risk of HIV infection
c. adolescent girls are less susceptible to infection than other aged women
d. oral sex is much less efficient mode of transmission of HIV than is receptive anal intercourse

answer c , is the wrong statement because due to properties of an immature genital tract with increased cervical ectopy or exposed columnar epithelium adolescent girls might be more susceptible to infection upon exposure than others

39q: why is the use of oral contraceptives associated with an increased incidence of HIV infection ?


Answer: drugs in OCPs induce certain changes in cervical mucosa, rendering it more vulnerable to penetration by viruses .


40q: Transfusion of which of the following is associated with transmission of HIV infection ?


a. hyperimmune gamma globulin
b. hepatitis B immune globulin
c. plasma derived hepatitis B vaccine
d. Rho immune globulin
e. Platelets

answer e . platelets transfusion is associated with HIV transmission, where as transfusion of a, b, c, d is not associated with HIV transmission because procedures involved in processing these products either inactivates or removes the virus

Part 7 HIV Multiple choice questions

31q: which subtype of the M group of HIV-1 viruses is most common in south and southeast asia ?


a. A subtype of M group of HIV-1
b. CRF01_AE
c. CRF02_AG
d. D subtype of M group of HIV-1

answer b . CRF01_AE

32q: which of the following is not a mode of transmission of HIV ?


a. sexual contact
b. needle prick
c. mosquito bite
d. transfusion of infected fresh frozen plasma

answer c . mosquito bite

33q: why is there a strong association between HIV transmission and receptive anal intercourse ?


Answer: There is a strong association of HIV transmission with receptive anal intercourse, probably because only a thin, fragile rectal mucosal membrane separates the deposited semen from potentially susceptible cells in and beneath the mucosa and trauma may be associated with anal intercourse. Anal douching and sexual practices that traumatize the rectal mucosa also increase the likelihood of infection.
It is likely that anal intercourse provides at least two modalities of infection: (1) direct inoculation into blood in cases of traumatic tears in the mucosa; and (2) infection of susceptible target cells, such as Langerhans cells, in the mucosal layer in the absence of trauma .


34q: why is the male to female transmission of HIV usually more efficient than female to male transmission ?


Answer: Studies in the United States and Europe have found that male-to-female HIV transmission is usually more efficient than female-to-male transmission, but small numbers of HIV-positive female index partners limit conclusive sex-specific estimates of transmission probabilities per sex act.
The differences in reported transmission rates between men and women may be due in part to the prolonged exposure to infected seminal fluid of the vaginal and cervical mucosa, as well as the endometrium (when semen enters through the cervical os). By comparison, the penis and urethral orifice are exposed relatively briefly to infected vaginal fluid.


35q: which of the following is the chief predictor of heterosexual transmission of HIV
( as per studies conducted in Uganda ) ?


a. duration of sexual intercourse
b. plasma viremia
c. presence of other Sexually transmitted diseases
d. genetic makeup

answer b . plasma viremia . presence of other STDs also has a strong association with the heterosexual transmission of HIV

Part 6 HIV Multiple choice questions

26q: the chimpanzee subspecies pan troglodytes troglodytes has been established to be the natural reservoir of which groups of HIV-1 ?


a. M and O
b. N and O
c. M and N
d. None

answer c . M and N groups

27q: what are CRFs ?


Answer: CRFs are circulating recombinant forms . these are generated by infection of an individual with two subtypes of HIV viruses that then recombine and create a virus with a selective advantage .


28q: which subtype of the M group of HIV-1 viruses is most common in Europe, Australia and America ?


a. A subtype of M group of HIV-1
b. B subtype of M group of HIV-1
c. C subtype of M group of HIV-1
d. D subtype of M group of HIV-1

answer b . B subtype of M group of HIV-1

29q: which subtype of the M group of HIV-1 viruses is most common worldwide ?


a. A subtype of M group of HIV-1
b. B subtype of M group of HIV-1
c. C subtype of M group of HIV-1
d. D subtype of M group of HIV-1

answer c . C subtype of M group of HIV-1

30q: which subtype of the M group of HIV-1 viruses is most common in India ?


a. A subtype of M group of HIV-1
b. B subtype of M group of HIV-1
c. C subtype of M group of HIV-1
d. D subtype of M group of HIV-1

answer c . C subtype of M group of HIV-1

Part 5 HIV Multiple choice questions

21q: env gene encodes which of the following constituents of the HIV-1 virus ?


a. encodes the enzymes responsible for protease processing of viral proteins
b. encodes the envelope glycoproteins
c. encodes the proteins that forms the core of the virion
d. p24 antigen
e. both c and d

answer b . env gene encodes the envelope glycoproteins

22q: HIV-1 genome contains all the following genes except ?


a. vpu
b. vpr
c. vpx
d. tat
e. rev
f. nef
g. vif

answer c . vpx gene is present only in HIV-2 and not in HIV-1

23q: HIV-2 genome contains all the following genes except ?


a. vpu
b. vpr
c. vpx
d. tat
e. rev
f. nef
g. vif

answer a . vpu gene is absent in HIV-2 and instead of it vpx gene is present .

24q: which of the following is not a group of HIV-1 viruses ?


a. L group
b. M group
c. N group
d. O group

answer d . L group , there is no such group M stands for Major and O stands for Outlier

25q: what are the nine subtypes or clades comprising the M group of HIV-1 viruses ?


a. A, B, C, D, E, F, G, H, I
b. A, B, C, D, F, G, H, J, K
c. A, B, C, D, G, H , J, K, L
d. A, B, C, D, E, H, J, K, L

answer b . A, B, C, D, F, G, H, J, K subtypes of M group

Part 4 HIV Multiple choice questions

16q: after the HIV viral DNA enters the nucleus of the host cell it is integrated into the host cell chromosomes through the action of another virally encoded enzyme called ?


a. protease
b. integrase
c. DNAse
d. RNAse
e. Reverse transcriptase

answer b . integrase

17q: what are lipid rafts ?


Answer: Budding of the HIV progeny virion occurs through specialized regions in the lipid bilayer of the host cell membrane which are known as lipid rafts, where the core acquires its external envelope .


18q: which of the following are the genes associated with HIV-1 ?


a. gag gene
b. pol gene
c. env gene
d. all the above

answer d . all the above

19q: gag gene encodes which of the following constituents of the HIV-1 virus ?


a. encodes the enzymes responsible for protease processing of viral proteins
b. encodes the envelope glycoproteins
c. encodes the proteins that forms the core of the virion
d. p24 antigen
e. both c and d

answer e . both c and d . core of the virion and p24 antigen

20q: pol gene encodes which of the following constituents of the HIV-1 virus ?


a. encodes the enzymes responsible for protease processing of viral proteins
b. encodes the envelope glycoproteins
c. encodes the proteins that forms the core of the virion
d. p24 antigen
e. both c and d

answer a . enzymes responsible for protease processing of viral proteins

Part 3 HIV Multiple choice questions

11q: what is DC-SIGN ?


Answer: certain dendritic cells express a diversity of C-type lectin receptors on their surface, one of which is called DC-SIGN, that also binds with high affinity to the HIV gp120 envelope protein, allowing dendritic cell to facilitate the binding of HIV virus to the CD4+ T cell upon engagement of dendritic cells with CD4+ T cells .


12q: what is TRIM5-ALPHA ?


Answer: it is a cytoplasmic protein found in rhesus macaque cells which blocks SIV
( simian immunodeficiency virus ) replication at a point shortly after the virus fuses with the host cell .


13q: what is the human form of TRIM5-ALPHA ?


a. cyclophilin A
b. cyclophilin B
c. cyclophilin C
d. cyclophilin D

answer a. cyclophilin A

14q: what are the proteins in humans that bind to nascent reverse transcripts and deaminate viral cytidine , causing hypermutation of HIV genomes and inhibits progression of virus infection after virus has entered the cell ?


a. TRIM5-ALPHA protein
b. Cyclophilin
c. APOBEC proteins
d. All the above

answer c . APOBEC proteins

15q: what is the powerful strategy evolved by HIV to protect itself from the APOBEC proteins ?


a. the viral protein Vif targets APOBEC for proteasomal degradation
b. the viral protein Vpu targets APOBEC for proteasomal degradation
c. the viral protein Vpx targets APOBEC for proteasomal degradation
d. the viral protein Vpr targets APOBEC for proteasomal degradation

answer a . Vif targets APOBEC for proteasomal degradation

Part 2 HIV Multiple choice questions

6q: what is the name of the species of the chimpanzee that has been established as the natural reservoir of HIV-1 ?

answer pan troglodytes troglodytes

7q: HIV-2 is more closely related phylogenetically to which virus ?


a. HIV-1 of chimpanzees
b. Simian immunodeficiency virus ( SIV ) in sooty mangabeys
c. SIV in sykes
d. SIV in African green monkeys

answer b . SIV in sooty mangabeys

8q: what are the two major envelope proteins that surround the HIV virion ?


a. gp 120 and gp 40
b. gp 120 and gp 41
c. gp 120 and gp 42
d. gp 120 and gp 43

answer b . gp 120 and gp 41 . gp 120 externally and gp 41 below it .

9q: all of the following are true about HIV except ?


a. it is a DNA virus
b. it has the enzyme reverse transcriptase
c. the gp120 protein binds to the host cell via the receptor called CD4 molecule
d. the CD4 molecule is a protein found predominantly on a subset of T lymphocytes
e. the CD4 is also present on monocytes/macrophages and dendritic/langerhans cells

answer a . HIV is a RNA virus and not a DNA virus

10q: once gp120 binds to CD4 , the gp120 undergoes a conformational change that facilitates binding to one of a group of co-receptors . what are the two major co-receptors to which HIV attaches ?


a. CCR5 and CXCR4
b. CCR6 and CXCR5
c. CCR7 and CXCR6
d. CCR8 and CXCR7

answer a . CCR5 and CXCR4