HIV Flashcards
Spread through
-blood, semen, breast milk, vaginal secretions
Sexual contact
-Genital, anal, oral
Parental
- IV drug use, blood transfusion
Perinatal
-placenta, maternal blood, delivery, breastmilk
Risky behavior….. who is likely to be more infected
- females from infected males
Anal intercourse is highest risk - Higher viral load > higher chance
Prevention via sexual transmission
- ABCD
- Abstinence, being faithful, condom use, Drugs
- PEP
Prevention through parental transmission
- use of cleaning needles with diluted bleach
- needle excahnge programs
- PrEP
- Blood donation screening
Perinatal prevention
- Drup therapy drops risk of transmission
- babies born to mothers with HIV should betreated with meds 4-6 weeks after delivery
- Cesarean delivery
- no breastfeeding
For HCW
- Common route is dirty needle stick
- may come from infected wounds and body fluids
- use standard precautions
- Sharps injury prevention
- PEP
4th generation testing
- Blood 4th gen HIV assay
-Detects HIV antibodies (HIV IgM and IgG) within 21 days
-Detects p24 antigen (HIV capsid protein) within 14 days
If positive-> test for HIV-1 vs HIV-2
NAT (nucleic acid test) looking for HIV RNA (acute infection
Home testing kits
Transmucosal exudate- results in 20 minutes
Drop of blood
If test is +, results should be verified with further testing
Viral Load
- Measures amount of HIV virla RNA particles in blood
- The higher the viral load, the greater the risk of transmitting
- Can detect as little as 40 particles/ mL - 80,000 particles
- For HIV infectivity and therapy effectiveness
Other diagnostic testing
-Lymphocyte count, Cd4 count, Viral load testing/ Quant RNA assays, CBC, CMP, Toxoplasmosis antibody titer, LFT, HEp A,B,C, Lipid profile, Syphilis
If they have syphillis
needs to be tested once a year
1) Acute HIV infection
flu- like symptoms
VEry contagious/ high viral load
2) Chronic HIV infection (asymptomatic)
- HIV active and reproducing slowly
- Lasts ten years, untreated
- Can transmit HIV to others
- With medication some people remain in this pahse indefinitely
3) AIDS
- Immune system is severely damaged
- CD4+ count is below 200 cells/ mm
- or they develop opportunistic infections
- Without treatment, death occurs in about 3 years
HIV stages (1-4)
Stage 1- CD4 T-cell count> 500 cells/ mm3 (no AIDs defining illness)
Stage 2 CD4 T-cell count btw 200-499 with no AIDS defining illness
Stage 3 CD4 T-cell count less than 200 cells or a person with over 200 but has an AIDS defining illness
Stage 4: Confirm HIV with no further info regarding CD4 status/ illnesses
HIV becomes AIDs when
CD4 T-cell count <200 cells or HIV positive with presence of OI’s
Who should be screened
- All adults btwn ages 13 and 65
- annual screening for those at higher risk for HIV
- Prenatal screening
- Frequent testing for people with repeated high- risk exposure
Assessment
- History
- Infections
- Malignancies
- Endocrin problems
- Neuro problesm
- Protein wasting
- Skin problems
- kidney problems
- support
- current level of fxn
Important Assessment priority!!!!
INfection!!
- should be monitored on a routine basis for immune fxn
and presence of infections/ disease progression
At risk for OIs and pathogenic infections
Opportunistic infections Your Role!
Assess for signs and symptoms for OI and how patinet is responding to treatments of OI’s
-report immediately
Most common OI
PCP
- Fungal infection
Symptoms: persistant cough, low-grade fever, tachypnea, dyspnea, crackles in lungs, wheezing, fatigue
PCP Diagnosis
-Presentation, sputum culture, bronchial lavage, transbronchial or open lung bioposy
PCP Txt
- TMP/SMX Bactrim
- support (O2, positive pressure)
Toxoplasmosis Enephalitis
Protozoa
- Stay away from cat litter and cook meat
Toxo encephilitis manifestations
- Neuro changes
- fever
- lethargy
- headaches
Txt for TE
Treated with pyrimethamine and sulfadiazine
Disseminated MAC
- CD4 < 50
- occurs in patinet who are not on antiretroviral therapy
Manifestation of Dissminated MAC
- Dissminated multi-organ infection
- anemia, fever, night sweats, fatigue, diarhhea, abd pain, wt loss
Dissiminated MAC txt
support
- Clarithromycin, ethambutol and rifabutan
TB manifestations
Cough, dyspnea, chest pain, night sweats, weight loss, anorexia, fever, chills
- CD4+ T-cell count is below 200 cells/mm 3 TB skin test may be positive
- Diagnosed by NAAT, CXR, sputum smear or culture
- Tx is complicated
Malignancies
- Karposi’s Sarcoma
- Kymphomas
- Cervical cancer
- Lung cancer
- Anal cancer
- GI cancer
Anal cancer
Caused by HPV
- Also cause cervical cancer
- Cervical PAP test every 6 months
- Can also perform anal PAP test
other findings
- Gonadal dysfunction
- Body shape changes
- Lipid abnormalaties
- Lipodystrophy
- Lioatrophy
- Type 1 DM
- AIDs dementia complex
- AIDs wasting syndrome
Interventions
- Education
- Montiro VS and tmep
- No fresh plants or flowers
- No visitors who are sick
- Hand washing
- Inspect patinet mouth, skin and genitals (watch for skin lesions)
- avoid catheters
Education
Avoid contact with sick people, bathe daily with antibacterial soap, avoid sharing personal items, dietary changes, avoid pet litter, signs of infection/ report
Drug therapy
ART
- Inhibits viral replications
- HAART
- Drugs should taken 90% correctly
Intervention oxygen
Apply oxygen as needed
- positioning
- rest/ limiting activities
Intervention nutrition
- cause by nausea, anorexia, diarhhea, n/v, mucosial lesions/ thrush
- determin cause make adjustments
- monitor weights I’s and O’s
- High calorie/ high protien/ low fat
- small frequent meals
- Mouth care (sodium bicarb, soft brush)
- Avoid foods that cause infections
Intervention Diarhhea
Symtom mangment, drug therpapy, food choices, avoid alcoholand caffeine, avoid dairy, small, frequent meals, fluid intake, skin assessment
Intevention for skin integrity
KArposi responds to ART - Analgesics -prevent infections Herpes simplex -clean with NS - Assess, assess
Care Continumm
Identify level of assistance needed
- social support
- pt and family support
- dealing with social stigma
- peer to peer education
