HIV Flashcards
______: This is a retrovirus that attacks __________
Human Immunodeficiency Virus
CD4 T Lymphocytes
HIV may be transmitted through:
sexually,
blood transfusions,
sharing intravenous needles,
and from mother to child
PAGE 3-4
-
T/F Once CD4 counts become too high, host immune defences
cannot fight against opportunistic infections and
malignancies
F, low
CD4 count <200 =
AIDS Dx
Treatment of AIDS is focused on opportunistic infection
treatment and decreasing the HIV viral load through ________
Antiretroviral Therapy (ART)
Most HIV+ patients develop AIDS after ______ years if left
untreated
10
Undetectable = Untransmissible
-
Around 39 million people have died from HIV infection
Currently around 36.7 million living with HIV
There has been AIDS-defining efforts in the areas of education, prevention and research to decrease transmission and treat the virus.
-
RISK FACTORS
MSM,
unsafe sexual practices,
use of intravenous drugs,
vertical transmission, and
blood transfusions
PAGE 7
-
PATHOPHYSIOLOGY
HIV attaches to host cells with _________ then the
virus then integrates its _________ material into that
of the host cell, taking over cell to generate more viral
proteins and genetic material. Eventually, the host cell
will die, and other CD4 cells will be infected.
Glycoproteins
Chromosomal
The number of CD4 cells within the affected individual
will fall by approximately _______ cells/uL per year WITHOUT the initiation of ART
50-80
With the addition of ART,__________ is now
the major cause of morbidity and mortality for HIV
patients.
Cardiovascular diseases
HX taking
Time of diagnosis
Complications/Opportunistic infections
Medications (ART)
Other comorbid illnesses
CD4 count and viral load
AFFECTED BODY SYSTEMS
CARDIAC
PULMONARY
OROPHARYNGEAL AND GI
CNS
ONCOLOGIC PROBLEMS AND HEMATOLOGIC SYSTEM
DERMATOLOGIC
T/F ART and HIV infection likely contribute to increased cardiovascular disease in patients
T
Common signs/symptoms of cardiovascular involvement:
Chest pain, SOB, fatigue
Jugular distension
Abnormal heart sounds
Pericarditis due to mycobacterium tuberculosis
PAGE 11
-
PULMONARY
Infectious diseases:
-URTI and acute bronchitis
Non-infectious diseases
-Kaposi’s sarcoma
-Non-Hodgkin’s Lymphoma
-Sarcoidosis
-Lung cancer
-Emphysema
For pulmnary sys., check for:
Signs of respiratory distress,
tachypnea,
cyanosis,
adventitious lung sounds
In the oro/GI system, HIV meds can cause:
pancreatitis,
hepatic steatosis, or
hepatotoxicity
*Hepatitis B or C co-infection
*Candida esophagitis and Cryptosporidium diarrhea
Assoc. symptoms for oro/GI system:
Nausea,
vomiting,
diarrhea,
constipation,
melena,
hematochezia, or
urinary symptoms
It is a very common manifestation of HIV infection
Candidia Esophagitis
FOR CNS, may include:
Meningitis,
focal demyelinating lesions,
malignancies from immunosuppresion
Pts with HIV affecting CNS will present c complaints of:
Altered mental status,
vision changes,
focalweakness,
seizures
Oncologic problems & Hematologic sys.:
-Anemia, thrombocytopenia, and leukemia
-Petechia or purpura
-Primary CNS lymphoma with Epstein Barr virus
ART and prophylactic medications can cause ________
Bone Marrow Toxicity
______patients will have concomitant infections
symptoms
Leukopenic
Hematologic problem that presents c weakness, fatigue, SOB
Anemia
PAGE 17
-
DERMATOLOGIC SYSTEM
Maculopapular or morbilliform rash
Oral ulcers or lesions
Molloscum contagiosum and HPV infections
Most common AIDS related cutaneous problem
Kaposi’s sarcoma
Kaposi’s Sarcome is a _______surrounded by violaceous
patches, nodules, or plaques
Vascular Neoplasm
PAGE 19-21
-
T/F Most patients with HIV will develop AIDS within 8 years if left untreated
F, 10
Asymptomatic phase: # of years: _______
~8 years
T/F If ART is started even after an initial diagnosis of AIDS,
the patient may live greater than 10 years
T
T/F Patients who are diagnosed with AIDS and do not get
ART will probably die within 1 year
F, 2 years
80% of people with HIV/AIDS experience:
-Pain and muscle weakness (impairment)
-Inability to walk, do self care, and bed mobility (activity limitations)
-Inability to work (participation restriction)
Physical therapists help manage complications or other
disease conditions that are set in or worsened due to
their HIV status
-
T/F Physical therapy is important in the continuum of HIV/AIDS care and can slow deterioration and enable thepatient to achieve independence
T
GOALS OF PT IN HIV:
-Improvement of quality of life
-Keeping the patient active in both his/her life and in the community.
-Improve their ability to do daily activities
-Improve balance, reduce pain, and maintain a healthy body weight
-Proper home exercise programs
Indications for physical therapy management:
-Atrophy
-Muscle weakness
-Arthritis
-Myelopathy
-Pain
-Lymphadema (Secondary to Kaposi’s Sarcoma)
-Polymyositis
-Peripheral neuropathy
-Guillain-Barre Syndrome
-Swelling
RX Exercise:
-Aerobic, resistive/progressive resistive, and
therapeutic exercise
-Indications include muscle atrophy and weakness
-Helps reduce body fat, increase lean muscle,
reduced HIV symptoms, and improvement in self efficacy and cardiovascular fitness
Manual therapy
-Massage, joint and soft tissue mobilization
-Compression bandages and garments for swelling
-Indications include pain, lymphadema, swelling,tightness
-Helps in the reduction of neuropathic pain, and pain in general which leads to an increased quality of life.
Gait and ADL training
-Use of orthotic sandals, treatment of gait
problems and transfer training
-Good for teaching independence
This is under chest/pulmonary PT which can be used in the management for recurrent pulmonary
infection
Positive expiratory pressure mask
*DRP, proper breathing techniques and pacing, proper coughing with or without splinting
Counselling and health ed.
Participants living with HIV described experiencing
social challenges such as:
social isolation,
stigma,
unstable living conditions.
They outlined how physical therapy may help to reduce feelings of _________and provide strategies for increasing social engagement.
social isolation
Participants with HIV felt interacting with
peers in a physical therapy program would allow them to“meet more people” and engage in “exercises together or go walking together.”
-
refers to the interdependency of health domains in the role of physical therapy in
HIV care, focused on specific needs and goals of people living with HIV.
Client-centered care
T/F Many participants living with HIV identified that although physical therapy could address
psychological, physical and social health
T
As HIV/AIDS is transmitted with bodily fluids andpatients have a myriad of other diseases
-
One precaution is ___________ when handling the patient with open
wounds or coughing episodes
Use of PPE
T/F One precaution is careful monitoring of vital signs during exercises
T
Precautions include Precautions based on other presenting diseases
-
Participants described a variety of experiences with physical therapy including cardiac, stroke and musculoskeletal rehabilitation, and a focus on addressing
health challenges associated with HIV or side effects of treatments.
-
Participants discussed experiences in which physical therapy helped improve their _________and _______
Mobility
Independence
“After having a stroke… physiotherapy got me walking…it’s allowed me to get back into… a relatively normal life now.
– Person Living with HIV-7”
-
For those engaging in physical therapy interventions, people living with HIV described how physical therapyprovided motivation for participation, education and
support beneficial to helping overcome the difficulty of adhering to an exercise routine
-
“It’s very hard doing physiotherapy without [a physical therapist] in your room, because she
’ll come and make sure you exercise… then it’s up to you, the individual, to be proactive.
– Person Living with HIV-12”
-
PAGE 35-36
-
Barriers of rehabilitation for HIV patients are:
-Not all participants living with HIV were able to access physical therapy or attend all the sessions they required
-Some referred to financial barriers, including lack of stable income or access to private insurance as a limiting factor to accessing physical therapy.
-Others described the lack of knowledge among healthcare professionals in outpatient physical therapy clinics about HIV and episodic disability
Framework of physical therapy
role in HIV care consisting of two components:
(1) multidimensional roles of
physical therapy in client-
centered HIV care, and
(2) contextual factors for consideration in HIV care.
PAGE 38
-
T/F Physiotherapists have
responsibility to treat their
patient without any form of
stigmatization.
T
According to _________(___), based on the ethical principles of ________, ________ and ______, physiotherapists do not have the right to refuse to treat PLWHA.
Voors
2000
Beneficence
Non-maleficence
Justice
Is one of the most common and clinically important CNS complications of late HIV-1 infections
AIDS Dementia Complex
T/F AIDS Dementia Complex is a source of great morbidity and when acute, is
associated with limited survival
F, Severe
T/F ADC is caused by HIV itself, and not by another opporunistic infection
T
Primary sensory, motor, and premotor cortices were _____% thinner
15
PAGE 41
-
AIDS DEMENTIA COMPLEX INCIDENCE
1 in 1000 patients not treated with HAART and with low CD4 counts would progress to HAD
Europe - incidence of HAD of 0.66 per 1000 persons
US - 10.5 cases per 1000 patients
are the presenting complaint
in 4% to 15% of patients diagnosed with HIV
Neurocognitive deficits
This may reveal subtle
cognitive deficits (ANI or MND) in as many as ____%
Neuropsychological Testing
40
T/F Prevalence of HAND among white and non-white patients as well as between men and women appears to mimic that of HIV infection and decreases with
age
F, Increases
The pathophysiology of AIDS dementia complex is the reduction in _______ and _______
Cortical gray matter
Brain atrophy
Pathophysiology of AIDS Dementia complex includes
Perivascular macrophage and lymphocyte infiltration, multinucleated giant cells, myelin loss, and white matter astrogliosis
T/F In AIDS dementia complex, the cerebellum is the most commonly affected
F, Basal Ganglia
due to progressive multifocal
leukoencephalopathy, non-Hodgkin lymphoma,
infection such as from cytomegalovirus,
toxoplasmosis, varicella-zoster, herpes simplex, or BK virus
Encephalitis
T/F Proteins expressed from viral genes in infected cells can directly damage neurons
T
This are produced by activation of the immune response in surrounding healthy glial cells which may also contribute to neuronal damage
Cytokines
This antibodies against brain tissue have
been isolated in HIV-infected patients
Autoimmune
Mean survival in HAD without ART is 3 to 6 months, increased to 38.5 months with the initiation of ART therapy
-
Worse prognosis is associated with the following factors:
lower educational level,
increasing age,
lower CD4 count,
higher viral load,
decreasing hemoglobin,
decreasing platelets,
lower body mass index,
hepatitis C coinfection,
intravenous drug use,
poor medication adherence
T/F Presence of HAD is a dependent predictor of risk of death in HIV-infected patients
F, independent
PAGE 47
-
The presentation of AIDS dem. com. is the alteration in mental status which is common in HIV infected patients
-
Cognitive deficits associated with HAD include:
impaired:
executive function,
decision making and
language;
T/F Cognitive deficits associated with HAD these are generally fast and intermittent
in onset
F, Slow and progressive
Movement Problems of AIDS dem.com.
-Speech problems
-Clumsiness
-Ataxia
-Gait problems
-Progressive weakness
-Loss of sensation of (B) UE and LE
-Visual problems
The mainstay of prevention and treatment of HAND spectrum disorders is______
Adherence to ART
*Appropriate treatment of HIV infection shows improvement in cognitive function in patients diagnosed with severe deficits
The selection of a specific ART regimen should follow standard protocols based on viral ribonucleic acid (RNA) load, genotype, drug interactions and presence of comorbidities
-
Psychiatric comorbidities may be present and
treatment should be initiated following a psychiatric
evaluation
-
PT GOALS
-Improving quality of life
-Keeping the patient active
-Proper home exercise program
-Quality of life issues
-Work hardening
-Community management skills (how to access transportation, socialisation opportunities, shopping,
banking, ability to access and negotiate health care
and insurance systems)
-Integumentary care
PT Mx
Aerobic activity
- 20 minutes at least 3 times a week for 5 weeks
- Improvement of CV fitness, body composition, and psychosocial status
Low to moderate intensity exercise to improve aerobic capacity
Strengthening exercises
