[Exam 1] Chapter 36: Management of Patients with HIV Infection and AIDS (Page 1025-1053) Flashcards
HIV-1 is transmitted by
body fluids containing HIV or infected CD4 lymphocytes
fluids include blood, seminal fluid, vaginal secretions, and breast milk
HIV: Most prenatal infections occur during
Delivery
HIV: And Casual Contact
Does not cause transmission
HIV: Breaks in skin or mucosa increases
risk
HIV and Gerontologic Considerations: signs of HIV/AIDS can be mistaken for
the aches and pains of normal aging
HIV and Gerontologic Considerations: Older adults living with HIV/AIDS also experience development of other comorbidities such as
cardiovascular disease, and diabetes
HIV and Prevention: In order to prevent the spread of HIV during intercourse, what can be done?
Pre-Exposure Prophylaxis (PrEP) involves taking one pill containg two HIV medications daily in order to avoid risk of sexual HIV acquisiton.
HIV and Prevention: Women who are pregnant can take this to reduce perinatal HIV transmission
ART. Should also not breast-feed their infants
Preventiion for Health Care Workers
Hand Hygiene
PPE
Soiled Patient Care Equipment Handling
environmental Control
Textiles and Laundry
Needles and Other Sharps
Patient REsuscitation
HIV and Health Care PRovider Treatment: If exposed, what must be done?
Post-Exposure Prophylaxis (PEP) includes taking antiretroviral medicine as soon as possible but no more than 3 days after exposure. 2-3 drugs prescribed must be taken for 28 days
STages of HIV Disease
Primary Infection
HIV Asymptomatic
HIV Symptomatic
AIDS
HIV Patho: HIV is a retrovirus because
it carries its genetic material in the form of RNA
HIV Patho: Illness is closer when caused by
HIV-2, which is more common in WEstern Africa
HIV Patho: What cna be done to screen for HIV-1?
Blood tests
HIV Patho: HIV cosnsits of a viral core contianing viral RNA surrounded by an envelope cosisiting of protruding
glycoproteins
HIV Patho: Virusees target cells with
CD4 receptors, which are expressed on surface of T Lymphocytes, Monocytes, Dendritic Cells, and Brain Microglia
HIV Patho: Stage 0, known as acute/recent infection, attacks T Cells how?
USe chemokine cell receptor molecule CCR5 to entry to T cells in addition to CD4 REceptors
HIV Patho Life Cycle: (1) Attachment / Binding Stage
First step, GP 120 and GP 41 glycoproteins of HIV bind with CCR5 which results in fusion of HIV with CD4
HIV Patho Life Cycle: (2) Uncoating / Fusion
Two strands of RNA nd three vital enzymes (reverse transcriptase, integrase and protease) emptied in here
HIV Patho Life Cycle:(3) DNA Syntehsis:
HIV changes its genetic material from RNA to DNA
HIV Patho Life Cycle: (4) Integration
New Viral DNA enters nucleus of CD4 and bleds with DNA of CD4
HIV Patho Life Cycle: (5) Transcription
When Cf4 T is acivated, DNA forms isngle stranded RNA which builds new viruses
HIV Patho Life Cycle: (6) TRanslation
MRNA creates chains of new proteins and enzymes
HIV Patho Life Cycle:(7) Cleavage
HIV protease enzyme cuts the polyprotein chain into the indivudual protein
HIV Patho Life Cycle:(8) Budding
New proteins and viral RNA migrate to the memrbane o fthe infacted CD4 and exit the cell
Hiv Patho: REsting CF4 T Cells can be stimuled to produce new particles if
something activates them, such as another infection
Hiv Patho: Whenevr the CD4 is activated, HIV replication and budding occur which..
can destroy the host cell. Newly formed HIV released into blood can infect over CD4 cells
Hiv Patho: Calculasins may have a mutation of CCR5, which may leave them
protected against HIV infection even if exposed
Hiv Patho: What determiens T Cells influence on HIV Acquisition?
CCR5
How many stages are there of HIV infection?
Five
Stages of HIV Infection: Period from infection with HIV to development of HIV specific antibodies is known as
primary infection or acute HIV infection and is part of stage 0
Stages of HIV Infection:Acute HIV infection is the inerval between
appearance of detectable HIV RNA and first detection of antibodies
Stages of HIV Infection:Primary or acute infection is characterized by
high levels of viral replication, widespread dissemination of HIV throughout the body, and destruction of CD4 T Cells.
Stages of HIV Infection:What is Viral Set Point?
The amount of virus in the body after the initial immune response subsides
Results in equilivrium betwee HIV levels and the immune response.
Stages of HIV Infection: The higher the set point, the poorer the
prognosis
Stages of HIV Infection:Stage 2 occurs when
CD4 T Lymphocytes are between 200 and 499 stages.
Stages of HIV Infection:Stage 3 occurs when
count drops bellow 200 cells . At this point, patient is considered to have AIDS for survillence purposes.
Primary Infection: PArt of CDc Categorry
A
Primary Infection: Symptoms are
none to flulike syndrome
Primary Infection: WIndow PEriod is
lack of HIV antibodies
Primary Infection: THis is a period of
rapid viral replication and dissemination through the body
HIV Asymptomatic: CDC category is
A
HIV Asymptomatic: How many T Lymphocytes / MM^3 do youhave?
> 500
HIV Asymptomatic: Upon reaching the virsl set point, what happens?
Chronic asymptomatic state begins
HIV Asymptomatic: Body has sufficent immune response to defend against
pathogens
HIV Symptomatic: CDC category
B
HIV Symptomatic: T Cell Count is between
200-499
HIV Symptomatic: CD4 T Cells grdually
fall
HIV Symptomatic: Patient develops symptoms or conditions releated to the HIV infection, which are not classified as
Category C infections
HIV Symptomatic: Patients who are once treated for Category B condiiton are considered
Category B
AIDS: CDC category
C
AIDS: How many T Lymphocytes?
< 200
AIDS: What happens as levels drop below 100?
Immune system is significantly impaired
Gerontology Considerations: what percentage of populcation over 50 hasHIV?
25%
Gerontology Considerations: Reasons for high number of cases in this population?
Unprotected Intercourse
Dont consider themselves a risk
Social bias toward homosexuality
MAy use IV drugs
May have received HIV infected blood before 1985
REduction in immune system function
HIV Tests: What is used to determine if HIV infection is recent or ongoing?
Serologic Testing Algorithm (STARHS)
HIV Tests: What are the three types of HIV diagnostic tests?
Anti-body tests, antigen/antibody tests, and nucleic acid (rna) tests
HIV Tests: Antibody test detect
antibodies, not HIV itself
HIV Tests: Antigen and RNA Tests directly test
HIV
HIV Tests: Antigen/Antibody tests detect infection in blood before
Antibody tests
HIV Tests: Follow up testing is performed if
the intial test result is positive to ensure a correct diagnosis
HIV Tests: HIV Follow Up Tests Include
Antidifferentiation Tests
HIV-1 Nucleic Acid Tests
HIV Tests: What is the EIA test?
Antibodies are detected, resulting positive results and marking the end of the window period
HIV Tests: What is the Western Blot?
Also detects antibodies to HIV, used to confirm EIA
HIV Tests: What is VIral Load?/
Measures HIV RNA in the plasma
HIV Tests: What is CD4/Cd8 Test
Markers found on Lymphocytes. HIV Kills CD4 cells which results in significantly impaired immune system
HIV Tests: What is OraQuick Test?
In-home HIV Test
HIV Tests: Viral Load Tests use
targeet amplification methods to quantify HIV RNA or DNA levels in teh plasma .
This measures plasma HIV RNA levels
HIV Tests: RT-PCR is also used to detect
HIV in high-risk seronegative poeple before antibodies are measurable to confirm a positive EIA
HIV Tests: Virial Load is better predictor of the risk of HIV disease progression than CD4 count because
lower the viral load, the longer the time to aids diagnosis and the longer the survivial time.
Treatment of HIV Infection: Overreaching goal of ART is to
suppress HIV replication to a level below which drug-resistance mutations do not emerge
Treatment of HIV Infection: Optimal Viral Suppression is defined as
viral load persistently below the level of detection.
Treatment of HIV Infection: Achieving viral suppression requires use of ART with at least two or three more drugs and should occur within
12-25 weeks.
Treatment of HIV Infection: Different drug classes of ART target
some of the stpes in the HIV/host cycle
Treatment of HIV Infection: Six Classes of drugs include
Nucleoside/Nucleotide Reverse TRanscriptase Inhibitors
Non-Nucleoside Reverse TRanscriptase Inhibitors
Protease Inhibitors
Fusion Inhibitors
CCR5 Antagonist
Integrase Strand TRasnfer Inhibitors
Treatment of HIV Infection: Adverse Effects associated with all HIV treatment regimens include
Hepatotoxicity
Nephrotoxicity
Osteopenia
along with increased risk of cardiovascular disease
Treatment of HIV Infection: Many of the antiretroviral agents may cause
fat reditrubition syndrome and metabolic alterations such as dyslipidemia and insulin resistance
Drug REsistance: Two major components of ART resistance and they are
- Transmission of drug-resistant HIV at the time of intial infection and
- Selective drug resistance in patietns who are receiving non-suppressive regimens
Drug REsistance: Genotypic assays detect
drug-resistant mutations present in relevant viral genes while
Drug REsistance: Phenotypic measures
ability of a virus to grow in different concentrations of ART drugs
Drug REsistance: Genotypic is preferred because of
lower cost, more rapid turnaround time, the assays ability to detect mixtures of wild tpe and resistant virus and relative ease of interpreting test results
Immune Reconstitution Inflammatory Syndrome (IRIS) : REsults from
rapid restortion of organism specific immune response to infections that cause either the deterioration of a treated infection or new presentation
Immune Reconstitution Inflammatory Syndrome (IRIS) : Typically occurs when
Initial months after beginning ART and is associated with a wide spectrum of organisms , most commonly myobacteriaa.
Immune Reconstitution Inflammatory Syndrome (IRIS) : Characterized by
fever , respiratory, and abdominal symptoms and worsening of clinical manifestions
Immune Reconstitution Inflammatory Syndrome (IRIS) : Treated with
anti-inflammatory medications usch as cortisone
Immune Reconstitution Inflammatory Syndrome (IRIS) : Patients with HIV-TV co infection with low CD4 counts who start ART are at high risk for devlelpoing
TB_IRIS
HIV and Clinical Manifestations - Respiratory: What is associated with various opportunistic infections
Shortness of breath, dyspnea, cough, chest pain and fever
HIV and Clinical Manifestations - Respiratory and Pneumocystis Pneumonia: Caused by
P. Jorovecii and the incidience has declined substantially with widespread use of PCP Prophylaxis, which i sused to prevent PCP and ART
HIV and Clinical Manifestations - Respiratory and Pneumocystis Pneumonia: Most common manifestations of PCP are
subacute onset of progressive dyspnea, fever, nonproductive cough and chest discomfort that worsens within days to weeks
HIV and Clinical Manifestations - Respiratory and Pneumocystis Pneumonia: Is the most common
life-threatening infection
HIV and Clinical Manifestations - Respiratory and Pneumocystis Pneumonia: Initial symptoms may be
nonspecific and may include nonnproductive cough, fever, chills, dyspnea and chest pain
HIV and Clinical Manifestations - Respiratory and Pneumocystis Pneumonia: If untreated, progreses to
pulmonary impairment and respiratory failure
HIV and Clinical Manifestations - Respiratory and Pneumocystis Pneumonia: Treamtnet includes
TMP -SMZ or PEntamidine , Prophylactic TMP-SMZ
HIV and Clinical Manifestations - Respiratory and Mycobacterium Avium Complex: What is this?
Disease that is a common opportunistic infection that typically occurs in patients with CD4 T Lympho count less than 50
HIV and Clinical Manifestations - Respiratory and Mycobacterium Avium Complex: MAC caused by
infection with diffferent types of mycobacterium
HIV and Clinical Manifestations - Respiratory and Mycobacterium Avium Complex: Early symptoms may be
minimal and can precede detectable mycobacterium by severalweeks and include fever, night sweats, weight loss, fatigue, diarrhea
HIV and Clinical Manifestations - Respiratory and Mycobacterium Avium Complex: Confirmed diagnosis based on
compatible clinical signs and symptoms coupled with isoloation of MAC from cultures of blood, lymph node, bone marrow, and other normally sterile tissues
HIV and Clinical Manifestations - GI: GI Manifestations include
loss of appeite, nausea, vomiting, oral and esophagal candidiasis adn chronic diarrhea
HIV and Clinical Manifestations - GI: Symptoms may be realted to
direct inflammatory effect of HIV Cells on lining of the intestines
HIV and Clinical Manifestations - GI: For patients with AIDS, effects of diarrhea cna be devasting in terms of
profound weight loss (Octreotide acetate) , fluid and electrolyte imbalance perianal skin excoveration, weakness, and inability to perform the usual activites
HIV and Clinical Manifestations - GI and Candidiasis: Oranpharyngeal Candidiasis is characterized by
painless, creamy white, plque like lesions that can occur on the buccal surface
HIV and Clinical Manifestations - GI and Candidiasis: Lesions can be easily scraped of with
a tongue depressor or other instrument
HIV and Clinical Manifestations - GI and Candidiasis: Treatment with
Mycelex Troches or Nystatin, Ketoconazole
HIV and Clinical Manifestations - GI and HIV Wasting Syndrome: Defined as
involuntary loss of more than 10% of ones body weight while having experienced diarhea or weakness and fever for more than 30 days
HIV and Clinical Manifestations - GI and HIV Wasting Syndrome: Wasting refers to
loss of muscle mass although part of weight loss may also be due to part of fight
HIV and Clinical Manifestations - GI and HIV Wasting Syndrome: hat may contribute to this?
Anorexia, diarrhea, GI malabsorption and lack of nutriton
HIV and Clinical Manifestations - Oncologic Manifestations: Those with HIV / AIDS are greater risk for developing certain cancers like
Kaposi Sarcoma , Lymphoma, And Invasive Cervical CAncer
HIV and Clinical Manifestations - Oncologic Manifestations and Kaposi Sarcoma: Caused by
human herpevirus and affects eight times more men than women. Spreads through sexual contact
HIV and Clinical Manifestations - Oncologic Manifestations and Kaposi Sarcoma: Involves the
epithelial layer of blood and lymphatic vessels
HIV and Clinical Manifestations - Oncologic Manifestations and Kaposi Sarcoma: Exhibits a variable and aggressive course, and it may start as
cutaneous lesions but may involve multiple organ systems
HIV and Clinical Manifestations - Oncologic Manifestations and Kaposi Sarcoma: Lesions cause
discomfort, disfigurement, ulceration and potential for infection
HIV and Clinical Manifestations - Oncologic Manifestations and Kaposi Sarcoma: What cna be the first manifestation?
They can appear anywehre on the body and are usually brownish pink to deep purple.
HIV and Clinical Manifestations - Oncologic Manifestations and Kaposi Sarcoma: Diagnosis confirmed by
biopsy of suspected lesions. Prognosis depends on the extent of the tumor
HIV and Clinical Manifestations - Oncologic Manifestations and AIDS Related Lymphomas: Unclude both
Hodgkin lymphoma and non-hodgkin lymphoma. Non more common
HIV and Clinical Manifestations - Oncologic Manifestations and AIDS Related Lymphomas: Three times of AIDS related LYmphomas?
Diffuse Large B Cells
B Cell Immunoblastic
Small Noncleaved Cell Lymphoma
HIV and Clinical Manifestations - Oncologic Manifestations and AIDS Related Lymphomas: Symptoms include
weight loss, night sweats, and fever
HIV and Clinical Manifestations - Neurologic Manifesations: HIV Related brain changes have profound effects on the body including
motor function, exectuvie function, attention, visual memory, and visusoatial function
HIV and Clinical Manifestations - Neurologic Manifesations: Neurologic dysfunction results from
direct effects of HIV on nervous sytem tissue, opportunistic infections, primary or metastatic neoplasm.,
HIV and Clinical Manifestations - Neurologic Manifesations and Peripheral Neuropathy: This is the most common
Neurologic symtpom at any stage of HIV infection
HIV and Clinical Manifestations - Neurologic Manifesations and Peripheral Neuropathy: May be side effect of some
ART drugs and may occur in a variety of patterns.
HIV and Clinical Manifestations - Neurologic Manifesations and Peripheral Neuropathy: Can lead to
significant pain of feet and hands and functional impairment
HIV and Clinical Manifestations - Neurologic Manifesations and HIV Encephalopathy: Formerly referred to as
AIDS Dementia Complex
HIV and Clinical Manifestations - Neurologic Manifesations and HIV Encephalopathy: Clinical syndrome that is characterized by
progressive decline in cognitive, behavioral, and motor functions as a direct result of HIV.
HIV and Clinical Manifestations - Neurologic Manifesations and HIV Encephalopathy: HIV infection is thought to trigger relase of
toxins or lymphokines that result in cellular dysfunction, inflammation, or intereference with neurotransmitter function
HIV and Clinical Manifestations - Neurologic Manifesations and HIV Encephalopathy: Signs and Symptoms may be subtle but include
memory deficits, headache, difficulty concentrating, progressive confusion, psychomotor slowing , apathy and ataxia
HIV and Clinical Manifestations - Neurologic Manifesations and HIV Encephalopathy: LAter stages of signs and symptoms include
Cognitive impairment, delay in verbal responses, a vacant stare and hyperflexia
HIV and Clinical Manifestations - Neurologic Manifesations and HIV Encephalopathy: Diagnosing includes
Extensive CT Scan. MRI and analysis of CSF as well.
HIV and Clinical Manifestations - Neurologic Manifesations and HIV Encephalopathy: Probably related to
HIV infection
HIV and Clinical Manifestations - Neurologic Manifesations and Cytococcus NEoformans: What is this?
Fungal infection characterized by fever, headache, malaise, stiff neck, nause and mental status changes
HIV and Clinical Manifestations - Neurologic Manifesations and Progressive Multifocal Leukoencephalopathy: What is this?
Demyelinating CNS disorder tha taffects the oligodendroglia.
HIV and Clinical Manifestations - Neurologic Manifesations and Progressive Multifocal Leukoencephalopathy: Clinical manifcations include
mental confusion and rapidly progress to include
blidness, aphasia, muscle weakness, paresis and death
HIV and Clinical Manifestations - Neurologic Manifesations and Depressive Manifestations: What substanceshave been associated with this?
Cocaine and Alcohol use and depression has been associated with less adherence with ART
HIV and Clinical Manifestations - Neurologic Manifesations and Integumentary Manifestations: Cutanous manifestions are associated with
HIV infection and the accompanying opportunistic iinfections and malignancies
HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Pneumocystis Pneumonia: Persons in stage 3 HIV should reieve
Chemoprophylaxis to prevent PCP with trimetroprim.
HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Pneumocystis Pneumonia: When person diagosed with PCP, What is the treatment of choice?
TMP-SMX lowering the dose if there was any abnromal renal function
HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Pneumocystis Pneumonia: Treatment duration lasts
21 days
HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Pneumocystis Pneumonia: Should be started when?
As soon as possible, preferentially within 72 hours.
HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Mobacterium Avium Complex: Initial treatment should consist of
2 or moer antimycobacteial drugs to prevent the delay the emergence of resistance
HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Mobacterium Avium Complex: Preferred first agent?
Clarithromycin but Azithromycin can be subbed
HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Cypotoccal Meningitis: Most commonly occurs as
subacute meningitis or meningoencephalitis with fever, malaise, and headache..
HIV and Clinical Manifestations - Neurologic Manifesations and Treatment of Crypotococcal Meningitis: Treatment includes
Three phasees, induction, consolidation, and maintenace.
Nursing Process: Care of PAtient with HIV/AIDS - Assessment: This incudes
Assess patients support system
Identidy potential risk factors, IV drug abuse
Immune system function
Nutritonal Status
Skin integrit
Respiratory status
fluid and electrolyte balance
Nursing Process: Care of PAtient with HIV/AIDS - Assessment: Nutritonal status obtained by
obtaining a dietary history and idetnifying factors that may interfere with oral intake
