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N304 > HIV/AIDS: Part 2, Treatment as Prevention to Precautions > Flashcards

HIV/AIDS: Part 2, Treatment as Prevention to Precautions Flashcards

1
Q

What are side effects of HIV drugs?

A
  • Range from mild and annoying to severe
  • Time - weeks to months
  • Common - GI disturbances: N&V, diarrhea, bloating, farting - appear within days, less problematic over time
  • Around 25% of people who start HAART will experience side effects that are severe enough to modify or stop treatment within the first year
  • Peripheral neuropathy and mitochondrial toxicity associated with NRTi’s
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2
Q

Describe how long QT is an unusual side effect:

A
  • A prolonged QT interval is associated with Torsades de Pointes and potential cardiac arrest
  • Associated with PLS and non-nucleosides
  • Number of associated meds including antidepressants, psychotropics and methadone as well as HIV
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3
Q

What are some non-physical side effects?

A
  • Impact on daily activities
  • Potential for unplanned disclosure
  • Psychological impacts
  • Changes in perception of health status
  • Treatment focused care - failure to see the whole person
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4
Q

What are some ways to reduce discomfort associated with HIV drugs

A
  • Manage nausea with anti-emetics, timing (pre-medicating), reassurance it will subside and taking meds with a meal or snack
  • CNS side effects (e.g. nightmares), try taking at bedtime or vice versa
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5
Q

What are the most common reasons that a person will stop taking ARV’s?

A
  • CNS side effects
  • GI side effects
  • Lipid issues
  • Renal impairment
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6
Q

What are the four predictors of durability (i.e. no resistance)?

A

1) Potency
2) Adherence *** (MUST take it accurately 95% of the time for success!)
3) Tolerance
4) Gold standard: triple therapy

These factors determine how well a patient does on HAART.

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7
Q

Describe the issue of adherence:

A
  • The single largest predictor of treatment success is adherence
  • Only 30% of people in a study filled their prescriptions > 95% of the time and had 2 serial undetectable plasma viral loads
  • Adherence levels of 60 to 90% most associated with resistance - close does not count - worst resistance with adherence levels of around 85%
  • Psychological and social barriers need to be evaluated in addition to demographic predictors
  • “It is more important to know what type of patient has a disease than what type of disease a patient has.”
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8
Q

What are some strategies to support adherence?

A
  • Ensure patient ready to start therapy
  • Patient education
  • Reinforce at each visit
  • Simplified regimens when able
  • Electronic reminders
  • Important to ask HOW people take meds, not IF
  • Assess for depression
  • Remember that adherence in chronic illness tends to decrease over time
  • Treat underlying addiction issues
  • Identify and treat side effects - don’t wait for patient to tell you!
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9
Q

What are common opportunistic infections?

A
  • Fungal infections
  • Protozoal infections
  • Bacterial infections
  • Viral infections
  • Cancers

These begin to appear in HIV+ persons as viral load increases and CD4 decreases. These are considered AIDS’s defining illnesses.

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10
Q

What are common fungal infections?

A
  • Oropharyngeal candidiasis (CD4 < 500)
  • Candida esophagitis (CD4 <100)
  • Vulvovaginal candidiasis
  • Cryptococcus - meningitis/pneumonia
  • Pneumocystis pneumonia (PCP)
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11
Q

What is significant about pneumocystis Jiroveci Pneumonia?

A
  • One of the most common
    AIDS related infections **
  • First identified about 100 years ago as a protozoa and called pneumocystis carinii
  • Reclassified as a fungus in 1988 and renamed in 1999 (pneumocystis jiroveci)
  • 50% of hospital admits with PJP are in people who have never been diagnosed with HIV
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12
Q

What is the most common bacterial infection in HIV+?

A
  • Mycobacterium Avium Complex (MAC), caused by bacteria in food, water and soil, and infects resp. and GI tract
  • CD4 <50, AIDS defining
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13
Q

What are common cancers in this population?

A
  • Kaposi’s sarcoma
  • Invasive cervical cancer
  • Lymphoma
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14
Q

What do most people with AIDS die of?

A
  • non-AIDS related cancers
  • liver failure
  • infections unrelated to AIDS
  • complications arising from substance use
  • suicide
  • heart attacks
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15
Q

Describe AIDS vs. Cancer:

A
  • AIDS differs from cancer in some significant ways:
  • predominantly impacts on a younger population; poorly housed; low income; mental health and/or substance use issues
  • Diseases of the marginalized
  • multisystem disease with multisysystem problems
  • unpredictable trajectory
  • polypharmacy
  • Informal caregivers are often HIV+ themselves
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16
Q

What are some issues for caregivers in the post-HAART era?

A
  • The timing of death has become even more uncertain
  • Decline and death most often seen in non-adherent clients or those who choose not to take HAART
  • There is a gap between caregivers’ preferences and patient’s wishes
  • Unpredictable course means that palliative care referrals should be made relatively early
  • Some treatments (i.e. for CMV retinitis) may be continued until death
  • People living with AIDS face a complex set of symptoms and conditions
17
Q

How is HIV different from other complex, chronic illnesses?

A
  • Stigma
  • Young age of clients/patients
  • Fear of contagion
  • Unpredicatable course of illness
  • Lack of resources, support
  • Multiple losses, death
  • Ethical and legal dilemmas
18
Q

Our attitudes, beliefs and experiences about ____ impact how we treat HIV+ individuals.

A
  • sexuality, sexual orientation
  • drug use
  • sex work
  • illness
  • death
  • professional omnipotence
19
Q

How do we as caregivers take care of ourselves?

A
  • Be reflective- seek out supervision or therapy
  • Do grief work for self
  • Limit caseload; use case mix
  • Set clear boundaries
  • Use stress management skills
  • Cultivate a healthy personal lifestyle
20
Q

What are significant exposures to HIV?

A
  • Any percutaneous exposure to infectious body fluids
  • Mucous membrane or non-intact skin exposure to a splash of blood (more than a few drops) and/or duration of exposure of a few minutes or more
  • Consider prophylaxis of large prolonged exposure on intact skin
21
Q

What are negligible exposures to HIV?

A
  • Minor percutaneous, mucous membrane or skin exposure to non-infectious body fluid (whether source is positive or negative)
  • Intact skin exposure to a small quantity of blood (< 3 drops) or fluid visibly contaminated with blood for short duration (< 3 minutes)
  • Bites unless there has clearly been a transmission of infected blood
  • A superficial scratch that does not bleed
  • Injuries received in fights would rarely be appropriate indications for prophylaxis unless it is clear that transfer of infected blood has occurred
22
Q

What are factors affecting degree of risk?

A
  • Prevalence of HIV/HCV
  • Source characteristics
  • Type of source fluid
  • Type of exposure - deep injury, visible blood on device, needle was placed in vein or artery
  • Illness of source patient - terminal AIDS = higher viral load = greater infectivity
23
Q

What do you do if you have an accidental exposure?

A
  • Wash area of exposure with warm, soapy water (for eyes and other mucous membranes just rinse with water)
  • Attend the nearest emergency department IMMEDIATELY - if you are determined to have a significant risk for HIV transmission the drugs should be started within 2 hours of exposure (PEP)
  • Take someone with you to advocate if you are feeling particularly anxious or distressed
  • Misc. such as supportive counseling, avoidance of sex/pregnancy/breastfeeding ~6 months, post-exposure blood-work, WCB claim, documentation and GP follow-up within 5 days
24
Q

What are some personal precautions?

A
  • Ensure you and sexual partners have open discussions about risks during intercourse
  • Insist on condoms
  • Never share needles
  • Get tattoos/piercing only in established businesses that follow best practice guidelines
25
Q

What are some routine work precautions?

A
  • Protect yourself from exposure to blood and body fluids from any and all sources
  • Hand-washing
  • NEVER recap needles
  • Gloves whenever there is a potential for handling blood or body fluids
  • Long-sleeved gowns and goggles PRN
  • Use PPE as designed and whenever available
26
Q

What are COMMON side effects that ART’s present with?

A
  • CNS disturbance (insomnia, nightmares)
  • Peripheral neuropathy
  • Hepatotoxicity
  • Renal failure
  • Lipid changes = increased risk of CAD
  • Hypersensitivity reactions
  • GI disturbances

N304 (16 decks)

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