HIV Flashcards
undetectable means what ***
untransmittable
transmits thru contact with body fluids ***
blood
semen
vaginal secretions
breast milk
most common work related HIV transmission ***
needle stick/puncture wound
perinatal transmission ***
25% of babys will get unless treatment is used
with treatment it reduces to 2%
pathophysiology of HIV
a retrovirus (replicates backwards, RNA to DNA)
needs a host to make copies of itself
T cells : HIV uses this specific receptor attached to CD4 cells to latch and enter the cell to begin replicating
how HIV works
gets into CD4 cell and replicates then kills cell and moves on
can kill 1 billion CD4 cells a day
normal CD4 count
800-1200 pr uL
HIV destroys billions of CD4 cells daily
body is able to replace for many years
eventually it cant keep up
when do immune problems start? ***
below 500 CD4 cells
severe problems: under 200 CD4 cells
-high risk of opportunistic diseases
phases of infection ***
- acute infection 1-3 weeks
- asymptomatic infection 3 weeks - 3 months
*(HIV antibody test become positive) - symptomatic infection
- AIDS
acute infection
2-4 weeks after infected
flu like symptoms (lasting 1-2 weeks)
*fever, HA, rash, swollen lymph nodes, sore throat, malaise
high viral load but low CD4 count
important to ask social history
asymptomatic disease
CD4 remain above 500
viral load is low
symptoms:
*low-grade fever, night sweats, persistant generalized lymphadenopathy
this is where they maty spread it without knowing
symptomatic disease state
CD4 drop to 200-500
viral load increases
early symptoms (worsen)
*main one = night sweats (drenching)
*lymphadenopathy
*persistant fever
*HA
*fatigue
common infections ***
candidiasis: yeast
*oral (thrush) or vaginal infections
shingles (varicella-zoster virus)
herpes outbreak (oral or genital)
bacterial infections
kaposi sarcoma
*large dark purple leasions (malignant lesions from HIV)
oral hairy leukoplakia
oral thrush vs oral hairy leukoplakia ***
oral thrush:
*white cottage cheese (bad pain)
oral hairy leukoplakia:
*white flaky only on sides of tongue (no pain)
late chronic or AIDS
CD4 under 200
opportunistic infection
wasting syndrome (10% loss of ideal BM)
AIDS dementia complex (ADC)
diagnotic studies
blood or saliva antibodies or antigen screens are best
“window period”
*time between infection and antibodies (delay up to 2 months)
rapid HIV antibody test (approved self test)
*results in 20 min
*blood sooner than saliva
*if positive itll be followed by other test
more diagnotic tests
nucleic acid test (NAT)
4th Gen HIV test: antigen/antibody combo
these are the test if you home test is positive
NAT: 10-33 days after exposure
*if viral load is present or not
4th gen HIV test: 18-45 days after exposure
*used as definitive diagnosis
monitoring HIV progression ***
lbs every 6 months after stalized
CD4 count
Viral load (VL)
we want high CD4 and low VL
CDC guidlines for 13-64 year olds ***
should be screened at least once and annually for those at high risk
collaborative care
Drug therapy goals***
drug therapy (goals)
- decrease VL
- maintain or raise CD4 cells
- delay onset of HIV symptoms and opportunistic diseases
ART: anti-retroviral therapy
What it does
How many we take***
inhibit replication of virus does not kill virus
drug resistance with monotherpay or inadequate dose
so we use combination therapy (3 or more)
combination therapy meds we use ***
nuceloside reverse transcriptase inhibitors (NRTIs)
*blocks HIV replication
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
*bind to and disable reverse transcriptase (cant replicate)
protease inhibitors (PIs)
*blocks an enzyme the virus needs to replicate
integrase inhibitors
*blocks an enzyme the virus needs to replicate
entry/fusion inhibitors
*blocks virus from entering CD4 cells
side effects of ART meds ***
GI: N/V/D
hematology: anemia, neutropenia
liver: hepatitis, elevated liver enzymes
metabolic: decrease blood glucose
genral: fatigue, HA
ART
Complainant rate needed***
95 compliance rate needed to be effective
may react with OTC
expensive
prevent infection ***
prophylaxis if CD4 under 200
*trimathoprim & sulfamethoxazole (bactrim or septra)
antibotics that prevent pneumonia
*pentamadine (IV,PO, or aerosol)
biktarvy ***
bictegravir - integrase inhibitor
emtricitabine - NRTI
tenofovir - NtRTI
Truvada ***
Emtricitabine- NRTI
tenofovir disoproxil fumarate- NtRTI
TB ***
9 months prophylaxis w/:
isoniozid (INH)
aids dementia
HIV infects brain (mental and physical decline)
stage 1-5
1=minimal changes
3=unable to work, may do minimal self car
5=vegetative
health maintenance
nutrition
exercise
safer sex practices
avoid ETOH, drug use, tobacco
pet caution
regular check ups
PrEP ***
take once daily
Truvada (most common)
Descovy
what does PrEP do? ***
reduce the risk of HIV
reduces getting HIV thru IVDA by 74%
PrEP education ***
high risk people should know about it:
*HIV positive partner
*MSM
*multiple partners
*dont always use barrier protecton
*IVDA
PrEP workup ***
prescription for 3 months at a time
must follow up every 3 months with provider
