Exam 4 Immunodeficiency Disorder HIV/AIDS

Question 1

PRIMARY TRANSMISSION

Answer 1

• Sexual contact is still the most frequent way HIV is transmitted: vaginal/cervical secretions, semen, through oral/vaginal/anal sex, donor insemination, use of contaminated sex toys, contamination of skin lesion with above secretions
• 2nd direct route of transmission is through blood, needles, drug paraphernalia
• Alcohol, cocaine, other drugs facilitates risky behavior
• Transmission in utero, during delivery, through breast milk
• Occupational HIV exposure (healthcare workers) is not common:
• (0.33% HIV as compared to 33% Hepatitis B and C).

Question 2

ROUTE OF TRANSMISSION

Answer 2

• HIV enters bloodstream
• • Attachment to T lymphocyte and macrophage receptors
• • Virus “unlocks” receptors and enters cell
• • Releases protein and viral RNA into T cells and macrophages
• • Reverse Transcriptase within virus changes RNA to DNA
• for reproduction to occur
• • Viral reproduction occurs and new virus “buds”
• • Release of new virus which invades other immune cells

Question 3

Primary Infection: CDC Category A

Answer 3

UNDETECTABLE = NON-TRANSMUTABLE

• * Acute HIV infection/acute HIV syndrome
• * Symptoms: none to flu-like syndrome
• * More than 500 CD4+ T lymphpocytes/mm3
• * Window period: lack of HIV antibodies
• * Period of rapid viral replication and dissemination through the body
• * Body has sufficient immune response to defend against pathogens
• * Viral set point: balance between amount of HIV and the immune response. (The higher the viral set point, the worse the prognosis for the patient).
  *

Question 4

INCUBATION PERIOD

Answer 4

• Seroconversion (development of antibodies) occurs usually within 1-3 months but may take up to 6 months.
• Window period is the time after infection to the development of antibodies or seroconversion.
• Patient will test negative for HIV during this “window” of time.
• This is the time that transmission can likely occur if protection isn’t used.

Question 5

HIV- Symptomatic Phase
CDC Category B

Answer 5

• CD4 T cells gradually fall to between 200 to 499 T cells/uL.
• The patient develops symptoms or conditions related to the HIV infection that are not classified as category C conditions
• Patients who are once treated for a category B condition are considered category B
• Examples:
• ITP → Ideopathec Thrombocytopenic purpura
  
  • immune system attacks platelets → platelet count goes down
  • causes petechia (purple or red spots on skin) on palmar hands and feet
• PID → Pelvic inflammatory disease (infection)
• oral candidiasis

Question 6

AIDS CDC
Category C

Answer 6

• CD4+ T cells Less than 200 cells/uL
• As levels drop below 100 cells/uL, the immune system is significantly impaired
• Development of opportunistic infections: P. Carinii Pneumonia, Mycobacterium TB, Candidiasis (in upper esophagus tract, Herpes simplex, etc.

Question 7

HIV-AIDS

Answer 7

• GI Complications: Wasting disease with loss of 10% baseline body weight, diarrhea, malabsorption, anorexia
• CNS Complications: dementia, meningitis, CMV (cytomegalovirus)
• Cancer: Kaposi’s sarcoma, malignancy of endothelia cells lining small blood vessels; Non-Hodgkin’s lymphoma

Question 8

CLINICAL MANIFESTATIONS

Answer 8

• Acute infection: patient may experience fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diffuse rash, diarrhea. This is when seroconversion develops (HIV specific antibodies develop). Occurs within 2-4 weeks after initial infection)
• Asymptomatic (chronic) infection: CD4+ count remains above 500 cells/uL and viral load is low.
• Symptomatic infection: CD4+ count drops below 500 and viral load increases. Symptoms appear: fever, HA, oral candidiasis, diarrhea, night sweats, fatigue.
• AIDS: CD4+ drops below 200, appearance of opportunistic infections, wasting syndrome, CMV, AIDS dementia complex, fungal, viral, bacterial, and protozoal infections appear.

Question 9

Testing for HIV/AIDS

Answer 9

• 1ST STEP EIA- Enzyme immunoassay-
• ▪Identifies antibodies directed specifically against HIV. Blood and saliva can be used for the EIA antibody test. If positive will confirm with Western Blot Assay.
• 2ND STEP Western Blot Assay-
• ▪Used to confirm seropositivity when the EIA is positive. People whose blood contains antibodies for HIV are seropositive.
• OraQuick Rapid HIV-1 Antibody test-
• ▪In 2002, the FDA approved a rapid HIV antibody screening test. Takes about 20 minutes and is 99.6% reliable. Screens for antibodies- not antigen.

Question 10

On-going Testing in HIV/AIDS

Answer 10

Viral load testing-

▪Has been found to be a better predictor of HIV disease progression than the CD4 count.

▪Measures plasma HIV RNA levels

▪Tracks viral load

▪Tracks response to treatment for HIV infection

Question 11

Treatment of HIV

Answer 11

• In general, treatment should be offered to all patients with Primary infection. Protocols on how to treat HIV disease change fairly often.
• GOALS OF DRUG THERAPY:
• Decrease the viral load
• Maintain or increase CD4+ T cell counts
• Prevent HIV related opportunistic diseases
• Delay disease progression
• Prevent HIV transmission

Question 12

HAART therapy

HIGHLY ACTIVE ANTRI RETROVIRAL THERAPY

Answer 12

• HAART therapy is a combination regimen consisting of two NNRTI’s plus a protease inhibitor or an NRTI or,
• Two protease inhibitors and an NNRTI or an NNRTI.
• The current initial recommendation for patients is two NNRTI’s, an Integrase inhibitor, and a Protease inhibitor.
• In some patients receiving 4-5-drug regimens, viral levels drop so low, they are undetectable.

Question 13

Medical Management

Answer 13

• TREATMENT OF RESPIRATORY INFECTIONS:
• PCP- Pneumocystis Carinii Pneumonia: Trimethoprim-sulfamethoxazole (TMP-SMZ; Bactrim, Septra) is the drug of choice for PCP
• Given prophylactically for any patients with a T-cell count of less than 200.
• Monitor for side effects of antibiotic: fever, rash, leukopenia, thrombocytopenia, and renal dysfunction.
• MAC- Mycobacterium avium complex: Clarithromycin (Biaxin) or Azithromycin (Zithromax) is prescribed.
• Keep Patient on this until they have responded to HAART with a CD-4 count greater than 100.
• Tuberculosis

Question 14

Medical Management

Answer 14

• ANTIDIARRHEAL THERAPY
• ▪Sandostatin (Octreotide Acetate) -effective in managing severe chronic diarrhea.
• • CHEMOTHERAPY-
• ▪For Kaposi’s Sarcoma- treatment usually localized and based on symptoms. Chemo injections (dilute Vinblastine) for oral lesions that are painful. Cutaneous lesions can be surgically excised. Alpha- interferon has been effective in tumor regression.

Question 15

Manifestations of AIDS—GI

Answer 15

• Oral candidiasis
• May progress to esophagus and stomach
• Treatment with Mycelex troches or nystatin and ketoconazole
• Diarrhea related to HIV infection or enteric pathogens
• Octreotide acetate for severe chronic diarrhea
• Wasting syndrome
• 10% weight loss and chronic diarrhea or chronic weakness and fever with absence of other cause
• Protein energy malnutrition
• Anorexia, diarrhea, GI malabsorption, and lack of nutrition may contribute
  
  • Treatment: esnure, boosts, milkshakes, family can bring in food

Question 16

Nursing Process—Assessment of the Patient With AIDS

Answer 16

• Assess physical and psychosocial status
• Identify potential risk factors: IV drug abuse and risky sexual practices
• Assess immune system function
• Assess nutritional status
• Assess skin integrity
• Assess respiratory status and neurologic status
• Assess fluid and electrolyte balance
• Assess knowledge level

Question 17

Nursing Process—Diagnosis of the
Patient With AIDS

Answer 17

• Impaired skin integrity
• Diarrhea
• Risk for infection
• Activity intolerance
• Disturbed thought processes
• Ineffective airway clearance
• Pain
• Imbalanced nutrition
• Social isolation
• Anticipatory grieving
• Deficient knowledge