1.3a Immune Flashcards
External Factors:
External Factors:
nutritional status, chemical exposure, UV radiation, and environmental Pollution
Internal Factors:
Internal Factors:
Genetics, functioning of neurological and endocrine systems, chronic illnesses, variations on our anatomy and physiology
Increased morbidity and mortality related to infections
Increase in cancer and autoimmune disorders
The Patient with H I V Infection
what is it
Human immunodeficiency virus (H I V)
Progresses to acquired immunodeficiency syndrome (AIDS)
Final, fatal stage of H I V
Retrovirus
Spread by direct contact with infected blood and body fluids
Blood, semen, vaginal secretions, cerebrospinal fluid
Not spread by casual contact
The Patient with H I V Infection
Behavioral risk factors
Behavioral risk factors Unprotected anal intercourse Heterosexual intercourse Injection drug use Needle and paraphernalia sharing Small occupational risk of health care providers
Manifestations of H I V
May be overlooked by healthcare providers Delay in care and treatment Asymptomatic to severe immunodeficiency Multiple opportunistic infections Fever Sore throat Malaise Arthralgias and myalgias Headache Rash
Manifestations of AIDS
H I V progresses to AIDS CD4-T cell count <200 mcL General malaise Fever Fatigue Night sweats Involuntary weight loss Skin dryness, rashes, diarrhea, oral lesions (hairy leukoplakia, candidiasis, gingival inflammation and ulcerations)
Neurologic Effects of H I V
HAND
H I V-associated neurocognitive disorders (H A N D)
Complex neurologic manifestations of H I V
Motor function and cognitive function affected
Neurologic Effects of H I V
Inflammatory, demyelinating, degenerative changes
Neurologic Effects of H I V
HAD
H I V-associated dementia (H A D; formerly AIDS dementia complex) Late complication of H I V Fluctuating memory loss Confusion Apathy (lack motivation to do anything or just don't care about what's going on around you) Diminished motor speed Lethargy Difficulty concentrating
Opportunistic Infections Associated with H I V
Most common manifestations of AIDS
Risk predictable by C D4 T-cell count
<200/m c L opportunistic infections and cancer likely
Opportunistic Infections Associated with H I V
Most common
Pneumocystis pneumonia (serious infection caused by the fungus Pneumocystis jirovecii. Most people who get PCP have a medical condition that weakens their immune system, like HIV/AIDS, or take medicines (such as corticosteroids) that lower the body's ability to fight germs and sickness.) Most common opportunistic infection
Opportunistic Infections Associated with H I V
Tuberculosis
Tuberculosis
Reactivation of prior infection
Leading cause of death among those with H I V
Opportunistic Infections Associated with H I V
Other
Other infections
Toxoplasma gondii
Cryptococcus neoformans
Candida albicans
Secondary Cancers to H I V Kaposi Sarcoma (K S)
Kaposi Sarcoma (K S)
Seen in fewer than 1% of patients with H I V due to antiretroviral therapy (A R T)
Herpes virus transmitted through sexual contact
Vascular macules, papules, or violet lesions
Secondary Cancers to H I V
Lymphomas
Lymphomas
Malignancies of lymphoid tissue
Late manifestation of H I V
Secondary Cancers to H I V
Cervical Cancer
Cervical Cancer
Frequently develops in women with H I V
Pap smear every 6 months
Other Conditions Associated with H I V/AIDS
Cardiovascular
Cardiovascular complications
Coronary heart disease
Dyslipidemia
Other Conditions Associated with H I V/AIDS
Hepatic
Hepatic complications
90% of patients with H I V are also infected with H B V
A R T may have negative affects on liver
Other Conditions Associated with H I V/AIDS
nephropathy
H I V - a s s o c i a t e d nephropathy
Disproportionately affects African-Americans and Hispanic/Latinos
Excessive protein in urine, nitrogen in blood
Glomerular lesions
Diagnosis of H I V
H I V rapid antibody test
H I V rapid antibody test: finger prick used to provide blood sample for antigen test strip; turns color if positive antibody present and takes <30 minutes.
Diagnosis of H I V
Enzyme-linked immunosorbent assay (E L I S A)
Enzyme-linked immunosorbent assay (E L I S A): Most common screen test. Only detects antibodies, not virus. Can have false negative if done prior to 13 weeks from infection
Diagnosis of H I V
Western blot antibody testing
Western blot antibody testing: Blood serum mixed with HIV proteins to detect antibody/antigen reaction. 99.9% sensitive if done with ELISA test
Diagnosis of H I V
viral load testing
H I V viral load testing: Measures amount of active replicating HIV. Correlates with disease progression/treatment effectiveness
Diagnosis of H I V
C B C
C B C: checks for anemia, leukopenia, and thrombocytopenia
Diagnosis of H I V
Absolute C D4 lymphocyte count
Absolute C D4 lymphocyte count: Most widely used test to monitor disease progress and guide therapy. AIDS defined as CD4 cell counts <200/mm3 or CD4 lymphocytes <14% regardless of an opportunistic infections present.
Diagnosis of H I V
H I V drug-resistance testing
H I V drug-resistance testing: Test to determine the sensitivity or resistance of virus in relation to current medication regimen.
CDC Recommendations Recommendations for Testing
Voluntary and confidential
Should involve counseling
All Healthcare settings should provide routine, voluntary screening for HIV
STI and TB treatment should include HIV screening
Patients and prospective partners should be tested prior to new sexual relationships
Annual HIV screening should be performed annually for high risk individuals
