HIV & AIDS Flashcards
Human immunodeficiency virus (HIV) causative agent
Retrovirus is the causative agent
2 of 5 know. Human retroviruses
- HIV-1: 80% of cases worldwide
- HIV-2: mostly in west Africa
- Both deplete T4 cells & subsequent cellular immunity
- HSRV: foamy virus (not pathogenic in humans)
- HTLV1: T cell leukemia and lymphoma
- HTLV2: no known pathology, ? Hairy cell leukemia
HIV Epidemiology
Cases since 1976 but originally treated as Gay Related Immunodeficiency Disease (GRID)
1st AIDS cases reported in 1981
1993 new definition of AIDS: HIV &CD4 T-lymphocyte count of <200 per mm3- 1/5 normal level
Can HIV affect children?
13-48% perinatal transmission through gestation, delivery, and rarely breast milk
HIV Prevalence
Make>female in US; worldwide:50/50
> 2/3 cases are in African-Americans
417/100,000 in 2010-2015
CDC allocates all HIV & AIDS prevention planning project (ECHPP): 3 year demonstration project to maximize the impact of HIV prevention in the 12 metropolitan statistical areas with the highest AIDS prevalence in the US
HIV Transmission
Sexual contact
Parenteral exposure to blood, blood products, & blood containing body fluids
Mother to child
Body fluids: blood, semen, vaginal fluids
Not associated with casual contact
More than 1.1 million people in the US have HIV and almost 1 in 5 (18.1%) are unaware
About 38,000 new cases each year
Gay, bisexual, and other men who have sex with men are most seriously affected by HIV
~636,000 have died from AIDS in the US since the epidemic began
Who is at risk/ should be tested
Sexually active
Use injection drugs
Engaged in sex work
Had a partner who was at risk
Sexual encounters with men from high HIV incident countries
Transfusion between 1978-1985
Symptoms that could be HIV related
In a correctional institution
Routine prenatal screening
HIV Diagnostic tests
13 testing centers within 30 miles
“Window period”: most develop detectable antibodies within 3 months; average is 25 days; rare cases up to 6 months
HIV antibody testing (ELISA)
Western blot
Rapid assays
Viral load
CD4 count
Antibody detection facts
Most people form HIV antibodies within 3 weeks to 3 months after exposure but can lag up to 6 months
Lag period= window period
It is possible to detect anti-HIV antibodies 3 months after infection, even in asymptomatic individuals
ELISA
Enzyme-Linked ImmunoSorbent Assay
Highly specific & 99.6% sensitive for HIV-1 antibodies
False +: Recent influenza or hep B vaccine Multiparous women After multiple blood transfusions Those with multiple myeloma Alcoholic hepatitis Biliary cirrhosis
Western Blot and Rapid Assays
Western blot confirms + ELISA
More HIV-1 sensitive
Detects antibodies= not reliable in early stages of infection
Rapid Assays vary in time and $$$
Fast & cheap: immunochromatographic (lateral flow) strips. Results in <20 minutes, no refrigeration necessary, some can detect HIV 1 & 2
Viral load (HIV RNA levels)
Measure of HIV RNA levels: amount of virus
3 assays can measure it
Use to monitor effectiveness of antiretroviral therapy: administer 2 assays within 1-2 weeks to establish a baseline
Undetectable viral load does not mean that infection has been eliminated or that replication has been halted completely
CD4 Cell Counts
Measure extent of immune damage
Monitor the benefits of antiretroviral therapy
Predict possibility of disease progression with viral load
Baseline Q2-4 weeks on initial drug therapy; Q3-4 months when CD4 >350/ mm3
Interpretation of Viral Load & CD4
HIV RNA < 7000 copies/ml &
CD4 count >350/mm3
=
2% chance of progressing to AIDS within 3 years without treatment
HIV RNA >55,000 copies/ml &
CD4 count <200/mm3
=
85% chance of progressing to AIDS within 3 years
⬆️ viral load= ⬇️ CD4 count
HIV Staging
Initial exposure (asymptomatic)
Primary HIV Infection (acute infection): flu-like symptoms; HIV replicates; develop antibodies to HIV in 6-12 weeks
Clinical latency or asymptomatic HIV infection (HIV seropositivity; latency): infections but no evidence of illness except +HIV antibody test; CD4+ T-cell count >500 cells/mm3; HIV continues to replicate
Late symptomatic stage (symptomatic infection): CD4<200 cells/mm; viral load >100,000 copies/ml; opportunistic infections (AIDS defining illness)
Advanced HIV Disease (AIDS): opportunistic infections CD4 <50
What are opportunistic infections?
1: pulmonary infections (often the first manifestation of AIDS
Pathogens that take advantage of low immunity to progress disease
Most likely to develop when CD4 <200
Can people other than HIV+ get opportunistic infections? YES! Ofc- anyone with a compromised immune system can
HIV ➡️ AIDS
Opportunistic infections
Bacterial and mycobacteria: Mycobacterium avium (MAC)
Viral: cytomegalovirus, herpes simplex
Protozoans: cryptosporidium (watery diarrhea)
Fungal: candida, crytococcosis (pneumonia and meningitis), histoplasmosis (pneumonia), pneumocystis carinii (pneumonia)
HIV related cancers: Kaposi’s sarcoma
AIDS Signs & Symptoms
Severe fatigue (>several weeks)
Sudden weight loss (>10 lbs in <2 months)
Night sweats, fever
Diarrhea
Bruising/bleeding
Coughing, SOB
Skin rashes, spots
Persistent Generalized Lymphadenopathy
Oral thrush
Neuro problems
Frequent infections
HIV Complications
Encephalopathy/ dementia
Anemia
Others
HIV Primary Prevention
Community education
HIV Secondary prevention
Early diagnosis
Testing
HIV Tertiary Prevention
Strategies to prevent opportunistic infection & reduce transmission
Good nutrition
Medications
Monitoring for side effects and signs of infection
HIV Drug Treatment
HAART: Highly Active Antiretroviral Therapy (now called ART- Antiretroviral therapy)
3+ drugs from these categories:
- nucleoside-Analog reverse transcriptase inhibitors
- nonnucleoside reverse transcriptase inhibitors
- protease inhibitors
- fusion inhibitors
Drawbacks: not a cure; expensive & complicated; interaction with other drugs; side effects
WHO Guidelines for ART (2013)
All individuals with CD4 <350 cells/mm3
CD4 >350 but <500 cells/mm3
Regardless of CD4 if:
- active TB
- co-infected with HBV
- if the person had an uninfected partner to decrease the incidence of transmission
- all pregnant and breastfeeding women with HIV
- all children with HIV if <4 years old
- those >5 years old with CD4 <500 cells/mm3
HIV/AIDS Meds
Monitor for drug effectiveness, interactions, and education
Reverse transcriptase inhibitors: Neucleoside Analogs
Limit HIV replications of HIV early in its life cycle
Most common: zidovudine (AZT, ZDV, Retrovir), Didanosine (ddi, Videx), Combivir (contains Lamivudine and AZT)
Side effects: GI, bone marrow suppression, peripheral neuropathy, hypersensitivity
Reverse transcriptase inhibitors: Non-Neucleoside Analogs
Inhibit reverse transcriptase
Not recommended as mono therapy
Most common: Etravirine (Viramune), Delavirudine (Rescriptor)
Interactions with other drugs: rifampin, antacids, phenytoin, phenobarbital, etc.
Protease inhibitors
Prevent replication and the release of viral particles
Indinavir (Crixivan)
Saquinavir (Invirase)
Nelfinavir (Viracept)
Side effects: GI, interactions with meds, rash
Fusion inhibitors
Early inhibitors that block the fusion of HIV with host cells
Enfuvirtide (fuzeon)
SQ injection
Drug interactions, hypersensitivity, local injection site reactions
Teach pts to report dyspnea, fever, and purulent mucous
Antifungal Meds
Amphitericin B
Diflucan
Antiprotozial meds
Pentadamine
Antiviral meds
Ganciclovir
Acyclovir
Antibacterial meds
Azithromycin
Bactrim
MAC
Clarithromycin
Rifabutin
Other meds for HIV/AIDS
Antineoplastics
Appetite stimulants
Antiemetics
NIH Panel Guidelines for use of AVR drugs
- HIV infection is always harmful; true long-term survival free of immune dysfunction is unusual
- Regular, periodic measurements of HIV RNA levels and CD4 T cell counts are needed to determine the risk for disease progression
- Treatment decisions should be individualized based on #2 and WHO guidelines
- Maximum achievable suppression of HIV replication should be the goal of therapy
- Women should be treated, regardless of pregnancy status
- Same Tx principles are utilized with HIV infected children although unique pharmacological considerations may be needed to be taken into account
- Individuals with viral loads below detectable limits should still be considered infectious
HIV/AIDS Health History
Risk factors: forms of transmission
Sexual Hx
Clinical manifestations: weight loss, low-grade fever, fatigue, night sweats, painful lymph nodes, nausea, headache
Symptoms: relief, exacerbations
Meds and Alternative remedies
ADL functional status
Concurrent med problem
Support system
Advanced directives
HIV/AIDS physical exam
Check weight < ideal for height
Abnormal VS
Check: non-elastic skin turgor, excoriated mucous membranes
Respiratory: cough, dyspnea, crackles, wheezes
GI: diarrhea, distention, tenderness
Fluid
HIV/AIDS NRSG plan of care: infection, risk for
communicable disease management
infection control
infection management
surveillance
HIV/AIDS NRSG plan of care: nutrition
Nutritional monitoring
Nutritional therapy
Nausea management
HIV/AIDS NRSG plan of care: fatigue
Energy management
Sleep enhancement
Mood management
HIV/AIDS NRSG plan of care: anxiety
Anxiety reduction
Presence
Coping enhancement
HIV/AIDS NRSG plan of care: individual coping, ineffective
Anxiety reduction
Coping enhancement
Decision-making support
Support group
Teaching: individual
Financial concerns
HIV/AIDS NRSG plan of care: family processes, altered
Counseling
Emotional support
Support system enhancement
Family integrity promotion
Nursing diagnosis
Ineffective therapeutic regimen management
Teaching, counseling, coping, decision-making
How do healthcare workers protect themselves?
Standard precautions
Post-exposure prophylaxis for healthcare providers
