Hiv Information and Courses from MediaLab, Inc.

Genetic mutations in HIV are well known and are very likely, considering the presence of two RNA molecules per virus. Either or both RNA molecules can mutate. These mutations potentially lead to drug resistance or encourage the virus to evade the body's immune response. Mutations have created three major groups of HIV - M, N, and O. M is found in 99% of all the HIV cases in the world. N and O are primarily found in West African countries. N, though, infects only a very small number of individuals. The M group has subgroups lettered A to J. Subgroup B predominates in North America.

HIV consists of two basic components: a core of nucleic acid, called the genome, and a protein component that surrounds the genome, called a capsid. The genome carries the genetic information of the virus, while the capsid gives the virus its shape and protects the genome. The capsid is made up of subunits called capsomeres.

The Human Immunodeficiency Virus type-1 (HIV) belongs to the Family Retroviridae.In HIV, RNA is the template for the synthesis of DNA. This differs from most cellular biochemistry in which DNA is used as the template for the synthesis of RNA.The enzyme that transcribes the RNA for the synthesis of DNA is called reverse transcriptase.Because of the enzyme's activity, HIV is known as a retrovirus - retro implying reverse.

The joining of the HIV and the host cell involves a spike on the HIV envelope and a CD4 molecule on the T-lymphocyte, macrophage, or brain cell.The molecule on the HIV spike is called glycoprotein 120 or gp120. The "120" refers to the molecular weight of the glycoprotein.While the CD4 site is important in viral binding, there is evidence that there are other molecules called co-receptors also involved.These molecules are embedded in the membranes of T-lymphocytes, macrophages, and brain cells. In the T-lymphocyte the abbreviated name of the protein molecule is CXCR4.

The risk factors that increase the risk of an exposure leading to HIV infection are: larger quantity of blood from source person, and blood from source person in terminal stage of HIV disease.

The follow-up to a healthcare work HIV exposure includes: psychological counseling medical evaluation postexposure testing at baseline, 6 weeks, 12 weeks, and 6 months.

Informed consent must be obtained first before a HIV antigen or antibody test can be ordered.Informed consent must be preceded by: Explanation of the test subject's right of confidentiality. Notification that a positive HIV test result will be reported to county health department with enough information to possibly identify the test subject. Availability and location of sites where anonymous testing is performedInformed consent can be given by a legal guardian or other person authorized by law when the test subject is: not competent incapacitated a minor

Each laboratory that performs a test indicative of HIV or AIDS shall report to the county health department in less than 2 weeks.To assure the confidentiality of the patient, reporting of HIV infection and AIDS must be conducted using a system developed by CDC or equivalent system.Each person who violates reporting rules may be fined $500 per offense.

HIV consists of nine genes. Three of the genes provide genetic information for the capsid proteins, envelope proteins, and viral enzymes. The other six genes are regulatory genes, controlling functions such as uncoating of the HIV genome and the penetration of host cells. Gene NumberAbbreviationGene Function1gagcapsid proteins2polviral enzymes3envenvelope proteins4vifregulatory gene5tatregulatory gene6vpuregulatory gene7nefregulatory gene8vprregulatory gene9revregulatory gene

Like many other viruses, the HIV has a lipid membrane that covers the capsid. This envelope is acquired when the virus leaves a cell after replication. The HIV envelope has projections known as spikes, which contain specific chemical components that may assist the virus when it attaches to other cells.

Once the gp120 drops down and binds with CD4 and the co-receptor, the HIV spike is exposed.The spike is a glycoprotein with a molecular weight of 41 Kilodaltons. This gp41 molecule acts much like a spring-loaded lancet. Once triggered into action by the attachment of the gp120 to the CD4 and co-receptor, the gp41 springs out and pierces the membrane of the host cell.

The joining of the HIV and the host cell involves a spike on the HIV envelope and a CD4 molecule on the T-lymphocyte, macrophage, or brain cell.The molecule on the HIV spike is called glycoprotein 120 or gp120. The "120" refers to the molecular weight of the glycoprotein.While the CD4 site is important in viral binding, there is evidence that there are other molecules called co-receptors also involved.These molecules are embedded in the membranes of T-lymphocytes, macrophages, and brain cells. In the T-lymphocyte the abbreviated name of the protein molecule is CXCR4.

After penetration of the cell membrane by the gp41, the HIV capsid enters the cell's cytoplasm. Next, cellular enzymes strip away the capsid so that the HIV genome is released. Also stripped away are proteins p24 and p17. Protein 24 coats the HIV genome and protein 17 lines the inside of the capsid.

The double-stranded DNA molecule now migrates to the nucleus of its host cell. Once it reaches the nucleus, a viral enzyme called integrase joins the replicated HIV DNA to the cell's DNA. The viral DNA now becomes one of the cell's chromosomes and is called a provirus. At this point an individual is infected with and is a carrier of HIV but does not have AIDS.

As the envelope is being formed, the HIV leaves the cell. This stage is known as budding. The virus moves through the cell membrane, acquires an envelope, and exits into the extracellular environment. It is now ready to infect another cell.

Commercially prepared controls come in either assayed or unassayed forms. Assayed controls are tested by multiple methods before sale, and are sold with the results of the tests. Assayed controls: are more expensive than unassayed controls are used to evaluate accuracy and precision avoid laboratory errors in determining control values may only be suitable for specific methods or conditionsWhile the manufacturer's control values can be used to some extent to measure accuracy, the best measure of accuracy is certified reference material.Unassayed controls are not tested by the manufacturer before they are sold. The control values for these materials must be determined by the individual laboratory. Unassayed controls: are less expensive than assayed controls are used to evaluate precision only avoid manufacturer error in determining control values control values are customized to the laboratory's own methods and conditionsA final note: although commercially available control materials are screened for hepatitis antigens and HIV antibodies, control materials should still be handled with precautions, since they contain biological materials and could contain infectious agents.

Meets one of the following:Doctoral degree in chemical science, biological science, clinical laboratory science, or medical technology + one year of lab experienceMaster's degree in chemical science, biological science, clinical laboratory science, or medical technology + three years of lab experienceBachelor's degree + five years of lab experience, of which two must have been as a technologistLicensed as a technologist or meets the requirementsMeets one of the following:Passes a Board-certified examCompletes 25 hours of continuing education in administration and supervisionCompletes one hour of HIV / AIDS continuing educationCompletes two hours of medical errors continuing education

Meets one of the following:Completes a medical lab technology training program at the technician levelHigh school or equivalency diploma + five years lab experienceAssociate's degree + four years lab experienceBachelor's degree + three years lab experienceBachelor's degree in medical technologyPasses an appropriate examination (certain specialties only)Completes one hour of HIV / AIDS continuing educationCompletes two hours of medical errors continuing education

The table below summarizes the qualifications for the four types of clinical laboratory personnel licenses. DirectorPhysician certified in clinical pathology OR Non-physician with: Doctoral degreeCertification in a lab specialtyCompleted course on administrationContinuing education in HIV/AIDS and medical errorsSupervisorOne of the following:Doctoral degree + 1 year experienceMaster's degree + 3 years experienceBachelor's degree + 5 years experienceLicensed as a technologist or meets the requirementsOne of the following:Completed course on administration25 hours of CE in administrationCE in HIV / AIDS and medical errors.TechnologistOne of the following:Bachelor's degree + medical technologist training program OR 3 years experienceAssociate's degree + Florida technician's license and completion of a medical laboratory training program OR 5 years experienceCompleted exam in 1+ specialtiesCE in HIV / AIDS and medical errorsTechnicianMeets one of the following:Completed medical lab technology training programHigh school or equivalency diploma + 5 years experienceAssociate's degree + 4 years experienceBachelor's degree + 3 years experienceBachelor's degree in medical technologyCompleted exam (certain specialties only)CE in HIV / AIDS and medical errors

To ensure the safety of those performing patient testing, controls do not contain HIV or the hepatitis B virus. Manufacturers place the same batch of control material into small vials. This allows only a small portion of the control to be handled while the remainder is stored until needed. Storage information for controls is printed on the label. These instructions should be followed carefully in order to prevent contamination or false results.