Q: HIV and opportunistic bacterial disease: Which common bacterial infections are frequently associated with HIV infection, particularly as immunosuppression progresses?

Introduction / Context: As HIV infection advances and CD4 counts fall, susceptibility to bacterial pathogens increases. Recognizing the range of common bacterial infections helps clinicians anticipate, prevent, and treat opportunistic disease. Given Data / Assumptions: Patients with HIV can develop both typical and opportunistic bacterial infections. Mycobacterial disease (tuberculosis and non-tuberculous species), nontyphoidal Salmonella bacteremia, and Bartonella infections are known associations. The item asks which of the listed are frequently observed in HIV disease. Concept / Approach: Each listed organism group is well documented among people with HIV. Tuberculosis risk is elevated at all stages; disseminated Mycobacterium avium complex rises at low CD4 counts. Recurrent Salmonella bacteremia is an AIDS-defining condition in many settings. Bartonella (e.g., B. henselae) can cause bacillary angiomatosis and peliosis hepatis. Step-by-Step Solution: Match each infection with known HIV-related syndromes (TB, disseminated MAC; Salmonella bacteremia; Bartonella-associated vascular proliferations).Confirm that all three appear with increased frequency relative to the general population.Therefore, select the comprehensive choice ‘‘all of these’’. Verification / Alternative check: Clinical guidelines and opportunistic infection manuals list these conditions among major bacterial complications in advanced HIV disease. Why Other Options Are Wrong: Choosing only one or two would omit other true associations; ‘‘none’’ contradicts established epidemiology. Common Pitfalls: Assuming only mycobacterial disease is relevant; overlooking vascular proliferative lesions of Bartonella or recurrent Salmonella bacteremia as hallmark bacterial issues in advanced HIV. Final Answer: all of these.

Q: HIV and parasitic disease spectrum: Which parasitic infections are frequently observed among people living with HIV, especially at lower CD4 cell counts?

Introduction / Context: Opportunistic parasitic infections contribute substantially to morbidity in advanced HIV disease. Understanding which parasites are common helps guide prophylaxis, diagnostic testing, and empiric therapy. Given Data / Assumptions: Cryptosporidium parvum can cause chronic, severe diarrhea in immunocompromised hosts. Toxoplasma gondii can reactivate as cerebral toxoplasmosis at CD4 counts typically <100 cells/µL. Cystoisospora (Isospora) belli causes prolonged watery diarrhea and weight loss in advanced HIV. Concept / Approach: The listed parasitic infections are classic opportunistic conditions in people with advanced HIV. Their risk rises as cellular immunity wanes, and some are preventable or treatable when recognized early (e.g., toxoplasma prophylaxis in seropositive patients with low CD4 counts). Step-by-Step Solution: Map each parasite to its core clinical syndrome in HIV (diarrhea or encephalitis).Recognize that all are well-documented in HIV literature.Select ‘‘all of these’’ to reflect the complete, correct set. Verification / Alternative check: Standard opportunistic infection tables enumerate these infections and their CD4 thresholds for highest risk. Why Other Options Are Wrong: Isolated selections omit other equally frequent infections; ‘‘none’’ is contradicted by clinical experience. Common Pitfalls: Confusing isosporiasis with other coccidian infections; forgetting that toxoplasmosis usually represents reactivation in seropositive patients. Final Answer: all of these.

Q: HIV virology fundamentals: Which unique feature best explains why HIV is classified as a retrovirus and is considered distinctive among human pathogens?

Introduction / Context: HIV is a member of the Retroviridae. The hallmark of retroviruses is their replication strategy, which requires copying RNA into DNA inside the host cell. Identifying the signature enzyme clarifies both the name ‘‘retro’’ and many drug targets. Given Data / Assumptions: HIV carries two copies of single-stranded RNA (diploid RNA genome). Reverse transcription converts RNA to DNA in the host cytoplasm. The question seeks the unique feature underlying HIV’s retroviral identity. Concept / Approach: Reverse transcriptase is the defining enzyme of retroviruses. It catalyzes RNA-dependent DNA polymerization, DNA-dependent DNA polymerization, and RNase H activity. This mechanism differentiates retroviruses from most other RNA viruses and explains susceptibility to nucleoside and non-nucleoside reverse transcriptase inhibitors. Step-by-Step Solution: Identify retroviral hallmark → reverse transcriptase.Exclude incorrect claims such as mixed DNA/RNA genomes within the same virion.Note that HIV is enveloped and has specific glycoproteins; the unique trait among options is the enzyme.Choose ‘‘a viral enzyme known as reverse transcriptase’’. Verification / Alternative check: Antiretroviral drug classes directly target reverse transcriptase, underlining its centrality. Why Other Options Are Wrong: More than 100 copies of the genome: HIV carries two RNA copies, not >100. Both DNA and RNA genome: Incorrect; the mature virion contains RNA. Sticky proteins: gp120/gp41 mediate binding/fusion but are not unique to retroviruses. Icosahedral capsid without envelope: HIV is enveloped; this is false. Common Pitfalls: Confusing the presence of both nucleic acids within infected cells (proviral DNA) with virion composition. Final Answer: a viral enzyme known as reverse transcriptase.

Question 1

HIV/AIDS in India: Which opportunistic infection is the most common co-infection among people living with AIDS in India?

Accepted Answer

Introduction / Context: Understanding regional epidemiology is critical for clinical decision-making. In India and many high-burden countries, tuberculosis (TB) is the most frequent opportunistic infection (OI) among people with HIV/AIDS, driving morbidity and mortality. Given Data / Assumptions: Setting: India, where TB prevalence is high. Population: AIDS patients with immunosuppression. We need the most common OI, not rare presentations. Concept / Approach: HIV-induced CD4+ T-cell depletion increases risk of reactivation and progressive primary TB. TB can present at any CD4 count and is often the sentinel AIDS-defining illness in endemic settings. Other OIs exist but are less prevalent overall than TB in India. Step-by-Step Solution: List common OIs in India: TB, candidiasis, cryptococcosis, PCP, toxoplasmosis, cryptosporidiosis. Weigh prevalence data: TB is consistently the most common co-infection. Select “Tuberculosis” as the best single answer. Verification / Alternative check: National program data and hospital cohorts show high TB–HIV coinfection rates; TB screening is integrated into HIV care (and vice versa) due to this burden. Why Other Options Are Wrong: Cryptosporidiosis/toxoplasmosis/cryptococcosis occur but are less common than TB overall in India; “PCP only” ignores broader epidemiology. Common Pitfalls: Transferring Western OI patterns (e.g., PCP predominance) to Indian settings; always consider local prevalence. Final Answer: Tuberculosis.

Question 2

Natural history of HIV: What is the average time from initial HIV infection to development of AIDS in untreated adults?

Accepted Answer

Introduction / Context: Before widespread antiretroviral therapy, the natural history of HIV infection showed a characteristic timeline from acute infection to advanced immunodeficiency (AIDS). Estimating this average helps in counseling, epidemiology, and exam recall. Given Data / Assumptions: Untreated adult infection. “Average” timeline, acknowledging individual variability. AIDS defined by CDC criteria or severe CD4 decline with opportunistic disease. Concept / Approach: Following acute retroviral syndrome and seroconversion, a prolonged clinically latent phase ensues, during which CD4 counts gradually decline. Without therapy, many adults meet AIDS criteria at around 8–10 years on average. Step-by-Step Solution: Recall phases: acute → clinical latency → symptomatic → AIDS. Anchor the timeline: most cohorts report ~10 years to AIDS without ART. Select “Ten years” as the best single estimate. Verification / Alternative check: Longitudinal cohort studies from the pre-ART era consistently centered around a median near 10 years, with faster progressors and long-term non-progressors as exceptions. Why Other Options Are Wrong: One/two years are too short for average; five years reflects rapid progressors; twenty years fits long-term non-progressors, not the mean. Common Pitfalls: Confusing average with ranges; forgetting that effective ART dramatically changes timelines. Final Answer: Ten years.

Question 3

HIV transmission routes: Globally and in India, which is the most common mode of HIV transmission among adults?

Accepted Answer

Introduction / Context: Understanding predominant transmission routes guides prevention strategies and exam reasoning. Among adults worldwide, sexual transmission—particularly heterosexual contact in many regions—is the leading driver of new HIV infections. Given Data / Assumptions: Adult transmission patterns (not pediatric). Population-level predominance rather than rare circumstances. Recognition that perinatal transmission pertains to infants, not adult spread. Concept / Approach: HIV spreads via exposure to infectious body fluids across mucosal surfaces or via direct blood inoculation. Among adults, sexual contact is most common; parenteral spread (injecting drug use, transfusion) and occupational exposures are less frequent on a global scale. Casual oral routes and vectors are not credible pathways. Step-by-Step Solution: Compare modes by population impact. Select sexual transmission as most prevalent in adult epidemics. Exclude perinatal as not adult-to-adult; exclude casual oral/vector myths. Verification / Alternative check: Epidemiological surveillance consistently attributes the majority of adult cases to sexual exposure, with regional variation in the balance of heterosexual and MSM contributions. Why Other Options Are Wrong: Parenteral is significant in specific subpopulations but not the global majority; perinatal concerns infants; casual oral and vector-borne routes are unsupported. Common Pitfalls: Overgeneralizing from local outbreaks (e.g., high-IDU regions) to global patterns. Final Answer: Sexual (heterosexual and/or MSM exposure).

Question 4

Opportunistic mycoses in HIV: Which fungal infections are frequently observed during the course of HIV disease?

Accepted Answer

Introduction / Context: Opportunistic fungal infections are a major cause of morbidity in advanced HIV disease. Recognizing the spectrum—common and less common—helps in clinical suspicion, appropriate diagnostics, and prophylaxis decisions. Given Data / Assumptions: Patient population: individuals with advanced immunosuppression (low CD4 counts). Target infections: candidiasis, cryptococcosis, and aspergillosis. Question asks about infections “frequently observed,” not exclusively the most common. Concept / Approach: Oropharyngeal and esophageal candidiasis are very common in HIV. Cryptococcal meningitis is a frequent life-threatening OI in many LMIC settings. Aspergillosis, while less common than the former two, still occurs in severely immunocompromised patients, especially with neutropenia or corticosteroid exposure, and remains on differential lists. Step-by-Step Solution: List major HIV-associated mycoses: Candida spp., Cryptococcus neoformans, Histoplasma, Pneumocystis (fungal), Aspergillus. Assess frequency: candidiasis (very common), cryptococcosis (common in late disease), aspergillosis (less common but recognized). Select inclusive option reflecting true spectrum: All of these. Verification / Alternative check: Clinical cohorts document high candidiasis rates and substantial cryptococcosis burdens; aspergillosis is reported in advanced cases and transplant-like immunosuppression scenarios. Why Other Options Are Wrong: Single-disease selections omit other well-documented HIV-associated mycoses; “None of these” contradicts extensive data. Common Pitfalls: Equating “most common” with “only”; overlooking aspergillosis because it is less frequent than candidiasis or cryptococcosis. Final Answer: All of these.

Question 5

Taxonomy of HIV: To which Retroviridae subfamily does human immunodeficiency virus (HIV) belong?

Accepted Answer

Introduction / Context: Viral taxonomy reflects biological behavior. HIV is a lentivirus—characterized by long incubation periods, persistent infection, and progressive immunopathology—placing it within the Retroviridae subfamily Lentivirinae. Given Data / Assumptions: Family: Retroviridae (reverse-transcribing RNA viruses). Ask: correct subfamily designation for HIV. Compare with other retroviral subgroups. Concept / Approach: Lentiviruses (e.g., HIV-1, HIV-2, SIV, FIV) cause slowly progressive diseases. Oncovirinae historically included oncogenic retroviruses (now Orthoretrovirinae subfamilies like Gammaretrovirus/Deltaretrovirus), while Spumavirinae covers foamy viruses (Spumaretrovirinae). Step-by-Step Solution: Match pathogen (HIV) → clinical behavior (slow, persistent) → Lentivirinae. Exclude oncogenic (HTLV) and foamy virus groupings. Select “Lentivirinae.” Verification / Alternative check: Standard virology texts and ICTV classifications list HIV under Lentivirinae. Why Other Options Are Wrong: Oncovirinae corresponds to tumor-associated retroviruses; Spumavirinae are foamy viruses; “None of these” is incorrect. Common Pitfalls: Confusing HIV (lentivirus) with HTLV (deltaretrovirus/oncogenic category). Final Answer: Lentivirinae.

Question 6

HIV vaccine challenges: Which set of barriers most accurately explains why developing a protective vaccine against HIV is difficult?

Accepted Answer

Introduction / Context: Despite decades of research, an effective, widely protective HIV vaccine remains elusive. Multiple biological factors undermine simple vaccine strategies, making this a classic exam theme linking virology and immunology. Given Data / Assumptions: HIV shows high genetic variability and immune escape. Neutralizing antibodies alone may not suffice; robust cellular immunity is needed. HIV can spread by direct cell–cell fusion, reducing exposure to antibodies. Concept / Approach: HIV’s error-prone reverse transcriptase drives antigenic diversity. Latency and reservoirs limit sterilizing immunity. Protective immunity likely requires broadly neutralizing antibodies plus strong CD8+ T-cell responses. Syncytium-mediated spread allows evasion of extracellular antibody neutralization. Step-by-Step Solution: Identify the immunologic requirement: both humoral and cellular arms. Account for rapid antigenic drift/diversity → vaccine mismatch risk. Incorporate cell-to-cell spread that bypasses antibody action. Choose inclusive option: All of these. Verification / Alternative check: Vaccine trials demonstrate partial or strain-limited efficacy; bnAb efforts highlight diversity barriers; studies show reduced neutralization during cell–cell transfer. Why Other Options Are Wrong: Any single factor alone underestimates the multi-layered challenges; “None of these” contradicts extensive literature. Common Pitfalls: Assuming antibody titers alone predict protection; ignoring latent reservoirs and mucosal immunity. Final Answer: All of these.

Question 7

HIV cellular targets: Which host immune cells are most frequently infected and depleted during HIV disease progression?

Accepted Answer

Introduction / Context: HIV pathology centers on progressive loss of cellular immunity. The virus primarily targets cells expressing CD4 and appropriate chemokine co-receptors (CCR5/CXCR4), leading to immunodeficiency and susceptibility to opportunistic infections. Given Data / Assumptions: Main target marker: CD4 surface glycoprotein. Co-receptors: CCR5 early, CXCR4 later in some strains. We are asked to name the most affected lymphocyte subset. Concept / Approach: CD4+ T helper lymphocytes orchestrate immune responses. HIV entry requires gp120 binding to CD4, then to a co-receptor, followed by fusion via gp41. Loss of CD4+ T cells correlates with disease staging and defines AIDS at critical thresholds (e.g., CD4 < 200 cells/µL or AIDS-defining illness). Step-by-Step Solution: Identify receptor usage: CD4 as primary receptor. Connect receptor to cell type: CD4+ T lymphocytes. Select the option naming this subset explicitly. Verification / Alternative check: Laboratory monitoring of HIV relies heavily on CD4 counts and percentages; ART recovery is tracked by CD4 reconstitution. Why Other Options Are Wrong: CD8+ T cells are crucial for control but are not the principal infected/depleted subset; “Null cells” is nonspecific; “None” and “mast cells only” are incorrect. Common Pitfalls: Confusing activation-induced CD8+ expansion with primary HIV tropism; overlooking macrophages and dendritic cells as additional targets but not the main defining subset for staging. Final Answer: CD4+ T lymphocytes.

Question 8

Clinical virology — HIV monitoring: In diagnostic practice, a “viral load” test for Human Immunodeficiency Virus (HIV) quantifies what parameter in an infected individual?

Accepted Answer

Introduction / Context: Viral load testing is central to the management of Human Immunodeficiency Virus (HIV) infection. It quantifies circulating virus and is used to diagnose acute infection, guide antiretroviral therapy (ART) decisions, and monitor treatment success or failure over time. Given Data / Assumptions: The term ‘‘viral load’’ in HIV care refers to RNA copies measured in plasma. Laboratory platforms report results as copies/mL or IU/mL. The question asks what a viral load test detects or measures in an infected individual. Concept / Approach: Modern HIV viral load assays are nucleic acid amplification tests that quantify HIV-1 RNA present in the patient’s plasma. They do not measure integrated proviral DNA in host cells, nor do they calculate virions per cell. Viral load is therefore a direct measure of the amount of virus circulating in the host at that time. Step-by-Step Solution: Identify what clinical teams use ‘‘viral load’’ for: monitoring HIV RNA in blood.Note that provirus refers to integrated viral DNA, typically detected by DNA PCR in cells, not by standard plasma RNA quantification.Exclude irrelevant options such as bacteriophages of E. coli and cell receptor density.Select the option stating ‘‘total amount of virus in the infected host’’ (operationally, plasma HIV RNA level). Verification / Alternative check: Guidelines recommend viral load testing at baseline and at defined ART intervals to confirm suppression (<200 copies/mL) and detect virologic failure, confirming this is a host-level quantitative measure. Why Other Options Are Wrong: Provirus in infected cells: That is integrated HIV DNA, not plasma RNA viral load. Viruses released per cell: Not directly measured in clinical assays. Bacteriophage in E. coli: Unrelated to HIV. CD4 receptor density: A host marker, not viral quantity. Common Pitfalls: Confusing proviral DNA assays with plasma RNA viral load, or assuming ‘‘viral load’’ means percentage of infected cells rather than circulating RNA copies. Final Answer: total amount of virus in the infected host.

Question 9

HIV and opportunistic bacterial disease: Which common bacterial infections are frequently associated with HIV infection, particularly as immunosuppression progresses?

Accepted Answer

Introduction / Context: As HIV infection advances and CD4 counts fall, susceptibility to bacterial pathogens increases. Recognizing the range of common bacterial infections helps clinicians anticipate, prevent, and treat opportunistic disease. Given Data / Assumptions: Patients with HIV can develop both typical and opportunistic bacterial infections. Mycobacterial disease (tuberculosis and non-tuberculous species), nontyphoidal Salmonella bacteremia, and Bartonella infections are known associations. The item asks which of the listed are frequently observed in HIV disease. Concept / Approach: Each listed organism group is well documented among people with HIV. Tuberculosis risk is elevated at all stages; disseminated Mycobacterium avium complex rises at low CD4 counts. Recurrent Salmonella bacteremia is an AIDS-defining condition in many settings. Bartonella (e.g., B. henselae) can cause bacillary angiomatosis and peliosis hepatis. Step-by-Step Solution: Match each infection with known HIV-related syndromes (TB, disseminated MAC; Salmonella bacteremia; Bartonella-associated vascular proliferations).Confirm that all three appear with increased frequency relative to the general population.Therefore, select the comprehensive choice ‘‘all of these’’. Verification / Alternative check: Clinical guidelines and opportunistic infection manuals list these conditions among major bacterial complications in advanced HIV disease. Why Other Options Are Wrong: Choosing only one or two would omit other true associations; ‘‘none’’ contradicts established epidemiology. Common Pitfalls: Assuming only mycobacterial disease is relevant; overlooking vascular proliferative lesions of Bartonella or recurrent Salmonella bacteremia as hallmark bacterial issues in advanced HIV. Final Answer: all of these.

Question 10

HIV and parasitic disease spectrum: Which parasitic infections are frequently observed among people living with HIV, especially at lower CD4 cell counts?

Accepted Answer

Introduction / Context: Opportunistic parasitic infections contribute substantially to morbidity in advanced HIV disease. Understanding which parasites are common helps guide prophylaxis, diagnostic testing, and empiric therapy. Given Data / Assumptions: Cryptosporidium parvum can cause chronic, severe diarrhea in immunocompromised hosts. Toxoplasma gondii can reactivate as cerebral toxoplasmosis at CD4 counts typically <100 cells/µL. Cystoisospora (Isospora) belli causes prolonged watery diarrhea and weight loss in advanced HIV. Concept / Approach: The listed parasitic infections are classic opportunistic conditions in people with advanced HIV. Their risk rises as cellular immunity wanes, and some are preventable or treatable when recognized early (e.g., toxoplasma prophylaxis in seropositive patients with low CD4 counts). Step-by-Step Solution: Map each parasite to its core clinical syndrome in HIV (diarrhea or encephalitis).Recognize that all are well-documented in HIV literature.Select ‘‘all of these’’ to reflect the complete, correct set. Verification / Alternative check: Standard opportunistic infection tables enumerate these infections and their CD4 thresholds for highest risk. Why Other Options Are Wrong: Isolated selections omit other equally frequent infections; ‘‘none’’ is contradicted by clinical experience. Common Pitfalls: Confusing isosporiasis with other coccidian infections; forgetting that toxoplasmosis usually represents reactivation in seropositive patients. Final Answer: all of these.

Question 11

HIV virology fundamentals: Which unique feature best explains why HIV is classified as a retrovirus and is considered distinctive among human pathogens?

Accepted Answer

Introduction / Context: HIV is a member of the Retroviridae. The hallmark of retroviruses is their replication strategy, which requires copying RNA into DNA inside the host cell. Identifying the signature enzyme clarifies both the name ‘‘retro’’ and many drug targets. Given Data / Assumptions: HIV carries two copies of single-stranded RNA (diploid RNA genome). Reverse transcription converts RNA to DNA in the host cytoplasm. The question seeks the unique feature underlying HIV’s retroviral identity. Concept / Approach: Reverse transcriptase is the defining enzyme of retroviruses. It catalyzes RNA-dependent DNA polymerization, DNA-dependent DNA polymerization, and RNase H activity. This mechanism differentiates retroviruses from most other RNA viruses and explains susceptibility to nucleoside and non-nucleoside reverse transcriptase inhibitors. Step-by-Step Solution: Identify retroviral hallmark → reverse transcriptase.Exclude incorrect claims such as mixed DNA/RNA genomes within the same virion.Note that HIV is enveloped and has specific glycoproteins; the unique trait among options is the enzyme.Choose ‘‘a viral enzyme known as reverse transcriptase’’. Verification / Alternative check: Antiretroviral drug classes directly target reverse transcriptase, underlining its centrality. Why Other Options Are Wrong: More than 100 copies of the genome: HIV carries two RNA copies, not >100. Both DNA and RNA genome: Incorrect; the mature virion contains RNA. Sticky proteins: gp120/gp41 mediate binding/fusion but are not unique to retroviruses. Icosahedral capsid without envelope: HIV is enveloped; this is false. Common Pitfalls: Confusing the presence of both nucleic acids within infected cells (proviral DNA) with virion composition. Final Answer: a viral enzyme known as reverse transcriptase.

Question 12

HIV-1 envelope glycoproteins: Which glycoprotein serves as the external ‘‘spike’’ antigen of HIV-1 that binds to CD4 and co-receptors on host cells?

Accepted Answer

Introduction / Context: HIV-1 entry into host cells depends on envelope glycoproteins that recognize and attach to CD4 and co-receptors (CCR5 or CXCR4). Knowing which protein lies on the virion surface helps interpret diagnostic assays and vaccine targets. Given Data / Assumptions: HIV-1 envelope is synthesized as gp160, then cleaved into gp120 (surface) and gp41 (transmembrane). ‘‘Spike’’ typically refers to the exterior ligand that engages host receptors. We must identify the specific glycoprotein acting as the spike antigen. Concept / Approach: gp120 is the external surface glycoprotein that binds CD4 first and then a chemokine co-receptor. gp41 is the transmembrane fusion subunit. p24 is an internal capsid antigen and not an envelope spike. Step-by-Step Solution: Recall gp160 cleavage → gp120 (surface), gp41 (transmembrane).Match ‘‘spike’’ and receptor binding to gp120.Exclude gp41 (fusion), gp36/gp140 (not standard HIV-1 envelope naming), and p24 (internal).Select ‘‘gp 120’’. Verification / Alternative check: Assays measuring anti-gp120 antibodies or neutralization titers focus on the receptor-binding surface moiety, confirming its role as the spike. Why Other Options Are Wrong: gp41: Anchors the complex and mediates fusion, not primary receptor binding. p24: Core capsid protein; not a spike. gp36/gp140: Not the canonical HIV-1 naming used for the receptor-binding spike. Common Pitfalls: Confusing the binding and fusion subunits; assuming p24 is external because it is commonly detected in labs. Final Answer: gp 120.

Question 13

HIV-1 envelope architecture: Which glycoprotein is the transmembrane ‘‘pedicle’’ (fusion) subunit of the HIV-1 envelope complex?

Accepted Answer

Introduction / Context: The HIV-1 envelope complex is composed of gp120 (surface) and gp41 (transmembrane). Distinguishing their roles clarifies how entry inhibitors and fusion blockers work. Given Data / Assumptions: gp41 spans the viral envelope and drives membrane fusion. gp120 binds CD4 and co-receptors. The item asks specifically for the transmembrane pedicle component. Concept / Approach: After gp160 cleavage, gp120 remains peripheral while gp41 anchors and undergoes conformational changes to fuse viral and cellular membranes. This makes gp41 the transmembrane ‘‘pedicle’’ subunit. Step-by-Step Solution: Identify which subunit is transmembrane and fusogenic → gp41.Exclude gp120 (surface binding), and the nonstandard labels listed.Select ‘‘gp 41’’. Verification / Alternative check: Fusion inhibitors (e.g., enfuvirtide) target gp41 interactions, reinforcing this function. Why Other Options Are Wrong: gp120 is not transmembrane; the other designations are incorrect or unrelated to HIV-1 envelope components. Common Pitfalls: Interchanging gp120 and gp41 due to their co-localization in the envelope trimer. Final Answer: gp 41.

Question 14

HIV and viral co-infections: Which viral infections are frequently seen in people with HIV infection due to impaired cell-mediated immunity?

Accepted Answer

Introduction / Context: Immunosuppression in HIV predisposes to viral reactivations and opportunistic infections. Recognizing common viral pathogens improves screening, prophylaxis, and timely therapy. Given Data / Assumptions: HSV causes recurrent mucocutaneous disease; severe or chronic lesions can occur in advanced HIV. VZV reactivation presents as shingles; disseminated disease can appear at low CD4 counts. CMV can cause retinitis, colitis, esophagitis, and other organ disease when CD4 is very low. Concept / Approach: All three viruses are well-known complications of advanced HIV. Antiviral therapy and immune restoration with ART are the mainstays of prevention and treatment. Step-by-Step Solution: Link each virus to typical HIV-associated syndromes (e.g., CMV retinitis).Confirm that each is ‘‘frequently observed’’ in advanced disease.Choose the comprehensive option ‘‘all of these’’. Verification / Alternative check: Ocular screening for CMV in patients with very low CD4 counts reinforces the frequency of such infections. Why Other Options Are Wrong: Single-pathogen choices omit other equally common infections; ‘‘none’’ is incorrect. Common Pitfalls: Underestimating VZV risk in relatively higher CD4 ranges compared with CMV, which tends to occur at very low counts. Final Answer: all of these.

Question 15

Laboratory diagnosis — screening for HIV infection: Which of the following assay types are used as screening tests for the detection of HIV infection prior to confirmatory testing?

Accepted Answer

Introduction / Context: Screening tests for HIV must be sensitive, scalable, and suitable for high-throughput or point-of-care use. Positive screens are then confirmed by more specific methods. Given Data / Assumptions: ELISA (including fourth-generation antigen/antibody tests) is a standard screening platform. Latex agglutination and dot blot/rapid assays have been used as preliminary screens in various settings. Confirmation requires a different, more specific method (e.g., differentiation immunoassay or nucleic acid test). Concept / Approach: The question focuses on screening, not confirmation. ELISAs and rapid immunoassays detect antibodies and/or p24 antigen with high sensitivity. Latex agglutination formats can serve as initial screens but are generally supplemented by confirmatory testing. Step-by-Step Solution: Identify which assays function as initial screens: ELISA, rapid immunoassays including dot blots, and latex agglutination.Exclude viral culture (too slow and not a screening tool).Select ‘‘all of these’’ among the screening formats. Verification / Alternative check: Algorithmic testing strategies begin with a sensitive screen followed by a highly specific confirmatory test, matching the selections here. Why Other Options Are Wrong: Viral culture only is not a screening approach due to logistics, biosafety, and turnaround time. Common Pitfalls: Confusing screening (sensitive, rapid) with confirmation (specific, often different method). Final Answer: all of these.

Question 16

Laboratory diagnosis — confirmation of HIV infection: After an initial positive screen, which methods are considered confirmatory or definitive for establishing HIV infection?

Accepted Answer

Introduction / Context: Confirming HIV infection requires specific evidence of the virus or its core components beyond a preliminary screen. Understanding which tests are confirmatory guides appropriate diagnostic workflows. Given Data / Assumptions: Confirmatory strategies aim for high specificity. Direct detection methods (nucleic acid, culture) are definitive, though culture is rarely used clinically. p24 antigen detection contributes in acute infection and in fourth-generation algorithms as part of a confirmatory cascade. Concept / Approach: Viral nucleic acid tests (RNA/DNA PCR) are definitive and widely accepted confirmations. Virus isolation is a gold-standard but impractical in routine settings. p24 antigen, when used within modern diagnostic algorithms and followed by discriminatory testing, supports confirmation, especially in acute infection. Step-by-Step Solution: Recognize nucleic acid detection as confirmatory.Acknowledge that culture is definitive but rarely done.Include p24 antigen as part of confirmatory algorithms for acute HIV when interpreted appropriately.Thus, select ‘‘all of the above’’. Verification / Alternative check: Diagnostic algorithms pair a reactive screen with a supplemental/confirmatory test—often a differentiation immunoassay and/or a nucleic acid test to resolve acute or indeterminate cases. Why Other Options Are Wrong: ESR is a nonspecific inflammatory marker and cannot confirm HIV. Common Pitfalls: Assuming p24 antigen alone, outside an algorithm, suffices; in practice it forms part of a sequence that includes highly specific follow-up testing. Final Answer: all of the above.

Question 17

Cellular targets of HIV: Which of the following cell types can be infected by HIV during the course of disease and contribute to viral persistence or pathology?

Accepted Answer

Introduction / Context: HIV exhibits tropism for cells expressing CD4 and appropriate co-receptors (CCR5 or CXCR4). Beyond classical CD4+ T lymphocytes, the virus can involve other immune and neural cells, shaping clinical manifestations and reservoir biology. Given Data / Assumptions: CD4+ T cells are the principal targets for productive infection. Cells of the monocyte–macrophage lineage, including microglia in the central nervous system, can be infected and act as reservoirs. M cells in mucosal tissues facilitate translocation and may be permissive to or involved in the entry and transfer of HIV across mucosal barriers. Concept / Approach: Evaluate each cell type for susceptibility or involvement with HIV. Microglia and CD4+ T cells are well-established. M cells participate in mucosal trafficking; experimental and ex vivo data support their role in facilitating HIV passage and potential infection dynamics at mucosal surfaces. Step-by-Step Solution: Confirm infection of CD4+ T lymphocytes as canonical.Acknowledge CNS involvement via infected microglia and macrophages, contributing to neurocognitive disorders.Recognize mucosal entry pathways where M cells can transport virus across epithelium and contribute to local infection processes.Select ‘‘All of these’’ since each listed cell type is implicated in HIV pathogenesis or entry. Verification / Alternative check: Neuropathology of HIV demonstrates microglial infection; mucosal transmission studies emphasize specialized epithelial and immune cell interactions during early infection. Why Other Options Are Wrong: Individual options are true but incomplete; erythrocytes lack nuclei and are not infected, hence included as a distractor only and not in the correct aggregate. Common Pitfalls: Overlooking non-T-cell reservoirs such as macrophages/microglia; assuming mucosal transport cells play no role in early infection events. Final Answer: All of these.

Retroviridae Questions