HIV, AIDS, & Rx's Flashcards
HIV disease
> C/b the human immunodeficiency virus (HIV)
Several stages ranging from acute infection to death
HIV-infected individual who does not receive treatment
> Infection to death is nearly 12 yrs
HIV infection & acquired immune deficiency syndrome (AIDS)
> ELISA (enzyme-linked immunosorbent assay)
- Details HIV exposure based on presence of human antibodies to the virus in the blood
> Retrovirus
> Transmitted by sexual activity, IV drug use, perinatally from mother to child
HIV Replication
- The lower the viral load the better off the pt is & the higher the CD4 count is most likely to be
- As viral load inc, CD4 count decreases
When the CD4 count is less than __, is when the dz is considered AIDS
200
3 Stages of HIV infection
- Acute HIV infection
- Chronic HIV infection (aka asymptomatic chronic infection to symptomatic chronic infection)
- AIDS
Acute HIV infection
- earliest stage
- develops within 2-4 wks >a person is infected
- flu-like sx’s; HIV multiplies rapidly & spreads thru body
- destroys CD4 cells
- lvl of HIV in blood is very high; inc risk of transmission
Chronic HIV infection
- HIV cont to multiply in the body but @ very low lvls
- may not have any HIV-related sx’s, but can still spread
- w/o rx’s progression to AIDS within 10 yrs or sooner
AIDS
- final, most severe stage of HIV infection
- body can’t fight off opportunistic infections
- w/o treatment, ppl survive ~3 yrs
- dx’d if CD4 count <200 or have certain opp infect
Recognize Cues
- Diagnostic or screening tests assess for antibodies to HIV virus
- Rapid tests do not require a lab to perform
- ELISA screening test
- Negative screening test does not require confirmation (should repeat 3-6 mos)
- HIV Western blot
?
Is a test that requires a blood sample & is not a rapid test
- Specimen must be sent out to a lab for testing; results avail 24-48 hrs
ELISA
A positive screening test requires confirmation by an __ __ __. This confirms the presence of proteins unique to the HIV virus.
If proteins absent, person is not infected w/HIV
A positive screening followed by a confirmatory test is used to dx HIV in all individuals over 12 mos
HIV Western blot
Clinical Manifestations
- Fever
- Cough
- Weakness
- N/V
- Diarrhea
- Dysphagia
- Forgetfulness
- Skin lesions
- SOB
- Headache (could be d/t meningitis)
- Vision changes
- Pain
- Night sweats (could be d/t TB)
- Lymphadenopathy
Opportunistic Infections
- Protozoal
- Fungal
- Viral
- Bacterial
- Opportunistic neoplasias
- HIV wasting syndrome
?
Major weight loss, chronic diarrhea & fever
HIV wasting syndrome
?
Various mycobacterial infections/others, extrapulmonary TB
Bacterial
?
Kaposi’s sarcoma/others
Opportunistic neoplasias
?
Toxoplasmosis of the brain/others
Protozoal
?
CMV dz, HSV infection/others
Viral
?
Candidiasis of the lungs, esophagus, trachea
Pneumocystis jirovecii pneumonia/others
Fungal
Treatment - Drug Therapy
- Prophylaxis
- Antiretroviral therapy (ART)
- Immunizations
> HIV+ more @ risk for infect d/t compromised immune system
- If an HIV+ person has a CD4+ count of 200 cells/L or less, prophylaxis to reduce the risk of OI’s such as toxoplasmosis & PCP involves Bactrim (TMP/SMX)
- For TB prevention, antitubercular complement of rx’s
- Generally per guidelines, pt will receive ART therapy & OI prophylaxis, if possible
- Helps reduce viral load, inc CD4 count & if that goes above 200 for >3 mos, OIP can be stopped
Antiretroviral Drugs
ART and TasP or PrEP
> Formerly HAART - Highly active antiretroviral therapy
> Treatment as Prevention
> Now just ART: Anti Retroviral Therapy
> Incl @ least 3 rx’s (“cocktails”)
> Work in diff ways to reduce viral load
- Aim of therapy is to ensure the suppression of HIV to so-called “undetectable” levels - meaning that the virus is not fully eradicated, but is beneath detection lvls of current testing assays
- As opposed to single-drug or dual-drug therapy, comb of 3 or more active drugs is known to effectively suppress variety of resistant HIV that can exist within a viral population
- If 1 rx can’t suppress a viral mutation, others might
?
- involves taking a 28-day course of anti-HIV rx’s, after poss exposure to HIV
- risk of HIV infection is assessed 1st
- is not a “cure” for HIV; not 100% effective
- may prevent HIV from entering cells in body & stop someone from getting HIV
PEP (postexposure prophylaxis)
- PEP usually consists of 3 anti-HIV rx’s, from 2 of the different classes
- Most recent UK guidelines recommend Truvada (fixed dose tablet of emtricitabine & tenofovir) from NRTI class & raltegravir (Isentress) from integrase inhibitor class
Antiretroviral Classifications (6 groups)
- Nucleoside Reverse Transcriptase Inhibitors (NRTI)
- Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
- Protease inhibitors (PIs)
- Fusion inhibitors (FIs)
- Entry inhibitor-CCR5 co-receptor antagonists
- HIV integrase strand transfer inhibitors
! Before any pt starts ART therapy, they must undergo baseline hepatic & renal (liver & kidney) fxn tests b/c the rx’s are metabolized there
> Historically, AZT was the 1st treatment
