Exam 4 Immunodeficiency Disorder HIV/AIDS Flashcards
1
Q
PRIMARY TRANSMISSION
A
- 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).
2
Q
ROUTE OF TRANSMISSION
A
- 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
3
Q
Primary Infection: CDC Category A
A
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).
*
4
Q
INCUBATION PERIOD
A
- 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.
5
Q
HIV- Symptomatic Phase
CDC Category B
A
- 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
6
Q
AIDS CDC
Category C
A
- 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.
7
Q
HIV-AIDS
A
- 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
8
Q
CLINICAL MANIFESTATIONS
A
- 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.
9
Q
Testing for HIV/AIDS
A
- 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.
10
Q
On-going Testing in HIV/AIDS
A
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
11
Q
Treatment of HIV
A
- 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
12
Q
HAART therapy
HIGHLY ACTIVE ANTRI RETROVIRAL THERAPY
A
- 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.
13
Q
Medical Management
A
- 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
14
Q
Medical Management
A
- 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.
15
Q
Manifestations of AIDS—GI
A
- 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
