HIV/AIDS Flashcards
HIV
Human Immunodeficiency Virus
A retrovirus that destroys CDS4+ T cells
Types of HIV and which one is most prevalent in the united states
-HIV-1 discovered first and most prevalent
-HIV-2 less pathogenic and confined to West Africa
AIDS
Acquired Immune Deficiency Syndrome
Caused by the HIV
-Typical untreated HIV infection that turns to aids
-Severe immune system dysfunction present when aids occurs
76% of adults and adolescents with HIV are
Men and black men have highest rate of new HIV infections
Men who have sex with men account for most new and existing HIV infections
New cases of HIV among women are increasing
Do not discount certain groups of people just because they arent highest risk
What is a retrovirus?
HIV
A type of virus that uses an enzyme reverse transcriptase, to translate its genetic information inot DNA
Pathophysiology of HIV/AIDS
- Retro virus that cannot replicate outside of living host cells
- Contains only RNA; no DNA
- Destroys the body’s ability to fight infections
- Infects CD$ cells - The primary target of HIV infection
Pathogenesis of HIV (main)
- Virus binds to the cell, the virus fuses with the cell membrane, allowing the virus to enter the cell
- Once inside, the virus uses** Reverse transcriptase** to make a DNA copy of its own RNA genetic material
- The viral DNA copy is then inserted into the genetic material of the infected cell, assisted by a viral enzyme call HIV integrase
- HIV inserts all the viral genes to direct the synthesis and assemble more virus
- The final stages of virus production requires a viral enzyme called HIV protease which is responsible for the virus particles that are released to attack, replicate and release more virus
-Helper T lymphocytes are their primary targets
Event: 1. HIV invades CD4+ cells and becomes part of cell DNA
Significance: 1. Individual is infected for life
Event 2: Virus proliferates in infected cells and shed virus particles
Significance 2: Virus present in blood and body fluids (also how they are spread)
Event 3: Body forms anti-HIV antibodies
Significance 3: Antibodies are marker of infection but are not protective like other antibodies
Event 4: Progressive destruction of HELPER T Cells
Significance 4: Compromised cell-mediated immunity
Event 5: Immune system collapse
Significance 5: Opportunistic infection, neoplasms
Why is HIV such a problem?
Decreases the number of CD4+ helper cells
-These CD4+ and T helper cells are necessary for immune function
Why is HIV such a problem?
HIV replicates prolifically
10 billion HIV particles are produced each day
Overwhelms the bodies defenses
Clinical Course: Stage 1 HIV
Early infection
-Rapid replications
-Not detectable by traditional lab tests
-No symptoms (non specific)
-Immediately infectious (spread disease before any symptoms)
Clinical course: Seroconversion
-Antibodies are detectable (We can detect the virus)
-Flu-like symptoms for several weeks
-HIGHLY INFECTIOUS
Clinical Course: Stage 2 HIV (latency)
Latency Stage
-Virus levels have stabilized (body is fighting infection)
-Last 3-12 years without tx (Can last decades with tx)
-Asymptomatic or mild symptoms
Clinical Course: Stage 2 (latency) (Rapid virus production)
-Persistent drop in CD4 T cell count
-Antiviral fight becomes less effective
-Viral load increases
Clinical Course: Stage 3 Symptomatic HIV infection
Eventually lead to AIDS
Symptoms of HIV
Symptoms usually 2-4 weeks post infection
-Sore throat
-Fever
-Night sweats
-Fatigue
-Chills
-Swollen lymph nodes
-Rash
-Muscle aches
Diagnosis of AIDS
1 and 2
Must have an AIDS defining conditions
and or
CD4 count less than 200 cell/mm3 regardless if an AIDS - defining condition is present
AIDS Defining Conditions (8)
- Pneumocystis Jiroveci Pneumonia
- Mycobacterium Tuberculosis
- Invasive Cervical Cancer
- HIV related encephalopathy
- Kaposi’s sarcome
- Pervasive candidiasis
- Aids defening Dementia
- Waisting syndrome
Wild, Alien, Pengiuns, Keep, Hiding, Inside, My, Pantry
Oral Manifestations HIV
-Very common and seen with CD4 counts drop
-Higher risk of progression to AIDS
-Teach patients about proper oral care
Oral Manifestations
-Oral hairy leukoplakia
-Periodontal disease
HIV associated Dementia
Aids dementia complex
Can cause cognitive problems because HIV cross BBB
Not as common now
How is HIV transmitted?
Transmitted through blood and body fluids
Anal and Vaginal Sex (not oral)
Perinatal transmission (mother to baby)
Sharing infected equipment
Contaminated blood transfusions or organ transplants
What can’t you get HIV from
Kissing
Hugging
Sharing food
Insect bites
Toilet seats
Bathing
Sneeze and Coughing
Sweat
Risk Behaviors HIV and AIDS
-Men having sex with men (black more)
-Injection drug use
-Male to male sexual contact + IDU
-Heterosexual contact
-Mother to child perinatal transmission
-Blood transfusion and blood exposure
Parenteral transmission of HIV
Needle/syringe sharing between IDU’s
Blood and blood products
Health care exposure to blood, body fluids, or needles/sharp instruments
What is the risk of HIV infections for HCW’s
Risk is little to none even in fluids have blood in them
Less than 1% even with needle stick injury
Pharmacology for HIV
-Antiretroviral therapy (ART) treats individuals with HIV
-6 major classes
Most common ART
2 nucleoside reverse transcriptase inhibitors and third agent from other class
Types of Agents: Entry Blockers
-Fusion inhibitors
-CCR5 Antagonists
Types of Agents: Enzyme Inhibitors
-Nucleoside Reverse Transcriptase Inhibitors (NRTI’s)
-Protease Inhibitors
-Integrase inhibitors
ALL HIV MEDS
-Prevent HIV from multiplication = lowering viral load = immune system chance to recover and produce more CD4 cells
-Does not cure
NRTI’s: MOA
Nucleoside Reverse Transcriptase Inhibitors
MOA: Inhibit reverse transcriptase –> thus blocking HIV retrovirus ability to incorporate its RNA into the host cell’s DNA
NRTI’s: Adverse Effects
-peripheral neuropathy
-pancreatitis
-hepatic steatosis
NRTI’S: BBW
Lactic Acidosis Syndrome
Rise in lactate
ART Principles
-Start ASAP after diagnosis
-GOAL: Decrease Viral Load to undetectable level
-Treatment guided by CD4 count, viral load, and patient preferences
When CD4 count is typically low, the ________ is usually ______
viral load - high
PrEP (pre-exposure prophylaxis)
-Use of antiretroviral medications usally one
-Detailed sexual and drug use history to determine risk (wont give to anyone because do not want to make it drug resistant)
-Condom use
-Can reduce risk of HIV transmission by great than 90%
PEP (post-exposrue prophylaxis)
-Recommendations based on exposure and barriers (treatment for non-occupational and healthcare professionals)
-Treatments include ART for 28 days check 6 week and 12 week
HIV targets CD4 receptors on
-CD4 (protein) on T lymphocytes, monocytes, macrophages
-T Lymphocytes (long term memory immune cells) (Main)
