HIV Flashcards
HIV
Causes immunosuppression making person more susceptible to infection
HIV transmission
through contact of certain bodily fluids: blood semen, vaginal secretions, and breast milk
what is the most common mode of transmission of HIV
unprotected sex
what is the main cause of disease, disability and death in patients with HIV
Opportunistic diseases
Patho of HIV
· Immune problems start when CD4+ T cell counts drop to < 500 cells/μL (Normal range 800-1200 cells/μL)
· Severe problems develop when < 200 CD4+ T cells/μL
<500 INDICATES
· HIV
<200 INDICATES
AIDS
what precautions is the best prevention for HIV
standard precaution
HIV Infectious Process
· CD4+ T-cells become “HIV factory” to make new viral particles daily
· Gradually, CD4+ T-cell count falls, viral load rises
· Immune systems weakens
· Everyone with AIDS has HIV; not everyone with HIV has AIDS
At-risk patients questions to ask
· Received blood transfusion or clotting factors before 1985?
· Shared needles with another person?
· Had a sexual experience with a penis, vagina, rectum, or mouth in contact with these areas of another person?
· Had a sexually transmitted infection?
Antiretroviral therapy:
a combination of medication used to control and suppress HIV replication.
· Acute HIV Infection clinical manifestations
· Mononucleosis-like syndrome (fever, swollen lymph nodes, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and/or a diffuse rash)
· Neurologic complications (aseptic meningitis, peripheral neuropathy, facial palsy, or Guillain-Barré syndrome)
· High viral load (the amount of HIV circulating in the blood)
· CD4+ T cell counts fall temporarily but quickly return to baseline or near-baseline levels
what is the most infectious time during HIV
acute phase, 2-4 weeks after infection because of the high amount of circulating HIV
clinical manifestations of HIV
· Weight loss
· Cough
· Sore throat
· Headache
· Swollen lymph nodes
· Diarrhea
· Vomiting
· Muscle pain
· Joint pain
· Skin rashes
· Fevers`
Opportunistic Infections
· Oropharyngeal candidiasis (Thrush)
· Oral Hairy Leukoplakia
· Varicella - zoster virus (Shingles)
· Persistent vaginal candida infections
· Herpes (oral and/or genital)
· Pneumocystis jiroveci pneumonia
· Karposi’s sarcoma
· Hepatitis B & C
· Oral Hairy Leukoplakia
o An Epstein-Barr virus infection that causes painless, white, raised lesions on the lateral aspect of the tongue, can occur at this phase of the infection and is another indicator of disease progression.
· Pneumocystis jiroveci pneumonia
o A type of pneumonia that can appear as an opportunistic disease associated with HIV infection
· Karposi’s sarcoma
o Malignant vascular lesions such as Kaposi sarcoma lesions can appear anywhere on skin surface or on internal organs.
Karposi’s sarcoma Treatments
o Radiation therapy, cryosurgery, or a topical retinoid, may be used if a person has only a few skin lesions
Diagnostic studies
· Diagnosis is made by testing HIV antibodies and/or antigens by using blood or saliva.
Lab Studies
· CD4+ T-cell counts
· CD4+ T-cell count provides a marker of immune function
· Viral load
· Blood chemistries, CBC, stool testing, biopsies
the lower the viral load, the _____
the less active the disease
AIDS is diagnosed when an individual with HIV develops at least one of the following conditions:
· CD4+ T cell count drops below 200 cells/µL.
· One of the following opportunistic cancers:
o Invasive cervical cancer
o Kaposi sarcoma (KS)
o Burkitt’s lymphoma
o Immunoblastic lymphoma
o Primary lymphoma of the brain
How to prevent HIV: ABCs
· Abstinence
· Be faithful
· Condoms
Interprofessional Care for HIV
· Monitor disease progression, immune function, and manage symptoms
· Initiate and monitor ART
· Prevent, detect and/or treat opportunistic infections
· Prevent or decrease complications of therapies
· Prevent further transmission of HIV
· Monitor disease progression, immune function, and manage symptoms
· Initiate and monitor ART
· Prevent, detect and/or treat opportunistic infections
· Prevent or decrease complications of therapies
· Prevent further transmission of HIV
· Patient readiness is most important concern
· To avoid burnout and non-adherence, treatment is recommended when immune suppression is great
· This required dedication to adhere to the treatment think about why a client may not be able to adhere, cost, inability to get the drug, transportation, lack of knowledge, teaching, anger, denial, etc. ART therapy works but only if it is taken as directed
HIV infection is preventable so…
o Avoid risky behaviors
o Modify risky behaviors
o Candid, culturally sensitive, language- appropriate, age-specific information and behavior change counseling
Should exposure to HIV-infected fluids occur, what is done
· postexposure prophylaxis (PEP) with combination ART can significantly decrease the risk of infection. The need for timely treatment and counseling makes it even more critical for nurses to report all blood exposures.
Prevention and Early Detection of HIV
· Increase safter sexual practices, including condom use
· Decrease equipment sharing among IV users
· Increase clinician skills to assess for risk factors of HIV infection, recommended HIV testing, and provide counseling for behavior change
· Make voluntary HIV testing a routine part of health care
· Increase access to new HIV testing technologies, especially rapid testing
· Increase access HIV testing facilities
· Decrease perinatal HIV infection by offering HIV testing as a part of prenatal care
· Provide counseling and appropriate HIV therapy to those who are infected
Antiretroviral therapy (ART)
· Inhibits viral replication but does not kill the virus.
· Monotherapy promotes drug resistance.
· Doses must not be missed!
· Must take 90% of doses correctly
· If an HIV patient can not be compliant they should not be started on therapy.
how to delay HIV progression
· Nutritional support to maintain lean body mass and proper vitamins and micronutrients
· Moderating or eliminating alcohol, tobacco, and drug use
· Keeping up to date with recommended vaccines
· Adequate rest and exercise
· Reducing stress
· Avoiding exposure to new infectious agents
· Accessing counseling
· Support groups
· Attending regular appointments
Antiretroviral Drugs patient teaching
Take full dose prescribes and take it on schedule and as prescribed
· Talk to HCP about dealing with side effects of drugs
· Do not quit taking one drug while continuing the others
· Do not take new drugs without checking with HCO for possible reactions
· Goal of antiretroviral medication is to decrease the amount of virus in your blood (your viral load) to keep CD4 cell count high, get lab work done every 3-6 months
Improving Adherence to Antiretroviral Therapy
· Determine whether the patient understands the importance of adherence and is ready to start therapy
· Provide teaching on medication dosing
· Review potential SE of drug
· Assure patient that SE can be treated, if not, medication regimens can be changed
· Use teaching and memory aids like pictures, pillboxes, and calendars
· Engage family and friends in the teaching process. Solicit their support to help the patient take treatment
· Simplify regiments, dosing, and food requirements as much as possible
Signs and symptoms HIV-Infected Patient Need to Report
· Any change in LOC
· HA accompanied by N/V changes in vision
· Persistent SOB
· N/V accompanied by abdominal pain
· Vomiting blood
· Dehydration
· Yellowing of skin
· Any bleeding from rectum not related to hemorrhoids
· Pain in flank with fever
· Blood in urine
· New onset weakness
· Seizures
Rash
· Main goals of drug therapy
o Decrease viral load
o Maintain/increase CD4+T counts
o Prevent HIV-related symptoms and opportunistic diseases
o Delay disease progression
o Prevent HIV transmission
A major problem with most drugs used in ART is…
o resistance develops rapidly when they are used alone (monotherapy) or taken in inadequate doses. For that reason, combinations of three or more drugs should be used.
SE of ART
metabolic disorder like lipodystrophy, hyperlipidemia, insulin resistance, hyperglycemia, bone disease (osteoporosis and osteopenia), lactic acidosis, renal disease, CV disease
