HIV/AIDS Flashcards by Tahlia Wasserman

What is HIV?

Human immunodeficieny virus that selectively incapacitates the CD4 T lymphocytes
An infectious sexually transmitted disease

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What is AIDS?

Acquired immunodeficiency syndrome
End stage HIV

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How is HIV transmitted?

Via exchange of body fluids like blood or semen

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Is HIV transmitted by casual or household contact, inanimate objects, saliva, or sweat?

Nope

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What are the modes of transmission of HIV?

Blood (needle sharing)
Sexual activity
Mother to fetus (breast milk or placenta)

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T/f: HIV is associated with high risk behaviors

True

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What high risk behaviors are associated with HIV?

Unprotected anal, vaginal, or oral sex
Multiple (6+/year) sexual partners
Sexual activity with someone with known infection
IV drug users

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Are we getting better at controlling transmission?

Yes

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Are more men or women affected by AIDS?

Men

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What is are the steps in pathogenesis of HIV?

Infection of CD4 cells, macrophages, B cells, microglial cells
Virus replicates and mitigates to CD4 cells inside of lymphocytes
Migrates to bloodstream and lymph tissues and spreads through the body and becomes symptomatic
Progressive loss of fxn of the immune system bc CD4 T cells amp up other parts of the immune system
Widespread signs of immune compromise-AIDS

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In acute HIV infection, are the CD4 cell counts normal?

Yes

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What is the timeline for acute infection of HIV?

1-6 weeks post infection

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What are the manifestations of acute HIV infection?

No antibodies
Possible flu like symptoms
High viral loads

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Are the CD4 counts normal in asymptomatic HIV?

Yes

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What is the timeline of asymptomatic HIV?

1-20 years

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What are the manifestations of asymptomatic HIV?

Positive for antibodies
Possible fatigue, and lymphadenopathy

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Are the CD4 cell counts normal in symptomatic HIV?

No, they are slightly lower between 200-500/mm3

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What is the timeline of symptomatic HIV?

Variable

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What are the manifestations of symptomatic HIV?

Generalized adenopathy
Diarrhea
Weight loss
Fatigue
Night sweats
Fever
Possible Neuro symptoms

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Are the CD4 counts normal in AIDS?

No, they are low <200/mm3

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What is the timeline of AIDS?

Variable

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What are the manifestations of AIDS?

Neuro symptoms
Opportunistic infections
Malignancies
Dermatological conditions

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What disease causes CD4 count to be <200/mm3 OR HIV with an AIDS-defining illness?

AIDS

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What are the AIDS-defining illnesses?

Cytomegalovirus
P carinii pneumonia
Toxoplasmosis
HIV-related dementia
Certain malignancies
Skin condition-Kaposi sarcoma

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What is Kaposi sarcoma?

A type of herpes only seen in ppl with AIDS

T/f: delayed healing is a key symptoms of HIV

True

What are the 3 classifications of pain syndromes in HIV?

Pain associated with HIV infection, immunosuppression, opportunistic diseases, correlated comorbidities Pain associated with HIV diagnostic procedures/treatment Pain unrelated to HIV disease

People with ____ CD4 cell counts have a high likelihood of severe pain, people with _____ CD4 cell counts are associated with lower risk of severe pain

Lower, higher

T/f: 1/3 of ppl with AIDS have distal sensory polyneuropathies (peripheral neuropathy)

True

What are the risk factors for peripheral neuropathy in AIDS?

Advanced stage, low CD4 cell count, high viral load

What are the causes of peripheral neuropathy in AIDS?

Antiviral meds, vitamin deficiencies, metabolic abnormalities, opportunistic infections

What are the symptoms of peripheral neuropathy in AIDS?

Pain, sensory impairments in glove and stocking pattern, balance impairment

What is the order of nerves affected in peripheral neuropathy?

Sensory—>motor—>autonomic

What are the MSK disease manifestations of HIV/AIDS?

Osteomyelitis Bacterial myositis Infectious arthritis Osteonecrosis Osteopenia Osteoporosis Avascular necrosis HIV wasting syndrome

What MSK disease manifestations of AIDS/HIV are associated with increased risk of infection?

Osteomyelitis Bacterial myositis Infectious arthritis

What are the MSK disease manifestations of HIV/AIDS that affect the balance of osteoblasts/coasts and are seen in people living with HIV for a long time?

Osteonecrosis Osteopenia Osteoporosis

What MSK disease manifestion of HIV/AIDS that is associated with some antiviral meds?

Avascular necrosis

What is HIV wasting syndrome?

Disproportionate loss of metabolically active tissue

What are the causes of HIV wasting syndrome?

Decreased food intake Altered metabolism Poor nutrient absorption

What are the symptoms of HIV wasting syndrome?

Extreme weight loss Chronic diarrhea Weakness Fever Malnutrition

What is HIV-associated myopathy?

Progressive ms weakness in proximal limbs and trunk

What is the presentation of HIV associated myopathy?

Symmetrical Proximal May affect face and neck ms

T/f: HIV associated myopathy can be seen at any stage of HIV disease

True

What do ms biopsies show with HIV-associated myopathy?

Ms fiber necrosis

What is lipodystrophic syndrome?

Defective fat metabolism, dyslipidemia, and insulin resistance resulting fat loss in the limbs and face and fat deposition in the viscera, abdomen, breast tissue, and back of the neck

Where do we see fat loss with lipodystrophic syndrome?

In the limbs and face

Where do we see fat deposition in lipodystrophic syndrome?

In the viscera, abdomen, breast tissue, back of neck

T/f: lipodystrophic syndrome is associated with starting HAART therapy

True

T/f: those with lipodystrophic syndrome are more at risk for CVP diseases

True

Why is pulmonary hygiene so important in pts with HIV/AIDS?

Bc they are very prone to respiratory diseases

What are the pulmonary disease manifestations of HIV/AIDS?

Opportunistic infections Bacterial pneumonia TB Bronchitis

What are the cardiovascular disease manifestations of HIV/AIDS?

Altered lipid metabolism, altered glucose metabolism, increased BP leading to atherosclerosis Increased risk for MI, cardiomyopathy, pericardial effusion, pericarditis

What is a major cause of mortality for people with well controlled HIV disease?

Cardiovascular disease manifestations

T/f: CV disease manifestations in HIV can be caused by HIV disease and HAART treatment

True

What lymphomas are more common with HIV positivity?

Burkitt lymphoma Non-Hodgkin lymphoma Hodgkin lymphoma

What is the second most common HIV associated CA after Kaposi sarcoma?

AIDS-related lymphoma???

AIDS-related lymphoma can occur at any disease stage of HIV but is more common with _____ CD4 cell counts

Lower

T/f: AIDS-related lymphoma is often aggressive and metastasizes

True

What is involved in prevention of HIV/AIDS?

Screening tests Limit needle sharing Reduce # of sexual partners Consistent and correct use of condoms Correct use of HAART treatment

What is the only contraceptive that can prevent HIV?

Condoms

When taken correctly, HAART meds do what?

Make the virus undetectable in blood sample

T/f: HAART meds can make it very unlikely to transmit the virus during sex and less likely to transmit through drug use

True

What are the 3 diagnostic tests for HIV?

Virus in blood Antigen/antibody Antibodies

If diagnostic tests are positive for HIV, that is done?

Test for viral load and CD4 T cell counts in about 2 weeks and start treatment immediately

Is there a cure for HIV?

Not yet

What do meds for HIV do?

Ease symptoms and prolong life

T/f: meds for HIV eliminate transmission

False, they reduce transmission, but don’t eliminate transmission

What is HAART (highly active antiretroviral therapy)?

7 classes of FDA approved drugs with each class active in different parts of the HIV cell cycle

What is involved in infection control in healthcare?

Protection of HIV (+) persons Protection of healthcare personnel

What is involved in protection of HIV (+) persons?

Infection control with handwashing, standard precautions, disinfection Prevention of pulmonary infections with frequent mobilization and position changes, and aspiration prevention

What is involved in infection control for persons with HIV?

Handwashing Standard precautions Disinfection

What is involved in prevention of pulmonary infections in persons with HIV?

Frequent mobilization and position changes Aspiration prevention

What are the potential sources of transmission of HIV to healthcare workers?

Blood, bloody body fluids, tissues, semen, vaginal secretions, CSF, synovial fluid, pericardial fluid, amniotic fluid, needle stick

T/f: sweat and non blood body urine/feces lead to exposure to HIV

False

In the asymptomatic phase of HIV, is exercise safe?

Yes!

In the asymptomatic phase of HIV, what is the benefit of exercise?

To increase CD4 cell count and delay progression

Are there limitations on exercise in asymptomatic HIV?

Nope

T/f: exercise in asymptomatic HIV may improve hyperlipidemia and glucose control

True

T/f: HAART may reduce aerobic capacity in asymptomatic HIV

True

During the symptomatic phase of HIV, what approach should we take to exercise?

Symptom based approach

T/f: With symptomatic HIV, pts need a more individualized exercise prescription to address any impairment or limitations

True

Who should we collaborate with to determine the precautions to exercise with symptomatic HIV?

The physician

What intensity aerobic exercise is recommended for symptomatic HIV?

Moderate intensity

What are the benefits of moderate intensity aerobic exercise for symptomatic HIV?

Improves fatigue, weight management, fat, central fat, CV fitness, anxiety, and depression

What exercise should be avoided with symptomatic HIV? Why?

High intensity exercise bc it can suppress the immune system

What is the benefit of progressive resistive exercise with HIV wasting syndrome?

Increase lean body mass

Why is there an increased # of pts with HIV today?

Bc of advanced treatment and longer life expectancy

Why should we include HIV status in hx taking?

Bc many pts are undiagnosed or unwilling to disclose the info otherwise and it affects our treatment

T/f: osteoporosis plays a role in risk factor assessment of HIV

True

What is the focus of PT management in HIV?

Managing impairments and functional limitations

What should we consider including in PT for HIV?

Strengthening, QOL, work and ADLs, community activities, stretching, breathing exercises

What should we work on in PT with pts with peripheral neuropathy and HIV?

Balance, gait, desensitization programs

T/f: therapy may have little benefit if nutritional deficiencies are not addressed in HIV

True

Is exercise appropriate for pts with acute myopathy?

No, it is contraindicated!!!

What are the psychosocial aspects of HIV care?

Awareness of prejudice and judgement Stigmatization, family isolation, fear Anxiety, depression Empathy compassion, understanding