HIV AIDS EXAM 3 Flashcards
Cultural and societal factors in HIV risk
-Poverty
-Lack of education opportunities
-Lack of access to health care
-Homophobia
-Stigma
-Racial /ethnic or gender discrimination
Human Immunodeficiency Virus (HIV) Patho
-Retrovirus that attacks immune cells
-Attacks T cells with CD4 receptors which are expressed on the surface of T lymphocytes and monocytes
-Virus enters the cell and replicates, causing the CD4 cells to die, the remaining infected cells release virions which infect other cells and leads to further progression
-If left untreated HIV can become Acquired immunodeficiency syndrome
How is HIV transmitted
-Mucus membrane, and any break in skin (Drug use)
-Through bodily fluids (Blood, semen, rectal fluids, vaginal fluids, amniotic fluid, breast milk)
Highest risk of HIV transmission
Anal or vaginal sex without condom
-Sharing needles, syringes or other ejection equipment
How long does HIV live in a syringe or needle
42 days depending on temp or other factors
Perinatal transmission of HIV
Mother to child during preg, birth or breastfeeding
-Less common
-Recommended all preg women be tested for HIB and start treatment immediately if positive
-Most common way for children to get HIV
-If baby is treated for 4-6 weeks after birth the risk of transmission is <1%
Occupational risk of HIV
-Needle pokes or sharp objects
-We are at risk as nurses
-Or splash of bodily fluids, have to cross mucus membrane
Oral sex transmission of HIV
-Rare transmission, has to either have blood, open sores, or other STI present AND has to have a detectable viral load
Rare HIV transmission
-Oral sex
-Blood transfusions, blood products or organ tissue transplants (Blood is screened)
-Being bitten by a person with HIV (Not unless skin is broken in person with HIV)
-Deep open mouth kissing, with open lesions
What is HIV not transmitted by
-Saliva, tears or sweat
-Hugging shaking hands, sharing toilets, sharing dishes, closed mouth kissing
-Mosquitos, ticks or other blood sucking insects
A patient develops gastrointestinal bleeding from a gastric ulcer and requires blood transfusions. The patient states to the nurse, “I am not going to have a transfusion because I don’t want to get AIDS.” What is the best response by the nurse?
A. “I understand what you mean, you can never be sure if the blood is tainted.”
B. “I understand your concern. The blood is screened very carefully for different viruses as well as HIV.”
C. “If you don’t have the blood transfusions, you may not make it through this episode of bleeding.”
D. “No one has gotten HIV from blood in a long time. You have to have the transfusion.”
B. “I understand your concern. The blood is screened very carefully for different viruses as well as HIV.”
HIV testing recommendation
Ages 13-64 get tested once
-High risk people (multiple sexual partners, IV drug user) at least once a year sometimes more
-Preg women, should be tested
-Early detection is key due to the high risk of transmission that precedes seroconversion and the potential opportunity to improve health outcomes with early treatment (If you catch early, reduces viral load and lowers chance of transmission)
Test to diagnose HIV: Standard Test
-With blood, done in the lab
-Takes weeks
-Identifies antibodies and antigens
Test to diagnose HIV: Rapid antibody screening test
-Antibody, means the body has to mount a response first for it to show as positive
-Rapid test, can be done from a finger prick or oral swab
-Cheap and easy, and can be anonymous
-Takes 5-40 min
-Main in with prick of blood or oral fluid
-Can buy in pharm or online for rapid test
-Initial positive rapid antibody test must be followed by a confirmatory lab based combination antigen/antibody assay (Rapid isnt good enough for diagnosis)
-Negative test does not need to be confirmed
-Shows the body mounting the immune response, can take time after the exposure for it to show up as positive
Test to diagnose HIV: Antibody only tests
-Enzyme-linked immunosorbent assay (ELISA) followed by a confirmatory western blot if the ELISA is positive (Antibody only test need further confirmation)
-Can fail to diagnose individuals who are early into the course of the infection where the body hasnt developed antibodies fully
-Super accurate for those with a chronic infection tho
-She basically said its kinda outdated
Test to diagnose HIV: Combination antigen/ antibody test
-Able to identify acute/ EARLY infection when compared to antibody only test
-Positive test is followed by a second test to confirm
-Combo antigen and antibody test can detect HIV p24 antigen, when the antibody may not even be present yet
Test to diagnose HIV: HIV-1/ HIV 2 Immunoassay
-Detects antibodies and P24 antigen
-Follow up with confirmatory test, to differ between HIV 1/2 (Strains of HIV) which is helpful for selecting treatment
-Detects both antibody and antigen
Test to diagnose HIV: HIV-1 / HIV-2 Differentiation assay
-Differentiates between HIV 1/2 or both strains
-HIV 2 is less common than HIV 1 in the US, can help with decision making
Viral detection test
- Establishes an HIV diagnosis since virus is present in blood before antibodies can be detected
- Most test are used to detect HIV RNA (Viral load) and HIV p24 antigen (foreign antigen)
- HIV P24 antigen test: detectable 1-2 weeks after viral transmission (Cheaper than NAT and can identify 80-90% of infections in the acute period)
-HIV RNA is a NAT
Test to diagnose HIV: Nucleic Acid Amplification testing (NAT)
-Multiple lab test, used to detect the genetic material of HIV in the blood
–Expensive
-HIV RNA is a NAT
Test to diagnose HIV: HIV RNA
-Type of NAT
-Detects the amount of virus in the body, or the “Viral load”
-Should be performed if there is a concern for acute HIV infection
-Used when there is a suspected opportunistic infection
You are counseling a patient who called concerned about possible HIV exposure during a one night stand with an individual. What test(s) would provide the most accurate results to determine HIV transmission? SATA
1.) Western Blot
2.) HIV RNA
3.)ELISA
4.) P24 Antigen
5.) HIV 1/2 Assay
2.) HIV RNA
4.) p24 Antigen
5.) HIV 1/2 Assay
Anything that test the antigens is more accurate than the antibodies
The Western Blot and ELISA test are antibody only tests.
Most accurate tests would be confirmatory test with a combined antibody/antigen test and a viral test
Assessment and monitoring HIV: 2 test
HIV RNA
CD4 T lymphocyte cell count
Assessment and monitoring HIV: HIV RNA
-Amount of virus in the blood (Viral load)
-Undetectable or low–> 20-50 copies
-Acute phase, super high plasma HIV RNA levels >100,000 copies
-Goal is to be in the undetectable stage, done with ART therapy
HIV RNA: Undetectable
-20-50 copies per ml
HIV RNA: acute
100,000+ copies per ml
Assessment and monitoring HIV : CD4 T lymphocyte cell count
-Level of immune function
-Used to stage disease
-Used to monitor for the destruction of CD4 Cells
-Monitors the effectiveness of the antiretroviral treatment
-Best indicator of disease progression
-Decline of CD4 T cells can lead to opportunistic infections and it increases mortality
Normal CD4 Level
500-1500 cells/mm^3
AIDS CD4 level
<200 cells/mm^3
Stage 0 HIV infection (CDC)
-First weeks and months after infection, no symptoms
Stage 1 HIV infection (CDC)
500+ cells/mm^3
-CD4 is at 26%+
-No AIDS defining condition
Stage 2 HIV infection (CDC)
200-499 cells/mm^3
-CD4 is at 14-25%
-No AIDS defining condition
-Starting to have symptoms
Stage 3 HIV infection (CDC)
<200 cells/mm^3
CD4% is less than 14
-AIDS defining condition
-Or they develop an opportunistic infection
HIV staging, Initial transmission/ Stage 0-1
-Huge amount of viral load, extremely contagious
-2-4 weeks after infection they have flu like symptoms or no symptoms (Super vague symptoms)
-May not know they have HIV infection may think its some other minor illness
-Test for acute infection, use an antigen/antibody or NAT is needed
NAT or p24 antigen
High antigen number, high viral load
HIV Staging: Stages 1-2
-Called asymptomatic HIV infection or chronic HIV infection
-Stage defined by CD4 count
-Asymptomatic or may exhibit fatigue or skin rash
-HIV is still active and SLOWLY reproduces (if untreated)
-Can still transmit HIV, even if asymp, if not on treatment
-If they are on ART, with an undetectable viral load they can stay healthy and not transmit HIV
-With treatment they can live for decades and never go to stage 3
-Without treatment they may last a decade and the disease may move faster
-End of stage the viral load increases and the CD4 count decreases, progressing to AIDS (CD4 is below 200)
HIV Staging: Stage 3
CD4 count under 200 or development of AIDS defining condition (Opportunistic infection)
- Super high viral load
- Most severe stage
-High viral load and can easily transmit HIV to others
-Immune system badly damaged and will develop opportunistic infections from lowered CD4
-Without treatment they survive 3 years
-Symptoms related to immunosuppression and the underling problem/opportunistic infection
Which statement reflects treatment of HIV infection
1.) Treatment should be offered to all clients once they reach CDC category B: HIV symptomatic.
2.)Treatment should be offered to only select clients once they reach CDC category B: HIV symptomatic.
3.) Treatment should be offered to clients with plasma HIV RNA levels less than 55,000 copies/mL (RT-PCR assay).
4.) Treatment of HIV infection for an individual client is based on the client’s clinical condition, CD4 T cell count, and HIV RNA (viral load).
4.) Treatment of HIV infection for an individual client is based on the client’s clinical condition, CD4 T cell count, and HIV RNA (viral load).
Per Lippincott–Although specific therapies vary, treatment of HIV infection for an individual client is based on three factors: the patient’s clinical condition, CD4 T cell count, and HIV RNA (viral load). Treatment should be offered to all clients with the primary infection (acute HIV syndrome). In general, treatment should be offered to clients with fewer than 350 CD4+ T cells/mm or plasma HIV RNA levels exceeding 55,000 copies/mL (RT-PCR assay).
Clinical manifestations AIDS
-Respiratory manifestations
-GI manifestations
-Oncologic manifestations
-Neuro manifestations
-Integumentary
-Gynecological
Clinical manifestations AIDS: Respiratory manifestations
-SOB, dyspnea, cough, chest pain
-Pneumocystis pneumonia, Mycobacterium avium complex (Non-infectious TB), TB (Infectious TB)
Clinical manifestations AIDS: GI manifestations
-Loss of appetite, N+V, oral candidiasis, Anorexia
-Wasting syndrome (cachexia)
Clinical manifestations AIDS: Oncologic manifestations
-Immune system is suppressed, certain cancers take advantage of this
-Kaposi Sarcoma: Purple red skin lesions
-AIDS related lymphomas
Clinical manifestations AIDS: Neuro manifestations
-Effects on cognition, motor function, attention, visual memory, visuospatial function
-HAND
-Peripheral neuropathy (From meds or from disease)
-Fungal infection, cryptococcus neoformans (Fungal infection in the brain
-Progressive multifocal leukoencephalopathy (Loss of vision)
-Depression or apathy
Clinical manifestations AIDS: Integumentary
-Herpes zoster
-Seborrheic dermatitis
-Genital ulcers
Clinical manifestations AIDS: Gynecologic manifestations
-Genital ulcers
-Persistant, recurrent vaginal candidiasis
-Pelvic inflammatory disease
-Menstrual abnormalities
-High risk of STI/STD
HIV associated neurocognitive disorder (HAND)
-Difficulties with attention, concentration, and memory, loss of motivation, irritability, depression and slowed movements
-Becomes at risk for developing HAND when they have a lack of viral suppression, low nadir CD4 count and increasing age
-Etiology is currently being studied by researchers
-May be residual injury from unsuppressed HIV viral replication in the brain prior to starting ART
What increases risk of HAND
-Lack of viral suppression
-Low nadir CD4 count
-Increasing age
Immune reconstitution inflammatory syndrome (IRIS)
Potential complication of HIV patients, Essentially ART causes you to have an immune system again which causes your body to attack pathogens in the body that were just chillin
-Occurs in HIV patients starting Antiretroviral therapy (ART)
-Occurs from restored immunity to specific infections or non-infectious antigens
-Paradocial clinical worsening of known condition or the appearance of a new condition after initiating therapy characterizes the syndrome. Improves CD4 but happens anyways
-Mycobacteria, varicella zoster, herpesviruses, cytomegalovirus (CMV)
What pathogens are in IRIS
-Mycobacteria
-Varicella zoster
-Herpesviruses
-Cytomegalovirus (CMV)
Goals of ART
-Viral load suppression, as low as possible for as long as possible (Undetectable is best)
-Suppress HIV replication
-Suppress HIV associated morbidity
-Prolong duration and QOL (Not a cure)
-Prevent HIV transmission (To others or to fetus)
When do you start ART
-Recommended all people with HIV start ART, no mater the T cell count
How long is art required for
Lifetime
What happens if you stop ART
-Causes increased viral load
-Decreased T cells/ progression of disease
-Taking inconsistently can lead to DRUG RESISTANCE , there are only 6 drug classes, and once youre out youre screwed
Highly active antiretroviral therapy (HAART)
-Triple drug therapy (more drugs the better)
- 2 drug classes, 3 drugs
-Novel formulations work by different mechanisms and target HIV in different stages of its life cycle
Goals of HAART
-Reduce morbidity and mortality (AIDS and non aids)
-Improve QOL
-Reduce plasma viral RNA load
-Prevent transmission to others
-Prevent drug resistance
-Improve immune function
HAART/ART Drug classes
-Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
-Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
-Protease inhibitors (PIs)
-Fusion inhibitors (FI)
-Chemokine Receptor antagonist (CCR5 antagonist)
Side effects of ART drugs
-There is so many for them, she said dont memorize them just know there is alot of them and eventually they get used to them, can take other drugs to help with side effect (Nausea meds for nausea)
-Kidney and liver toxicity
A female client with human immunodeficiency virus (HIV) receives family-planning counseling. Which statement about safer sex practices for persons with HIV is accurate?
1.) If the client and her sexual partners are HIV-positive, unprotected sex is permitted.
2.) A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse.
3.)Contraceptive methods, such as hormonal contraceptives, implants, and injections, are recommended to prevent HIV transmission.
4.) The intrauterine device is recommended for a client with HIV.
2.) A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse.
A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse. The nurse should caution the client not to have unprotected sex because continued exposure to HIV in a seropositive client may hasten the course of the disease or result in infection with another strain of HIV. Hormonal contraceptives, implants, and injections offer no protection against HIV transmission. The intrauterine device isn’t recommended for a client with HIV because it may increase her susceptibility to pelvic inflammatory disease.
Routine Lab monitoring HIV
CBC with diff: Infection and all that
-BUN: Liver
-Creatinine : Kidney
-LFTs: Liver
-Lipids: Meds can cause rise in cholesterol
-Glucose: Hyperglycemia
-Urinalysis: proteinuria, fluid and electrolyte imbalances
Routine Lab monitoring HIV: CD4 cell count
-3 mo after initiating therapy and then every 3-6 mo when stable
Routine lab monitoring HIV : HIV RNA test
Test viral load
-2 wk after the initiation of ART and then everry 4-8 weeks until level falls below the level of detection
(20-50 copies/ml)
-Then every 3-6 mo to confirm ongoing viral supression
-Dont check more than every 3 mo unless there is an issue at that point
Indications to change therapy
-Virologic Failure
-Toxicity
-Intolerance (Cant take meds/ cant take 2x a day)
-Inconvenience or preference (Doses are too frequent, pill burden, requirements with admin with food (can be erratic), expensive)
Virologic failure
-Failure for the viral load to decrease, indicates its time to change therapy
Nursing assessment , HIV
Identification of potential risk factors
-Physical status (Sores or wounds, chills, Feet)
-Psych status
-Immune system functioning
-Nutritional status
-Respiratory status (Breathing)
-Neuro status
-Fluid and electrolyte balance
-Knowledge level
Goal of care HIV
-Improve nutritional status, Infection cant be fought without food
-Increased socialization and expression of grief (People can feel socially isolated)
-Increased knowledge regarding disease prevention and self care
-Absence of complications
Nursing interventions HIV: Improving Nutritional status
-Monitor weight, dietary intake, serum albumin (Tells nutritional status)
-Prone to lose weight, need to monitor
-Goal is to maintain IBW. or increase weight
-HIGH PROTIEIN, HIGH CAL, LOW FAT
-Small frequent feedings
-Instruct ways to boost nutrition, lactose free supplements (Boost, ensure)
-Oral and tube feedings
-Appetite stimulants (Megace, Dronabinol,(weed))
Nursing interventions HIV: Decreasing sense of isolation
-Social work or psych
-Address pattern of social isolation
-Observe for behaviors indicative of social isolation
-Assist with identifying resources
Nursing interventions HIV: General
-Coping, grief/depression
-Bowel assessment and mgmt
-Monitor for infection
-Impaired airway clearance/gas exchange
-Reaction to meds
-Fluid and electrolyte imbalance
-Mgmt of fatigue
-Side effects mgmt
-Body image changes
HIV teaching: prevention strategies
-Education, behavior changes, testing
-Abstinence (Catholic school flashbacks)
-Avoid risky types of sex
-Dont share needles or syringes (use needle exchanges/ clean with bleach)
-Male and female condoms every time
-Frequent testing if engaging in high risk behavior, PrEP
-Occupational exposure standard, standard precautions, hand hygiene, counseling,PEP
Pre-exposure prophylaxis (PrEP)
- Two meds approved by the FDA for PrEP
-Most effective when taken every day
-Significantly reduces rate of infection in both sex and drug use
PrEP meds
-Truvada
-Descovy
Side effects of PrEP
-Nausea mainly, SE are not serious and go away over time
Post exposure prophylaxis (PEP)
-Take within 72 hours of a possible HIV exposure
-Taken every day for 28 days
-The sooner you take it after an exposure the better
-Only for emergent situations , not for those who may be exposed to HIV frequently
-Not a substitute for regular use of HIV prevention methods (Condoms, PrEP)
-Needs further testing after
-Needle sticks and all that
Treatment adherence is KEY
-Collab approach: nurse, social work, pharm, provider, case mgmt
-Assess knowledge and readiness to learn about HIV transmission, treatment and prevention
-Assess barriers to treatment and adherence (To avoid drug resistance)
-Provide info on meds, dose frequency, MOA, side effects
-Check adherence every visit
-CD4 and viral load checked
-Ask how many doses they miss each day in a non judgemental manner (Pill count)
-Patients may overstate adherence, do a pill count
-Check pharm refill records to monitor patient adherence
-Determine underlying reason for missing doses or stopping meds
HIV P24 antigen test
- Type of viral detection test
-Can establish HIV diagnosis since virus is present in the blood before antibodies can be detected
-Detectable 1-2 weeks after viral transmission
-Cheaper than the NAT
