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HIV & AIDS Flashcards

1
Q

Highest prevalence of HIV is in ______

A

Africa

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2
Q

by sex assigned at birth, more common in ________
more prevalent in ______ race

A

males (but pretty even worldwide)
black Americans

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3
Q

______ prevalence, but _____ new cases

A

increase
less

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4
Q

PLWHA

A

people living with HIV or AIDS

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5
Q

HIV is a _____ infection and ______

A

primary
retrovirus

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6
Q

retrovirus is an ________ virus which replicated using enzyme ________ to copy RNA to DNA

A

enveloped RNA
reverse transcriptase

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7
Q

HIV invades the genetic core of the _________ cells to replicate.

A

CD4+ T-helper lymphocyte cells

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8
Q

HIV infection causes a progressive depletion of _____ cells which cause ______

A

CD4+ cells
immunodeficiency

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9
Q

transmission of HIV through ?

A

blood
semen
vaginal secretions
breast milk

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10
Q

most common method of transmission

A

sexual contact

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11
Q

in utero, during birth, or breast feeding

A

perinatal

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12
Q

what is recommended for babies

A

not breastfeeding unless country has unclean water
milk bank or formula

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13
Q

what test screens for HIV
window period?

A

HIV Antibody testing
up to 3 months

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14
Q

Prep is ?

A

Pre-exposure Profalaxis

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15
Q

The two main biomarkers used to assess disease progression are ?

A

CD4+ T-cell count
Viral load

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16
Q

Stages of HIV

A
  1. Acute HIV infection
  2. Clinical Latency
  3. Symptomatic HIV infection
  4. Aids
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17
Q

Period from transmission to the host until the production of detectable antibodies against the virus (_______) is ?

A

Acute HIV Infection
seroconversion

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18
Q

initial symptoms of Acute HIV infection
Occur _____ of infection
duration of symptoms ?

A

fever, malaise, pharyngitis, myalgia, swollen lymph glands
2-4 weeks
1-2 weeks

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19
Q

In the acute HIV infection phase, rapid viral replication prior to ___________, ___________ at this time

A

the specific immune response
highly infectious

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20
Q

when virus is active and replicating but at a lower rate than during acute stage?

CD4+ counts steadily decline. CD4+ is >_____

A

clinical latency/ asymptomatic HIV

> 500

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21
Q

characteristics of clinical latency HIV

A

lymphadenopathy (swollen glands)
seborrheic dermatitis (red blotches on skin)

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22
Q

clinical latency of HIV can last ______

A

10 years

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23
Q

what stage for symptomatic HIV infection has reduced cell-mediated immunity?

A

symptomatic HIV infection

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24
Q

symptomatic HIV infection CD4 count is _____

A

<500

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25
symptoms of symptomatic HIV infection
fevers chronic diarrhea unintentional weight loss recurrent fungal, bacteria, or viral infections oral candidiasis (mouth mucous infection), oral hairy leukoplakia (tongue looks hairy), herpes zoster (shingles)
26
AIDS stage includes the HIV infection along with CD4+ cell count of ______ or documentation of ______________
<200 an AIDS defining condition
27
when in aids are highly susceptible to __________
opportunistic infections
28
AIDS invloves opportunistic infections such as _____, _____, ______, and _____
pneumocystis jiroveci pneumonia cytomegalovirus (CMV) - can cause enteritis (inflammation on small intestine) and can cause blindness cryptosporidiosis - causes severe diarrhea Tuberculosis
29
other manifestations of AIDS (not opportunistic infections)
Kaposi's sarcoma lymphoma HIV-associated encephalopathy (can develop dementia) HIV-associated wasting direct organ damage
30
what is kaposi's sarcoma
Cancer of the lymphatic and vascular endothelium
31
clinical manifestations of kaposi's sarcoma
Purple nodules on skin, mucous membranes, lymph nodes, or throughout the GIT Lesions in the oral cavity or esophagus=> painful swallowing and/or dysphagia GIT - diarrhea or intestinal obstruction
32
Drug therapy for HIV And AIDS
antiretroviral therapy (ART) drugs used for complications consider side effects and food-drug interactions
33
Antiretroviral drugs => act to __________________ Combination of _____ antiretroviral agents Reduces __________ of the virus in the _____ Decrease rate of _______________ Increases survival time
suppress replication of HIV three concentrations blood opportunistic infections
34
what drugs block the virus's replication mechanism
nucleoside reverse transcriptase inhibitors (NRTIs)
35
NRTIs example
zidovudine (Retrovir)
36
what side effects can NRTIs cause
anorexia nausea diarrhea anemia
37
food Drug interactions with NRTIs
High fat meals (around 40 g) decrease drug absorption
38
drugs that Inhibit protease enzyme which HIV cells need to develop and mature
protease inhibitors (PI)
39
protease inhibitors example
indinavir (Crixivan)
40
side effects of protease inhibitors
nausea metallic taste diarrhea hyperglycemia hyperlipidemia lipodystrophy
41
FDI of protease inhibitors
avoid st. johns wort - increase metabolism of drug (decrease serum levels) avoid grapefruit - compete for cytochrome p450 enzymes and result in increased or decreased drug levels
42
drugs that Blocks the virus’s replication mechanism
Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
43
Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) example
nevirapine (viramune)
44
Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) side effects
N/V stomatitis diarrhea hepatotoxic
45
Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) FDI ?
avoid st.johns wort - induces enzymes systems leading to increased metabolism and lower serum levels
46
challenges of Antiretroviral Therapy (ART)
Adherence - Complicated regimens - Side effects - Cost Drug resistance
47
other medications for HIV AIDS
Antifungal (Amphotericin B) Antibiotics Antiprotozoal (Pentamidine) Antiviral (Acyclovir) Isoniazid (INH)
48
Isoniazid (INH) FDI ?
Causes decreased vitamin B6 levels Rx: Pyridoxal 5-phosphate supplementation of 25-50 mg/d
49
HIV-associated Wasting Syndrome is unintentional weight loss and loss of LBM... CDC definition: >____ weight loss from baseline accompanied by: ___________________; or ______________________________
10% diarrhea for >30 days chronic weakness & fever for >30 days in the absence of an infection
50
cycle of HIV wasting
Decreased intake, malabsorption, and increased caloric needs malnutrition tissue mass depletion and muscle wasting increased susceptibility to infection increased vulnerability to treatment related toxicities increased weekness
51
Impact of Malnutrition
decreased immune functions Reduced response to treatments, decreased quality of life, decreased longevity
52
decreased immune functions can create deficiencies such as ________ that interfere with immune function ?
protein EFA vitamins A, C, D, E, zinc, selenium
53
Causes of Malnutrition & Wasting
Inadequate oral intake GI tract disorders, infections, malabsorption Increased metabolic rate Lack of physical activity Alcohol use disorder
54
Decreased Oral Intake Due to:
Anorexia: meds or illness GI distress Fatigue Dysgeusia due to meds, xerostomia, or oral candidiasis Depression Dyspnea Neurologic disease=> altered mental status Food insecurity Disorders of the oral cavity & esophagus
55
Disorders of the Oral Cavity & Esophagus examples
Oral candidiasis Tumors, lesions, Kaposi’s sarcoma
56
Disorders of the Oral Cavity & Esophagus can cause ?
soreness of the mouth & tongue, difficulty chewing, odynophagia, dysphagia
57
GIT is one of the most common systems affected by HIV _________ is the most common symptom Can also experience ______, ______, and _______
Diarrhea N/V Abdominal pain Malabsorption
58
Causes of Diarrhea
Medications Intestinal pathogens Kaposi’s Sarcoma Lactose intolerance Fat malabsorption
59
Gastrointestinal Pathology in HIV/AIDS - Intestinal _______________
pathogens & neoplasms
60
Gastrointestinal Pathology in HIV/AIDS what are some problems that can happen? (pathogens? and neoplasms?)
Cytomegalovirus, Cryptosporidiosis, Mycobacterium avium complex (MAC) Neoplasms=> GI Kaposi’s sarcoma; Lymphomas HIV-enteropathy
61
causes of Gastrointestinal Pathology in HIV and AIDS
diarrhea enteritis colitis GI bleeding malabsorption obstruction
62
Infections of the small intestine can cause malabsorption of ?
fat (steatorrhea) fat-soluble vitamins protein vitamin B12 minerals
63
Infections of the large intestine can cause problems absorbing _________
water & electrolytes
64
NFPE & Anthropometry for HIV AIDS Anthropometric data? NFPE?
Ht, Wt, %IBW, %Wt change over time, BMI TSF, MAMC=> assess fat and lean body stores Muscle & fat wasting Functional status HIV-associated lipodystrophy syndrome (HALS)
65
HIV-associated Lipodystrophy Syndrome (HALS) is associated with: body shape changes=>_______________ metabolic abnormalities=> ________________ The cause of is multifactorial and includes duration of HIV infection and duration & type of ______ medications
fat deposition on the back of the neck, abdominal area, and around the organs high TG & LDL-chol; low HDL-chol ART
66
biochemical data to look at
Electrolytes BUN, creatinine FPG LFT’s CBC Lipid profile CD4 count Viral load
67
Living arrangements Social/family support Financial resources Educational background and health literacy Substance abuse Depression, anxiety Food insecurity
Psychosocial & Economic Issues
68
Nutrition History __________=> Adequacy of diet _______ history GI status; ____________ ability Food allergies & intolerances Alcohol & caffeine intake Ability to prepare meals Available cooking/shopping facilities Exercise Supplement use Use of __________________
Usual food intake Weight chewing & swallowing complementary or alternative therapies
69
Complementary/Integrative & Alternative Therapies
Concentrated garlic supplements =>can decrease serum levels of some protease inhibitors St. John’s Wort=>can decrease serum levels of some indinavir (PI) and nevirapine (NNRTI) Probiotic supplements=>used for diarrhea and gut dysbiosis
70
Must individualize and consider weight and nutrition status, severity of disease, opportunistic infections, & comorbidities because there is a _______________ for this population
Lack of accurate predictive equations
71
REE may be ________ in PLWHA compared to HIV-negative individuals Asymptomatic HIV: REE may be increased by ____ Opportunistic infection: REE may increase by ______
higher 10% 20-50%
72
Generalized nutrient recommendations for transgender HIV patients are ____________ __________ kcal/kg calculations may be preferred Transgender men on androgen therapy=> _______ in LBM and a _________ in body fat Transgender women on antiandrogens & estrogen therapy=> __________ in LBM and an _________ in body fat
not yet established Gender-neutral increase decrease decrease increase
73
PROTEIN Consider factors that increase protein requirements=> infections, healing, protein malnutrition, protein-losing enteropathy, comorbidities Asymptomatic HIV: ________ g/kg BW Symptomatic patients: ________ g/kg BW
1.0-1.4 1.5-2.0
74
FAT Individualize _____ for % kcal from fat Consume <_____ of kcal from SFA Increase intake of ___________ For individuals with hyperlipidemia or other CVD risk factors=> ____________ If fat malabsorption use ____________
DRI 10% omega-3 fatty acids heart healthy diet 40 g low fat diet
75
Monitor for potential deficiencies due to: Inadequate diet GI losses; __________ Altered _________ _______ interactions Nutrients of concern: _______________ Provide a MVI with minerals (100% DRI’s), if __________
malabsorption metabolism Food-drug vitamins B12, A, E, D, selenium, zinc, & iron dietary intake is inadequate
76
Fluid & Electrolytes Individualize Factors increase fluid requirements: _______________________ Replace electrolyte losses (e.g., ____)
Fever Vomiting Diarrhea K+
77
Goals of MNT Optimize nutritional status and _________ Maintain a healthy ______ Prevent nutritional deficiencies Reduce the risk of _________ or treat/manage Maximize the effectiveness of _________ treatment Enhance ___
immune function BW & LBM comorbidities pharmacologic QOL
78
Nutrition Education - Educate on importance of nutrition and maintaining adequate nutritional status Well-balanced, _______ diet Emphasize regular physical activity ________ diets as needed ________ management Food-drug interactions Potential SE and interactions of herbal or micronutrient supplements _______ precautions to prevent food-borne illness
high protein Therapeutic Symptom Food safety
79
Food Safety Precautions Avoid _____________ Avoid using _________ eggs Thaw perishable foods in the_________ Wash raw fruits and vegetables thoroughly Use only _________ milk Cook to appropriate temperatures Store food at appropriate temperature Adhere to the ___________ on labels Wash hands before handling food
raw protein foods, rare meat cracked eggs refrigerator pasteurized expiration dates
80
Inadequate Intake Obtain food preferences Rx ___________ Focus on _________ foods Concentrate intake at time of day when _________ and in a pleasant environment _____________ as needed Consider home delivered meals Rx ____________ Consider recommending MD to order __________ May require __________
small, frequent meals nutrient dense appetite is best Oral nutrition supplements (ONS) MVM supplement appetite stimulants enteral nutrition
81
MNT for Oral or Esophageal Inflammation or Lesions ___________ foods Avoid highly ________ and ______ foods & beverages Avoid hard and salty foods Avoid ________ extremes Provide _______ for drinking Avoid dry foods Drink liquids _______ ______ to numb mouth
Soft, moist seasoned and acidic temperature straws with meals Popsicles
82
MNT for Dysgeusia Food preferences ______ foods Drink fluids ________ Experiment with flavors & seasonings Alternative sources of _______ Avoid ______ foods Good ______ care
Cold with meals protein canned mouth
83
MNT for Diarrhea Adequate _________ __________ meals Limit _______ fiber and _______ soluble fiber Limit intake ________, _______, ________ Avoid high _____ foods and spicy foods Low lactose diet if needed Reduce intake of _______
hydration & electrolytes Small, frequent insoluble increase sorbitol, caffeine, alcohol fat sugars
84
MNT for HIV-associated Lipodystrophy Syndrome (HALS) follows what guidelines ?
Follow the American College of Cardiology/American ♡ Association (ACC/AHA) Guidelines n Reduce intake of saturated fat to 5-6% of total kcal n Reduce trans-fat to as little as possible n Increase soluble fiber n Include omega-3 fatty acids n Increase physical activity
85
MNT for HIV-associated Lipodystrophy Syndrome (HALS) Reduce intake of saturated fat to_____ of total kcal Reduce trans-fat to ________ Increase _______ Include _______ fatty acids Increase __________
5-6% as little as possible soluble fiber omega-3 physical activity
86
Enteral Nutrition used when ___________ Tube placement considerations: ______ of therapy _________ Avoid nasoenteric tubes if __________ Formulas: Use _____________ formulas If fat malabsorption=>__________
patient cannot consume adequate nutrition orally Duration GI function painful esophageal lesions high protein, polymeric semi-elemental
87
Parenteral Nutrition Indication=>________ Risk is ________ Must consider risk vs. benefits
Severe GI dysfunction Increased infection risk

Advanced MNT 1 (20 decks)

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