Exam4- HIV disease Flashcards
HIV patho
retrovirus
-changes itself to be inserted into the host and it can never be killed
What is HIV’s genetic material?
RNA: single stranded ribonucleic acid
How is RNA converted in the HIV life cycle?
Reverse transcriptase (RT) is used to covert single stranded RNA into double stranded DNA
Role of intergrade enzyme in the HIV life cycle
Integrase enzyme allows the viral double stranded DNA to be inserted into the double stranded DNA of the host
HIV Life Cycle
- Attachment and fusion
- Injection of core
- Uncoating
- Conversion to DNA
- Circular DNA
- Entrance into nucleus
- Integration
- Transcription
- Translation
- Protein modification
- Assembly of core
- Budding
Effects of HIV
0f CD4+ T-cells patient has, whether any opportunistic infections have occurred, indicates difference
Immune system can attack & destroy early on; 3 of HIV particles overwhelms system over time
HIV s/s
- acute infection develops within 1st month after infection
- night sweats, chills, headaches, muscle aches, rash,, sore throat
-symptoms fade & patient feels better (some may not look into the symptoms due to them leaving so fast)
Stage 1
confirmed HIV infection
CD4-T call count >500 cells mm3
Stage 2
Confirmed HIV infection
CD4 T-cell count b/w 200-499 cells mm3
Stage 3
confirmed HIV infection
CD4 T-cell count <200 cells mm3 or > 200 with a documented AIDS defining illness (ex. pneumocystis pneumonia)
Stage 4
Confirmed HIV infection
No other information regarding CD4 cell counts or AIDS defining illness
Not worse, just don’t know the answer to the questions
Long-term nonpregressors (LTNPs)
genetic mutation does cause a resistance to the virus entering the host cells. HIV positive for greater than 10 years & without symptoms
Health Promotion
Educate best hope for prevention
3 ways HIV usually transmitted
sexual
parenteral
perinatal
ABCs
A- abstinence
B-be faithful to one partner
C- use condoms
Transmission Health care workers
needle stick injuries
exposure to non intact skin/mucous membranes to blood and body fluids
STANDARD PRECAUTIONS ARE BEST PREVENTION!!!
Management
Assessment - ask questions
Hx
Physical Assessment/clinical manifestations: Infections, Malignancies, Endocrine complications
Manifestations: Infections
opportunistic, protozoal, fungal, bacterial, viral
Manifestations: Malignancies
Kaposi’s scarcoma, malignant lymphomas
Manifestations: Endocrine complications
Gonadal dysfunction
Body shape changes
Adrenal insufficiency
Manifestations: AIDS dementia complex
occurs in 70% of those with AIDS
Varies in severity
Manifestations: AIDS wasting syndrome
altered metabolism
GI dysfunction
Manifestations: Skin changes
dry, itchy irritated skin
viral load
amount of virus present in blood/other body fluids
should be less than 50 if they are taken regularly
more likely t transmit with high viral load
Higher Blood levels of HIV (viremia)
greater risk for sexual/perinatal transmission
Lymphocyte count
WBC <3500 cells/mm3
CD4+ T-cells & CD8+ T-cells
ratio normally is 2:1
normal CD4 is 500-1500
AIDS can be fewer than 100
Antibody tests
ELISA: early testing can result in false negative
Western blot, viral load: more accurate, more expensive, used to confirm presence of HIV
Quantitative RNE assays
used to monitor therapy
Home test kits
dont want family to know
may be more difficult to get insurance with HIV
Needs confirmation by blood test
HAART: Highly Active Antiretroviral Therapy
NRTIs: Zidovudine NNRTIs: Delavirdine Pis: Atazanavir Fusion inhibitors: enfuvirtide Entry inhibitors: Maraviroc Integrase inhibitors: Raltegrase
cART= combination antiretroviral therapy (new name)
Safe Sex Practices
Latex or polyurethane condoms
Latex gloves
Dental Dams
New research- vaginal gel with antiretroviral agent
Priority patient problems
potential for infection inadequate oxygenation pain inadequate nutrition diarrhea reduced skin integrity confession reduced self-esteem potential loss of social contact
