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HIV for Health Professionals: An Introduction SCHOOL OF MEDICINE Working together to improve healthcare for patients GLOSSARY OF TERMS & ACRONYMS ADC AIDS Dementia Complex AIDS Acquired Immunodeficiency Syndrome AIDS related conditions Range of diseases and cancers present as a result of a compromised immune system due to HIV infection. Alopecia A disease in which the hair falls out – baldness; absence of the hair from skin areas where it normally is present. ALT Alanine aminotransferase. An enzyme that transfers amino acid groups and whose serum concentration is increased in viral hepatitis (and myocardial infarction). Amniocentesis Percutaneous transabdominal puncture of the uterus to obtain amniotic fluid. Amniotic fluid Fluid surrounding the embryo and later the foetus. Amplicor One type of viral load test currently available. Anaemia Any condition in which the number of red blood cells per cubic millimetre, the amount of haemoglobin in 100 ml of blood and the volume of packed red blood cells per 100 ml of blood are less than normal. Angular chelitis Inflammation and fissuring radiating from the commissures of the mouth secondary to predisposing factors such as lost vertical dimension in denture wearers, nutritional deficiencies, atopic dermatitis, or Candida albicans infection. Anorexia A mental disorder occurring predominantly in females, having onset usually in adolescence and characterised by refusal to maintain a normal minimal body weight. Antibodies (Immunoglobulins) A chemical substance produced to inhibit the growth of or to kill other microorganisms. (Immunoglobulins – any of the structurally related glycoproteins that function as antibodies). Antigen Any substance which is capable of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitised T-lymphocytes, or both. Arthralgia Pain in a joint Autoimmune antibodies Pertaining to autoimmunity. Autoimmunity is a condition characterised by a specific humoral or cell-mediated immune response against 1 HIV for Health Professionals: An Introduction SCHOOL OF MEDICINE Working together to improve healthcare for patients constituents of the body’s own tissues. Bacteria Member of a large group of unicellular microorganisms lacking organelles and an organised nucleus, some of which are capable of causing disease. bDNA Branched Chain DNA Brachial neuritis Also known as brachial plexus neuropathy or neuralgic amyotrophy, it is a neurological disorder, of unknown cause, characterized by the sudden onset of severe pain, usually about the shoulder and often beginning at night, soon followed by weakness and wasting of various forequarter muscles, particularly shoulder girdle muscles; both sporadic and familial in occurrence with the former much more common. CALD Culturally and Linguistically Diverse Candidiasis Infection with a fungus of the genus Candida, especially C. albicans. It is usually a superficial infection of the moist cutaneous areas of the body, although it becomes more severe in immunocompromised patients. It most commonly involves the skin, oral mucous membranes, oesophagus, respiratory tract and vagina. cART Combination Antiretroviral Therapy CD4 A type of blood cell involved in protecting the body against viral, fungal and protozoal infections. The cells are so named as they have a particular marker, known as a CD4 receptor on their surfaces. CD4 cells are sometimes referred to as the ‘conductors’ of the immune response as they orchestrate the responses of other cells. CD stands for Cluster of Differentiation. CD8 Similar to CD4 but responsible for a different aspect of the immune system’s response. CDC Centre for Disease Control and Prevention Cerebral toxoplasmosis Disease caused by the protozoan parasite Toxoplasma gondii affecting the brain. Usually, toxoplasmosis causes no symptoms. However, the infection can be very serious, and even fatal, in individuals with weakened immune systems. CIN Cervical Intraepithelial Neoplasia Cirrhosis Progressive disease of the liver associated with failure in the function of hepatic cells and interference with blood flow in the liver. CMV retinitis Cytomegalovirus (CMV) retinitis is a viral inflammation of the retina of the eye caused by a member of a group of herpes-type viruses. Usually, CMV produces no symptoms. However, serious CMV 2 HIV for Health Professionals: An Introduction SCHOOL OF MEDICINE Working together to improve healthcare for patients infections can occur in people who have weakened immune systems. CNS Central Nervous System CSF Cerebrospinal fluid Cytokines A generic term for non-antibody proteins released by primed Tlymphocytes on contact with specific antigen, which act as intercellular mediators, as in the generation of an immune response. Cytotoxic The degree to which an agent possesses a specific destructive action on certain cells or the possession of such action. Dermatopathic Pertaining or attributable to disease of the skin. Desquamation The shedding of epithelial elements, chiefly of the skin, in scales or small sheets - exfoliation. Diffuse urticaria An eruption of itching wheals, usually of systemic origin; it may be due to a state of hypersensitivity to foods or drugs, foci of infection, physical agents (heat, cold, light, friction), or psychic stimuli – hives. Disequilibrium A disturbance or absence of equilibrium DNA Deoxyribonucleic Acid – the nucleic acid in which the sugar is deoxyribose. Constitutes the primary genetic material of all cellular organisms. ELISA Enzyme-Linked Immunosorbent Assay – first test conducted for presence of HIV antibodies. Encephalitis Encephalitis is an inflammation (irritation and swelling) of the brain, usually caused by infections. Although most forms of encephalitis are caused by viruses, bacteria can also cause this problem. AIDS patients and various other high risk individuals throughout the world can develop encephalitis due to parasites such as toxoplasmosis. Env gene A component gene of the structure of HIV Envelope glycoproteins Those glycoproteins – conjugated proteins containing one or more covalently linked carbohydrate residues – present in the envelope surrounding and protecting the virus. Enzyme-Linked Immunosorbent Assay See ELISA Erythematous papular rash A rash showing redness of the skin due to capillary dilatation with small, circumscribed, solid elevation on the skin. 3 HIV for Health Professionals: An Introduction SCHOOL OF MEDICINE Working together to improve healthcare for patients FBC Full Blood Count Fibrosis Formation of fibrous tissue as a repairing mechanism or reactive process rather than formation of fibrous tissue as a normal process of an organ or tissue. Fundoscopy Examination of the fundus of the eye by means of the ophthalmoscope. Fungi Plural of fungus. Fusion Inhibitor A class of HIV antiretroviral therapy. When HIV infects a cell, it attaches to the outside of the cell. Then it "fuses" or joins itself with the cell membrane. A Fusion inhibitor stops this process of fusion. This means that HIV cannot infect that cell. Gag gene A component gene of the structure of HIV. Gastrointestinal Pertaining to or communicating with the stomach and intestine. Genome The complete gene complement of an organism, contained in a set of chromosomes in eukaryotes, a single chromosome in bacteria, or a DNA or RNA molecule in viruses. Gingivitis Inflammation of the gingivae. Gingivae – the gums: the mucous membrane, with the supporting fibrous tissue, which overlies the crowns of unerupted teeth and encircles the necks of those that have erupted. Glycoprotein Conjugated proteins containing one or more covalently linked carbohydrate residues. GP120 Glycoprotein 120. A protein found on the surface of HIV that initiates entry of HIV into cells. It binds with CD4 molecules enabling gp41 to fuse with the surface of CD4 cells. 4 HIV for Health Professionals: An Introduction SCHOOL OF MEDICINE Working together to improve healthcare for patients Guillain-Barre syndrome Acute febrile polyneuritis. Polyneuritis being a non-traumatic generalised disorder of peripheral nerves, affecting the distal fibres most severely with proximal shading (i.e., feet, before, or more severe, than hands), and typically symmetrical; most often affects motor and sensory fibres almost equally, but can involve either one solely or very disproportionately. HAART Highly Active Antiretroviral Therapy HAD HIV-Associated Dementia HCPs Health Care Professionals HCWs Health Care Workers HIV Human Immunodeficiency Virus HIV Microvasculopathy Microvasculature – the portion of the vasculature of the body comprising the finer vessels, sometimes described as including all vessels with an internal diameter of 100 microns or less. HIV PCR PCR – Polymerase Chain Reaction HIV seroconverters Seroconversion – the change of a serologic test from negative to positive, indicating the development of antibodies in response to infection or immunisation. HIV-1 A strain of Human Immunodeficiency Virus HIV-2 A strain of Human Immunodeficiency Virus HLA Human Leucocyte Antigens – histocompatibility antigens governed by genes of the HLA complex (the human major histocompatibility complex), a region on the short arm of chromosome 6 containing several genetic loci, each having multiple alleles. HSV Herpes Simplex Virus HSV retinitis HSV – Herpes Simplex Virus. Retinitis – inflammation of the retina; used in the older ophthalmological literature to denote impairment of sight, perversion of vision, oedema, and exudation into the retina, and occasionally by haemorrhages into the retina. Hyperlipidaemia The presence of an abnormally high concentration of lipids in the circulating blood. HZV Herpes Zoster Virus ID physician Infectious Diseases Physician 5 HIV for Health Professionals: An Introduction SCHOOL OF MEDICINE Working together to improve healthcare for patients IgM Immunoglobulin M IL-2 See Interleukins Immortalisation The gaining of immunity to normal limitations on growth or life span, sometimes achieved by animal cells in vitro or by tumour cells; causes may be spontaneous mutation, exposure to chemical carcinogens, or viral infection. Immunodeficiency A deficiency of immune response or a disorder characterised by deficient immune response; classified as antibody (B cell), cellular (T cell), combined deficiency, or phagocytic dysfunction disorders. Infectivity Infectiousness – the state or quality of being infectious. Innate Inborn; hereditary; congenital. Integration Assimilation; anabolic action or activity. In bacterial genetics, assimilation of genetic material from one bacterium (donor) into the chromosome of another (recipient). Interferon Any of a family of glycoproteins, production of which can be stimulated by viral infection, by intracellular parasites, by protozoa, and by bacteria and bacterial endotoxins, that exert antiviral activity and have immunoregulatory functions; they also inhibit the growth of nonviral intracellular parasites. Interferons are designated α, β, γ, and ω on the basis of association with certain producer cells and functions; all animal cells, however, can produce interferons and some cells can produce more than one type. Interleukins A generic term for a group of multifunctional cytokines that are produced by a variety of lymphoid and non-lymphoid cells and whose effects occur at least partly within the lymphopoietic system; originally believed to be produced chiefly by and to act chiefly upon leukocytes. Kaposi’s sarcoma KS. Kaposi’s sarcoma, varicelliform eruption. A multicentric, malignant neoplastic vascular proliferation characterised by the development of bluish-red cutaneous nodules, usually on the lower extremities, most often on the toes or feet, and slowly increasing in size and number and spreading to more proximal sites. The tumours have endothelium-lined channels and vascular spaces admixed with variably sized aggregates of spindle-shaped cells, and often remain confined to skin and subcutaneous tissue, but widespread visceral involvement may occur. Kaposi’s sarcoma occurs endemically in certain parts of Central Africa and Central and Eastern Europe, and a particularly virulent and disseminated form occurs in immunocompromised patients. KS Kaposi’s sarcoma 6 HIV for Health Professionals: An Introduction SCHOOL OF MEDICINE Working together to improve healthcare for patients LAV Lymphadenopathy-Associated Virus. See Human Immunodeficiency virus – a virus of the genus Lentivirus, separable into two serotypes (HIV-1 and HIV-2), that is the etiological agent of Acquired Immunodeficiency Syndrome (AIDS). HIV-1 is of worldwide distribution, while HIV-2 is largely confined to West Africa; transmission and manifestations are very similar. HIV-1 was formally called Human TLymphotropic Virus Type III (HTLV-III) and LymphadenopathyAssociated Virus (LAV). Lethargy/malaise Lethargy – A lowered level of consciousness marked by listlessness, drowsiness, and apathy. Malaise – A vague feeling of bodily discomfort and fatigue. Leukocytes Types of white blood cells. One of these being neutrophils. Lipid Any of a heterogenous group of fats and fatlike substances characterised by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Lipoatrophy Loss of subcutaneous fat. Lipodystrophy Lipodystrophy, or "lipo" for short, is a collection of changes in people taking HIV antiretroviral therapies. "Lipo" refers to fat, and "dystrophy" means bad growth. These changes include fat loss, fat deposits, and metabolic changes. Logarithm The power to which a number, called the base number, must be raised to obtain a second number. Lymphadenopathy Disease of the lymph nodes. Lymphocyte Any of the mononuclear, non-phagocytic leukocytes, found in the blood, lymph, and lymphoid tissues, that are the body’s immunologically competent cells and their precursors. They are divided on the basis of ontogeny and function into two classes, B and T lymphocytes, responsible for humoral and cellular immunity, respectively. Lysozyme An enzyme of the hydrolase class that catalyses the hydrolysis of specific glycosidic linkages in peptidoglycans and in chitin. The enzyme occurs in saliva, tears, egg white, and many animal fluids and catalyses the breakdown of some bacterial cell walls. Meningoencephalitis Inflammation of the brain and meninges. Mitochondria Organelles of the cell cytoplasm (all of the cell except the nucleus) that are the principal energy source of the cell. Mitochondria are the cell's 7 HIV for Health Professionals: An Introduction SCHOOL OF MEDICINE Working together to improve healthcare for patients power plant. They use oxygen, fat and sugar to produce adenosine triphosphate (ATP). This process is called "cellular respiration." When the cell needs energy, it breaks down molecules of ATP to release the stored energy. Mitochondrial toxicity Mitochondrial toxicity is damage that decreases the number of mitochondria. If there are too few mitochondria in a cell, it might stop working properly. Molluscum contagiosum A common, benign, usually self-limited viral infection of the skin and occasionally the conjunctivae by a pox virus, transmitted by autoinoculation, close contact, or fomites; it primarily affects children but may also be seen in adolescents and adults, in whom it is often sexually transmitted. MSM Men who have Sex with Men Mucocutaneous Pertaining to or affecting the mucous membrane and the skin. Mucocutaneous ulceration Breaks in skin or mucous membranes that are often accompanied by loss of tissue on the surface. Mucous membranes A thin layer of tissue which covers a surface, lines a cavity, or divides a space or organ. Myalgia Pain in a muscle or muscles. Neoplastic Neoplasm – any new and abnormal growth; specifically a new growth of tissue in which the growth is uncontrolled and progressive. Malignant neoplasms are distinguished from benign in that the former show a greater degree of anaplasia and have the properties of invasion and metastasis. Neuropathic Neuropathy – a functional disturbance or pathological change in the peripheral nervous system, sometimes limited to non-inflammatory lesions as opposed to those of neuritis; the aetiology may be known or unknown. Neutropenia The presence of abnormally small numbers of neutrophils in the circulating blood. Neutrophils are a type of mature white blood cell. Neutrophils A mature white blood cell in the granulocytic series, formed by bone marrow, and the circulating blood where they normally represent 54% to 65% of the total number of leukocyctes. NK cells Natural Killer cells NNRTI’s Non-Nucleoside Reverse Transcriptase Inhibitors NRL National Reference Laboratory 8 HIV for Health Professionals: An Introduction SCHOOL OF MEDICINE Working together to improve healthcare for patients NRTI’s Nucleoside/Nucleotide Reverse Transcriptase Inhibitors Oesophageal candidiasis Candidiasis infection in the oesophagus. It is usually a superficial infection of the moist cutaneous areas of the body, although it becomes more severe in immunocompromised patients. It most commonly involves the skin, oral mucous membranes, oesophagus, respiratory tract and vagina. OHL Oral Hairy Leukoplakia Oral hairy leukoplakia (OHL) OHL – A condition that appears as white thick growths, typically located on the side of the tongue or the inner cheeks. The cause of OHL is unknown but Epstein Barr virus seems to be associated. Oropharyngeal Relating to the portion of the pharynx that lies posterior to the mouth. p18, p24 Proteins in the core of HIV. P34 (endonuclease) A nuclease (phosphodiesterase) that cleaves polynucleotides (nucleic acids) at interior bonds. Pathophysiology Derangement of function seen in disease; alteration in function as distinguished from structural defects. PCP Pneumocystis carinii Pneumonia PCR Polymerase Chain Reaction PEP Post Exposure Prophylaxis 9 HIV for Health Professionals: An Introduction SCHOOL OF MEDICINE Working together to improve healthcare for patients Pericardial fluid Fluid found in the pericardium, the fibroserous sac that surrounds the heart and the roots of the great vessels, comprising an external layer of fibrous tissue and an inner serous layer. Peripheral neuropathy A degeneration of the peripheral nerves. The most common type seen in HIV infection occurs at the end of the nerve, affecting the soles of the feet, the tips of toes or the tips of fingers. Peritoneal fluid Fluid found in the peritoneum – the serous membrane lining the abdomino-pelvic walls and investing the contained viscera. A strong, colourless membrane with a smooth surface, it forms a double-layered sac that is closed in the male and is continuous with the mucous membrane of the uterine tubes in the female. The potential space between the parietal and visceral peritoneum is called the peritoneal cavity. Pharyngitis Inflammation of the pharynx. Pharynx – (the throat) the musculomembrane passage between the mouth and posterior nares and the larynx and oesophagus. PHI Primary HIV Infection PI’s Protease Inhibitors PJP Pneumocystis jiroveci Pneumonia. Used interchangeably with previous name Pneumocystis carinii Pneumonia. This causative organism is a fungus, and does not cause infection in healthy people. Pleural fluid Pleural – pertaining to the pleura. Pleura – (rib/side) the serous membrane investing the lungs and lining the thoracic cavity, completely enclosing a potential space known as the pleural cavity. There are two pleurae, right and left, entirely distinct from each other. The pleura is moistened with a serous secretion which facilitates the movements of the lungs in the chest. PLWHIV Person living with HIV PML Progressive Multifocal Leukoencephalopathy. Multifocal – arising from or pertaining to many foci. Leukoencephalopathy – any of a group of diseases affecting the white matter of the brain, especially of the cerebral hemispheres, and occurring as a rule in infants and children. Pol gene products A component gene of the structure of HIV PrEP Pre-Exposure Prophylaxis Protozoa A subkingdom comprising the simplest organisms of the animal kingdom, consisting of unicellular organisms that range in size from 10 HIV for Health Professionals: An Introduction SCHOOL OF MEDICINE Working together to improve healthcare for patients submicroscopic to macroscopic; most are free living, but some lead commensalistic, mutualistic, or parasitic existences. According to newer classifications, Protozoa is divided into seven phyla. QAP Quality Assurance Program Radiculopathy Disease of the spinal nerve roots. Resistance Drug – the ability of a micro-organism to withstand the effects of a drug that are lethal to most members of its species. Primary drug resistance refers to initial infection by a resistant organism; secondary drug resistance to resistance that develops during the course of therapy. Microbial resistance to a drug can be symbolised by the superscript R or attached to the name of the drug. Retro-orbital pain Retro – a prefix meaning backward or located behind. Orbit – a bony cavity that contains the eyeball. Retrovirus (RNA) The retrovirus; a family of RNA viruses having a virion 80-100nm in diameter consisting of a lipid-containing envelope with peplomers, surrounding an icosahedral capsid. Reverse transcriptase RNA-directed DNA polymerase. RNA Ribonucleic Acid Roseola-like rash A symmetrical eruption of small closely aggregated patches of rose-red colour. It is believed to be caused by Human Herpes Virus. SCID Severe Combined Immunodeficiency Seborrhoeic dermatitis A common scaly macular eruption that occurs primarily on the face, scalp (dandruff), and other areas of increased sebaceous gland secretion; the lesions are covered with a slightly adherent oily scale. Seroconverters Individuals in the process of seroconverting. The change in the blood from antibody negative to antibody positive. Seroconversion is one of the immune system’s responses to the presence of antigens in the blood and occurs shortly after transmission of any infective agent. 11 HIV for Health Professionals: An Introduction SCHOOL OF MEDICINE Working together to improve healthcare for patients Starter Pack Anecdotal name given to the set of HIV antiretroviral drugs available to Health Care Workers exposed to HIV or after nonoccupational exposure to HIV. STIs Sexually Transmissible Infections Synovial fluid Synovial – pertaining to or secreting synovia. Synovia – a transparent alkaline viscid fluid, resembling the white of an egg, secreted by the synovial membrane, and continued in joint cavities, bursae, and tendon sheaths. T cells A Thymocyte-derived lymphocyte of immunological importance that is long-lived (months to years) and is responsible for cell-mediated immunity. Vertical transmission Vertical Transmission – ie mother to baby Viral Load The term used to describe the level of virus in the blood. Virion An entire mature virus particle found outside a living cell. Viruses One of a group of minute infectious agents, with certain exceptions (eg. Pox viruses) not resolved in the light microscope, and characterised by a lack of independent metabolism and by the ability to replicate only within living host cells. Western Blot tests A blot test that detects the presence of specific antibodies. The western blot test is used to diagnose HIV infection and to confirm a positive ELISA test. Window period The interval between initial transmission of an infective agent and the appearance of detectable antibodies in the blood. 12