HIV/AIDS

Question 1

HIV

Answer 1

• human immunodeficiency virus
• virus that causes AIDS
• HIV+ does not mean AIDS

Question 2

AIDS

Answer 2

• acquired immunodeficiency syndrome
• final stages of HIV infection
• AIDS does mean HIV+

Question 3

HIV Transmission

Answer 3

• unprotected sexual intercourse
• sharing needles/syringes
• cuts/injuries from sharp instruments (scalpel)
• prenatal/perinatal transmission (1/3 of all HIV+ women)
• blood transfusion (1985 mandate; routine screening)- no longer a problem
• HIV is not transmitted via food, air, or casual contact

Question 4

The Immune System

Answer 4

• described as a constellation of responses to attack from outside the body (antigens)
• antigens: any substance that elicits an immune response
• antigen-specific response: recognize and act against particular antigens
• system response: not confined to the initial site of infection but works throughout the body
• memory: recognize and mounts stronger subsequent attacks

Question 5

Adaptive Immune System

Answer 5

• natural immune system protects the body for a few days secondary to its nonspecific antigen focus
• the adaptive immune system defends and protects from infection and foreign invaders; has the capability to call upon other aspects of the immune system to complete specific tasks
• the adaptive immune cells develop in the thymus and the bone marrow and then congregate in the lymph nodes moving throughout the body via the blood and lymphatic streams

Question 6

The blood system

Answer 6

• humans possess approximately 5 liters of blood
• all blood cells are manufactured by stem cells found in the bone marrow; stem cells produce hemocytoblasts
• hemocytoblasts mature into: red blood cells (erythrocytes), white blood cells (leukocytes), and platelets (thrombocytes)
• leukocytes are comprised of several differing subtypes one of which includes the lymphocytes; the two primary lymphocytes are B-cells and T-cells

Question 7

The lymphatic system

Answer 7

• lymph nodes are filters that attempt to identify antigens; that is why they become edematous when we are sick (persistent generalized lymphadenopathy or PGL)
• the lymphocytes that manage and execute all activities of the adaptive immune system are the B-cells and the T-cells
• B-cells recognize the presence of antigens and then acts per the activation signal by releasing antibodies
• T-cells (various categories specifically CD-4 T-cells); detects antigen presence but kills antigen itself; does not use antibodies

Question 8

HIV Presence

Answer 8

• HIV attacks the CD-4 T-cells and kills them
• CD-4 T-cells send activation signals to the B-cells
• because the CD-4 T-cells are unable to activate the B-cells, the pt with HIV is susceptible to a host of other infections and diseases

Question 9

HAND or ADC 1

Answer 9

• HIV associated neurocognitive decline/disorder
• AIDS dementia complex
• essential features: disabling cognitive impairment with motor dysfunction, speech problems, and behavioral change
• cognition: mental slowness, memory deficits, and poor concentration
• motor: loss of fine motor skills, clumsiness, poor balance, tremors

Question 10

HAND or ADC 2

Answer 10

• behavioral changes: apathy, lethargy, diminished emotional responses, and decreased spontaneity
• ADC or HAND associated with low CD4 cells; often present as the first sign of AIDS
• HAND/ADC has declined secondary to HAART or high active antiretroviral therapy; medications will only delay onset
• dementia exists when the pt’s neurocognitive impairment is severe enough with daily functions or be unable to work; social interaction

Question 11

HAND or ADC Stages 1

Answer 11

• stage 0: normal mental and motor function
• stage 0.5: (subclinical) minimal symptoms of cognitive or motor dysfunction characteristic of ADC/HAND or mild signs but without impairment of work or capacity to perform ADLs; gait and strength are normal
• stage 1: (mild) evidence of functional intellectual or motor impairments characteristic of ADC/HAND but able to perform all but the more demanding aspects of work or ADLs; can walk without assistance

Question 12

HAND or ADC Stages 2

Answer 12

• stage 2: (moderate) cannot work or maintain the more demanding aspects of daily life but are able to perform basic ADLs of self-care; ambulatory but may require a single prop
• stage 3: (severe) major intellectual incapacity; cannot follow news or personal events; cannot sustain complex conversation with considerable slowing of all output; motor disability where pt cannot walk unassisted; requires a walker or support
• stage 4: (end stage) nearly vegetative; intellectual and social comprehension and responses are rudimentary; possible mute and paraparetic or paraplegic; urinary/fecal incontinence