HIV

Question 1

Is HIV an RNA or DNA virus ?

Answer 1

RNA

Question 2

What cells are destroyed by HIV ?

Answer 2

CD+4 / T cells

Question 3

What is the normal CD4 range ?

Answer 3

800-1200 cells/ul

Question 4

What is the life span of a normal and infected T cell/CD4 ?

Answer 4

• normal: 100 days
• infected: 2 days

Question 5

At how many CD4+ T cells does immune problems occur ?

Answer 5

below 500 cells/ul

Question 6

What are the modes of transmission ?

Answer 6

• sex with infected partner
• exposure to infected blood or blood products
• pregnancy, delivery, or breastfeeding
  (HIV is fragile outside the body so exposure has to happen quickly for it to survive)

Question 7

Who is at risk for HIV ?

Answer 7

• received blood transfusion or clotting factors before 1985
• shared needles, syringes, or other injection equipment
• sexually active, inconsistent/no protection with multiple partners
• babies of mothers who have HIV/AIDS

Question 8

What is viremia ?

Answer 8

large viral levels in blood

Question 9

Why does viremia occur during initial exposure ?

Answer 9

takes our body a while to create antibodies against the virus
- viremia occurs for 2-3 weeks
- transmission more likely to occur when viral load is high

Question 10

How long does the acute infection stage last ?

Answer 10

1-3 weeks

Question 11

What happens in the acute infection phase ?

Answer 11

• CD4 will drop which causes pt to feel flu-like symptoms
• viral load is at it’s highest

Question 12

How long does it take for the body to build antibodies that can be detected in a positive HIV test ?

Answer 12

3 weeks to 3 months

Question 13

What are some flu-like symptoms someone in the acute infection phase may feel ?

Answer 13

• fever
• swollen lymph glands
• sore throat
• HA
• malaise
• muscle joint pain
• diarrhea
• diffuse rase

Question 14

What happens in the asymptomatic chronic infection phase ?

Answer 14

• generally asymptomatic
• CD4 count above 500 (stable)
• viral load is low/plateauted
• most are unaware of infected status and may unknowingly spread the virus
• the best possible phase we can get our patients to stay in

Question 15

What are some symptoms someone in the asymptomatic chronic infection stage may feel ?

Answer 15

• fatigue
• HA
• low-grade fever
• night sweats

Question 16

What is the CD4 count of someone who is in the symptomatic infection stage ?

Answer 16

200-500
- viral load is increasing (could happen because they are becoming resistant to their meds)

Question 17

What are some complications that could happen in the symptomatic infection stage ?

Answer 17

some of these diseases are dormant in the body and then once the pt has HIV it becomes active again
- localized infections
- lymphadenopathy (swollen lymph nodes)
- candida/thrush
- oral hairy leukoplakia
- Kaposi sarcoma
- singles

Question 18

What is the CD4 count for someone with AIDS ?

Answer 18

below 200 cells/ul

Question 19

What does AIDS stand for ?

Answer 19

acquired immune deficiency syndrome

Question 20

What are some opportunistic infections that happen in those with AIDS ?

Answer 20

• candida (stomatitis, esophagitis, vaginal)
• pneumocystis jiroveci
• herpes simplex virus with chronic ulcers
• toxoplasmosis of the brain
• mycobacterium tuberculosis
• cytomegalovirus (CMV) disease other than liver, spleen, or nodes

Question 21

What are some opportunistic cancers that happen in those with AIDS ?

Answer 21

• invasive cervical cancer
• Kaposi sarcoma (KS)
• Burkitt’s lymphoma
• immunoblastic lymphoma
• primary lymphoma of the brain

Question 22

What does the testing for HIV look like ?

Answer 22

it looks for the antibodies to the virus as well as the virus itself
- most diagnostic tests are focused on antibodies
- retesting to confirm is almost always necessary (to be sure it isn’t a false negative)

Question 23

What kind of precautions are there for prevention of transmission ?

Answer 23

standard precautions
- consider ALL body fluids to be contaminated
- clean with blood, body fluids, and surface areas with germicide solution

Question 24

What are some diagnostic studies for HIV ?

Answer 24

• HIV serum detection of antibodies
• WBCs: neutropenia
• Platelets: thrombocytopenia
• RBCs: anemia (due to disease process & tx)
• the lower the viral load the better
• progression monitored by CD4/T Cell counts and viral load

Question 25

Why do we use a combination of medications to treat HIV (HAART)?

Answer 25

risk of drug resistance is reduced
- they attack viral replication in different ways
- pt’s need to be ready, financially and emotionally to begin the regimen

Question 26

What is the reason for PEP medications ?

Answer 26

Post-Exposure Prophylaxis (PEP)
- in case of possible exposure like sexual assault, or needlestick injury
- HAART will be started to reduce risk of infection and protect the pt until testing is confirmed

Question 27

What is the reasons for PREP medications ?

Answer 27

Pre-Exposure Prophylaxis (PREP) (Truvada-Tenofovir)
- taken daily by high risk individuals to reduce risk of contracting HIV
- like someone whose sexual partner is HIV+

Question 28

What are some S/E of HIV drug therapy ?

Answer 28

• diarrhea
• peripheral neuropathy pain
• N/V
• fatigue
• insulin resistance which can lead to diabetes and then kidney failure
• bone disease
• cardiovascular diseases

Question 29

What is the goal for HIV treatment ?

Answer 29

• decrease viral load
• prevent transmission
• raise CD4 counts
• delay symptoms/infections
• prevent opportunistic infection (prophylaxis antibiotics)