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Medcon Rehab IV > HIV Disease: Opportunistic Infx's and Co-Morbidities > Flashcards

HIV Disease: Opportunistic Infx's and Co-Morbidities Flashcards

1
Q

Complications of HIV

2:

A
  1. Opportunistic Infxs
  2. Co-morbs
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2
Q

Comps of HIV Disease

Opportunistic Infxs vs Co-morbidities

Whats the main difference?

A

You will see Opportunistic Infxs in pts w/ HIV who are NOT successfully tx’d w/ ART

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3
Q

Comps of HIV Disease

Opportunistic Infxs

A

Seen in people w/ suppressed immune systems such as pts w/ HIV who are NOT successfully treated w/ ART

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4
Q

Comps of HIV Disease

Co-morbs

A

Seen in SOME HIV+ people→ EVEN those who ARE successfully treated w/ ART***

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5
Q

Opportunistic Infxs come from

Well…one contributor..

A

LOW CD4 counts

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6
Q

HOW can a person who is HIV+ avoid getting an opportunistic infx?

A
  • Take ART EVERY DAY (prn/prescribed)
  • Goal:
    • NON-detectable lvls
    • Maint CD4 count so immune system can function
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7
Q

Opportunistic Infections

Kaposi’s Sarcoma

A
  • Skin, mucous membranes
  • MAY affect lymphatic system
    • Lymphedema
    • Painful LEs
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8
Q

Opportunistic Infections

Pneumocystis carinii pneumonia (PCP)

A

Think “Fungal” one*

Also….”Pneumo”→ LUNGS!

  • Up to 85% of healthy adults possess antibodies
  • Fever, dyspnea, hypoxia
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9
Q

These are ESP. in Compromised immune systems

2:

A

TB

Non-Hodgkin’s Lymphoma

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10
Q

Opportunistic Infections

Oral thrush (Candidiasis)

A

*Fungal also!!

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11
Q

Opportunistic Infections

Mycobacterium** Avium (MAC)**

A

INITIALLY affect GI and Pulmonary tracts

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12
Q

Opportunistic Infections

Tuberculosis (TB)

A
  • RE-surgence in NON-HIV pops in poor urban areas**
  • Up to ⅓ HIV+ individuals coinfected w/ Myobacterium TB
  • 23% deaths due to TB***
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13
Q

Opportunistic Infections

Non-Hodgkin’s Lymphoma

A

Know it exists as an opportunistic infx

along w/ TB→ ESPECIALLY in compromised immune systems

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14
Q

This tumor is RARE in NON-HIV population

A

Cerebral Lymphoma

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15
Q

Neuro comps of HIV:

Caused by 4:

A
  • Specific tumors:
    • Cerebral lymphoma
      • NOTE: this is RARE in NON-HIV pop.
  • Opportunistic infxs
  • PRIMARY HIV infx
  • Autoimmune rxns*
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16
Q

Neuro comps of HIV

Can include:

A
  • Peripheral neuropathies* (COMMON)
  • Cog impairs
  • SZs
  • Dementia
  • Para/Hemiplegia
  • Other focal deficits→ depending upon location of patho.
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17
Q

Opportunistic CNS Infxs

Explain how we get them there…

A
  • Blood/brain barrier (BBB) usually prevents entry of infectious material
  • HIV is able to cross BBB**
    • maybe on its own, maybe in infected macrophages and T-cells
  • Even in a normal immune system→ LESS immune protection in CNS vs rest of body:
    • NO lymphatic system
    • LOWER antibody lvls
    • FEWER WBCs
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18
Q

Even in a normal immune system→ LESS immune protection in CNS vs rest of body:

3 reasons WHY?

A
  1. NO lymphatic system
  2. LOWER antibody lvls
  3. FEWER WBCs
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19
Q

CNS Opportunistic Infx

Meningitis

In general…

A
  • Inflammation of meninges of the brain and/or SC
  • *USUALLY a complication of another infx
  • Sx’s:
    • HA, nausea, painful stiff neck, altered LOC
  • Usually extends into cortex and SC
  • Potentially severe comps
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20
Q

CNS Opportunistic Infx

Meningitis

Cryptococcal Meningitis

A
  • MOST COMMON FUNGAL INFX IN THE CNS***
    • ~5% of people w/ AIDS
  • Infx usually limited to meninges→ Sxs similar to meningitis
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21
Q

MOST COMMON FUNGAL INFX IN THE CNS

~5% of people w/ AIDS

A

Cryptococcal Meningitis

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22
Q

This CNS Opportunistic Infx often Co-Exists w/ Meningitis

A

Encephalitis

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23
Q

CNS Opportunistic Infx

Encephalitis

A
  • Gen inflammation of Parenchyma
    • Cause MAY be Viral
      • Herpes simplex, Herpes Zoster, Cytomegalovirus (CMV)
  • Findings:
    • Aphasia, SZs, hemiparesis, s/s intracranial mass, fever, HA
  • *Similar to, but distinct from, Meningitis
    • **OFTEN COEXIST!
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24
Q

CNS Opportunistic Infx

Brain Abscess

A
  • Due to local infx, OR spread from distant infx
  • INC incidence w/ exotic protozoan OR fungal organisms
  • Abscessed area becomes→ Necrotic and encapsulated
  • Sx risk:
    • Exposes CNS structures to other antigens
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25
Q

Medical Tx for Brain Abscess

A
  • Antibiotics→ MUST cross BBB to be effective
    • Intrathecal tx often used BUT:
      • Neurotoxic SEs
      • Drug conc LOW in Lat. ventricles
  • Incision and drainage
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26
Q

CNS Opportunistic Infx

Cerebral Toxoplasmosis

ALL STUFF

A
  • Cause→ reactivation of dormant toxoplasma cysts (T. gondii protozoan)
    • Oocysts excreted by cats; eggs survive in soil (litter) for extd pds of time
  • *MOST COMMON INTRACRANIAL infx in PWAIDS
    • 80-90% w/ CD4 count <100*
  • Deficits→ Focal
    • SZ, hemiparesis, ataxia, aphasia, HA, mental status change, confusion, lethargy
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27
Q

MOST COMMON INTRACRANIAL INFX in PWAIDS

A

Cerebral Toxoplasmosis

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28
Q

Cerebral Toxoplasmosis

MOST common intracranial infx in PWAIDS

Potentially curable?

A

POTENTIALLY curable w/ EARLY Tx

*Relapses common (in compromised immune systems)

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29
Q

Cerebral Toxoplasmosis

MOST common intracranial infx in PWAIDS

PREVENTION for PW HIV:

A
  • Gloves working in garden
  • Avoid raw/undercooked meat
  • Wash hands after handling raw meat/veggies
  • Avoid changing litter box (if cats) or use gloves/mask
30
Q

This DEmyelinating disease (Opportunistic Infx) is RARE

A

Progressive Multifocal Leukoencephalopathy (PML)

31
Q

CNS Opportunistic Infx

Progressive Multifocal Leukoencephalopathy (PML)

A
  • Demyelinating dis.
    • Cause→ papoVIRUS→ Present, BUT dormant in brain most people
  • RARE!→ <1% OF PWAIDS
    • SEVERE neuro sx’s may lead to death
32
Q

Cytomegalovirus (CMV)

A

Think…. “OPTIC”!!!

  • Primarily Optic structures
  • CAN affect GI and respiratory systems
33
Q

Comorbs/Complications can be seen in _________ treated w/ ________

A

Long term survivors; treated w/ ART

34
Q

MSK Complications are mostly found _________ in disease process

35
Q

MSK Complications a frequently a ________ of ________ resulting in _____________

A

2* complication of neurologic deficits resulting in improper mechanics of mvmt and compensatory strategeis

36
Q

MSK Complications

How and leads to what?

A

2* complication of neuro deficits resulting in improper mechanics of mvmt and compensatory strategies

37
Q

When are MSK complications found ?

A

LATE in disease process

38
Q

SC patho specific to people w/ AIDS

A

Vacuolar Myelopathy

39
Q

COMORBIDITIES

Vacuolar Myelopathy

A
  • SC patho specific to PWAIDS
  • Due to→ macrophages in lateral and post. columns of SC
  • Sx’s:
    • weakness, spasticity, ataxia, sensory changes, reflex changes (Hoffman’s)
      • Later→ urinary/fecal incont, dementia
  • *Variable progression over time
40
Q

COMORBIDITIES

MOST COMMON NEUROLOGICAL COMPLICATION OF AIDS***

A

AIDS DEMENTIA COMPLEX

41
Q

COMORBIDITIES

AIDS DEMENTIA COMPLEX

A

MOST COMMON NEUROLOGIC COMPLICATION OF AIDS***

42
Q

COMORBIDITIES

Neuro complication→ AIDS Dementia Complex

A

*MOST COMMON NEURO COMPLICATION OF AIDS

  • Thought to be due to HIV infx in brain
  • Progressive cog loss w/ motor and behavioral dysf.
  • Early signs:
    • Apathy, social w/draw, depression, Diff concentration and complex mental tasks
43
Q

MOST COMMON COMPLICATION of HIV Disease (NOTE just “complication”)

A

Peripheral Neuropathy

44
Q

COMORBIDITIES

Peripheral Neuropathy

A

Most common complication of HIV Disease

45
Q

COMORBIDITIES

Peripheral Neuropathy

*most common comp. of HIV dis.

3 types:

A
  1. Distal Sensory Polyneuropathy (DSP)→ MOST COMMON*
    1. Stocking-glove numbness, parasthesia, burning
  2. Demyelinating Polyneuropathy
  3. Mononeuropathy
46
Q

What should you remember about Peripheral Neuropathy?

A

DISTAL MUSCLES!!!!

47
Q

Peripheral Neuropathy: Issues for PT

A
  • DISTAL WEAKNESS in advanced cases; weakness in foot mm’s (intrinsic and extrinsic)
    • PROnation, Tendinitis
  • Grip weakness, balance/sensory/proprio deficits
  • Gait disturbs, mvmt disorders
  • PAIN!!!!
48
Q

Kietrys Study Example DSP

49
Q

Another Kietrys Study Example DSP

50
Q

What is Myopathy ?

A

Inflammatory disease of mm tissue

51
Q

COMORBIDITIES

HIV Associated Myopathy

Primarily WHERE?

A

PROXIMAL MUSCLES!!!

Trunk, shoulder girdles, pelvic girdles

52
Q

DSP vs HIV ASSOCIATED MYOPATHY

A

DSP→ Distal mm’s (just remember DSP, Distal..both start w/ D!!)

HIV Associated Myopathy→ Proximal mm’s

53
Q

COMORBIDITIES

HIV Associated Myopathy

What etiology suspected?

A

Autoimmune etiology

54
Q

HIV Associated Myopathy

*Proximal mm’s!

A
  • Progressive, symmetric, PAINLESS, weakness of Proximal limb mm’s+trunk
  • Biopsy→ muscle fiber necrosis
  • Autoimmune etiology suspected*
55
Q

W/ Myopathy…

Appropriate interventions?

A

GENTLE ROM & stretching as tolerated ONLY!

56
Q

COMORBIDITIES

Myopathy

A
  • Inflammatory dis. of muscle
  • Etiology→ MAY be related to zidovudine (AZT) and chronic dis. process
  • Sx’s→ PROXIMAL weakness, diffuse aching, “myalgia”
  • Dx→ serial CPK lvls (leaks as mm destroyed), EMG, mm biopsy
57
Q

COMORBIDITIES

Acute, inflammatory Myopathy

A
  • ELEVATING serial CPK lvls
58
Q

COMORBIDITIES

Chronic Myopathy

A

CPK lvls DECLINING toward NORMAL

*NOTE: when steroids kick in

59
Q

Acute, inflamm myopathy vs Chronic myopathy

A

ACUTE→ ELEVATING CPK lvls

CHRONIC→ CPK lvls DECLINE TOWARDS NORMAL

60
Q

Acute, inflammatory Myopathy

PT + Medical Mx:

A
  • PT→
    • AVOID strenuous activity, OK to do gentle ROM and stretching as tolerated
  • Med Mx→
    • anti-inflamms and analgesics
  • *nutritional support
61
Q

Chronic Myopathy

PT:

A
  • PT→
    • SLOWLY progress to PREs w/ emphasis on proximal musculature***
62
Q

COMORBIDITIES

This is the one w/ the Truncal obesity********

A

Lipodystrophy

63
Q

COMORBIDITIES

Lipodystrophy

The “truncal obesity” one***

A
  • Truncal obesity→ INCd subQ and visceral fat
  • enlarged dorsocervical fat pad (whale hump)
  • atrophy and fat wasting in extremities and face (remember the calves, sunken face!!!)
  • *Insulin resistance
64
Q

COMORBIDITIES

Lipodystrophy Diagnosis:

A

Observation, bioimpedance abnorms, abnorm blood lipids (HypERlipidemia, HypERglycemia), body comp changes, metabolic changes

65
Q

COMORBIDITIES

Lipodystrophy Etiology:

A

UNCLEAR: related to prolonged use of antiviral meds (PIs, NNRTIs), OR chronic dis. process

66
Q

COMORBIDITIES

Lipodystrophy Interventions:

A

Aerobic exercise and PREs, growth hormones, testosterone, anabolic steroids, nutrition support

67
Q

Dealing w/ Body Composition Changes

(HIV Related Muscle Wasting)

Egrifta

A

Egrifta= precursor to HGH

See study pics/results

68
Q

Long term survivors of HIV aka People Living w/ HIV (PLHIV)

this is common

A

Chronic pain

69
Q

Chronic Pain in PLHIV

A
  • Prev→ 39-55%
    • HIGHER + higher severity of pain in indigent population
  • Concurrent psychiatric illness→ 40% more likely pain
  • Concurrent subs abuse→ higher pain severity and disruption daily function
70
Q

Multifactorial Etiology of Chronic Pain in PLHIV:

A
  • Direct effects of HIV infx
  • Chronic inflamm and immune activation
  • SEs of ART drugs/other drugs
  • Neuro mechs
  • Comorbs/Multimorbs
  • Opportunistic infx’s***
  • Aging/frailty
  • Psychosocial influences
  • Rx opiods misuse/heroin use
  • Gender/ethnic diffs→ perception/expression of pain
71
Q

2 MOST COMMON CHRONIC PAIN AREAS

+ A 3rd and example

A
  1. *SPINAL
  2. *ARTHRALGIA (Jt pain)
  3. Neuropathic (Peripheral neuropathy)

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