HIV + IBD

Question 1

What is HIV?

Answer 1

Disease that attacks and weakens the immune system. It progresses on a continuum.

Question 2

HIV I stage?

Answer 2

HIV 1- is acute infection, development of HIV antibodies is called window period (individual has been exposed to HIV but not detectable in blood). Flu like symptoms are fever, body aches, sore throat, swollen nodes. Occurs 3-4 weeks of being infected. HIV levels rise and CD4 counts fall. Symptoms will resolve and individuals feel better.

Question 3

HIV II stage?

Answer 3

Chronic stage. Early on in this stage indicates can be asymptomatic. CD4 counts >500 cells/mm. Untreated this stage can last decade or more. Towards end of stage the CD4 counts is 200-500 and viral load is increased.

Question 4

HIV III stage?

Answer 4

AIDS. CD4 count drop to >200 cells, viral dose high, opportunistic infections develop. AIDS is HIV diagnosis + at least 1 opportunistic infection. If left untreated then person can survive up to 3 years.

Question 5

How does HIV enter body?

Answer 5

HIV connects onto CD4 cells and enter the cell. Once in the cell HIV converts itself into double stranded DNA. HIV DNA can now enter cells nucleus and start making copes of the virus.

Question 6

Normal life cycle of CD4 T cells vs. HIV infected?

Answer 6

Normal life cycle are 100 days but HIV infected CD4 T cells are 2 days. HIV destroys 1 billion T cells daily and makes billions of new virus daily.

Question 7

What is CD4 count?

Answer 7

Measures immune system function. It’s a blood test and measures amount of helper T cells in the body. Normal range is 600-1500 cells/mm cubed. When it drops to >200 cells/mm cubed then there’s risk for infection.

Question 8

What is a good immune system made of for viral load and CD4 count?

Answer 8

Low viral load and high CD4 count.

Question 9

What is viral load?

Answer 9

Measure amount of HIV in our blood. Goal is we want >40 copies/mL in bloodstream. Higher viral load=higher risk of HIV transmission.

Question 10

Transmission of HIV?

Answer 10

Through sexual contact (unprotected anal/vaginal sex with someone infected with HIV), blood contact (share needles, needle stick injuries), vertical transmission (mom to baby during pregnancy, delivery, breastfeeding). Exposure to body fluids (blood, semen, anal secretions, breast milk affected).

Question 11

What is antibody antigen test?

Answer 11

Test virus and antibodies (measures patient response to virus).

Question 12

What is antibody only test?

Answer 12

HIV self test that is rapid and need to confirm results with antibody antigen test if tested positive. If negative then repeat test at 4 weeks/3 months after exposure, repeat every 3-6 months for people with high risk activities, and every 12 months for people sexually active.

Question 13

What is a window period?

Answer 13

Time after HIV infection when person is infectious but tests negative on HIV antibody antigen test.

Question 14

How long does it take take to develop antigens/antibodies in response to HIV?

Answer 14

21-28 days

Question 15

What is combination antiretroviral therapy (CART)?

Answer 15

Group of drugs from different classes that inhibit viral replication at different parts of virus replication cycle. It prevents resistance if used daily. Treatments decrease viral loads by 90-99% and this is a life long treatment.

Question 16

Goals for drug therapy for HIV?

Answer 16

Decreased viral load, maintain or raise CD4 count, delay development of HIV symptoms/opportunistic infections, and prevent HIV transmission. Suppress viral load so it’s undetectable=untransmittable.

Question 17

What is pre-exposure prophylaxis?

Answer 17

Antiretroviral drugs taken by HIV negative people at greater risk of HIV to prevent infection. Goal is to interrupt virus replicating in body. Reduces risk of getting HIV when taken as directed. Tooken daily and doesn’t protect against other STIs.

Question 18

What is post exposure prophylaxis?

Answer 18

Antiretroviral drugs taken by HIV negative people who may have been exposed to HIV. Start drugs as soon as possible but within 72 hrs of exposure. Combination of 3 drugs daily for 28 days. HIV test taken prior to starting, 3?6 weeks after starting, and 3 months after.

Question 19

Pregnancy and HIV treatment?

Answer 19

Without treatment HIV can pass to baby during pregnancy/delivery/breastfeeding. With treatment transmission rate is >1%. Shouldn’t breastfeed if you have HIV.

Question 20

What is the 90-90-90 untied nations global goal?

Answer 20

90% of people with HIV are diagnosed, 90% of those diagnosed are on treatment, and 90% of those on treatment are virally suppressed.

Question 21

What is the positive living program?

Answer 21

Provincial program that provides services/care to all HIV positive clients. Provides counselling, health monitoring/assessment, CART, immunizations, education.

Question 22

What is crohns disease?

Answer 22

Affect anywhere in GI tract from mouth to anus. Inflammation impacts all layers of bowel wall. Patchy inflammation (skip lesions- some areas inflamed and others healthy). Has active periods and remissions. Causes rectal bleeding, toxic megacolon rare. Weight loss is severe, surgery doesn’t cure, nutritional deficits, fistula/strictures/absceses/obstructions common.

Question 23

What is ulcerative colitis?

Answer 23

Only in the large intestine/rectum/anus. Innermost bowel layers are affected (submucosa and mucosa). Causes continuous and uniform inflammation. Starts from the bottom of colon and works it way up. Has periods of inflammation and remission. Causes rectal bleeding, fistulas/strictures/abscesses are rare. Toxic megacolon is possible (colon ruptures). Weight loss common, less nutrition deficits, and surgery will cure.

Question 24

IBD risk factors/why it happens?

Answer 24

Don’t really know. Could be genetics (predisposed to develop it), exposed to something in environment which then creates gut microbiome which triggers abnormal immune response/body starts to attack its own tissues. Children more likely to develop IBD.

Question 25

What do we assess history wise for IBD?

Answer 25

Family hx, nutritional intake, recent intestinal infections, NSAID use causes inflammation, arthritis, mouth sores, vision problems, skin disorders.

Question 26

Lab assessments for IBD?

Answer 26

C reactive protein/erythrocyte sedimentation rate are markers of inflammation. WBC count for infections, hemoglobin, electrolytes (because of water loss), albumin levels, and stool assessment to rule out other diseases

Question 27

Assessments to diagnose IBD?

Answer 27

Colonoscopy, CT scan, intestinal ultrasound (non invasive and is like a doppler), barium enema (receive enema with radioactive substances in it).

Question 28

S+S of IBD?

Answer 28

When active- abdominal pain, rectal bleeding, urgency, bloating, fatigue, lots of weight loss, anemia, stools are loose/bloody/mucous, cramping prior to BM, dehydration, possibly low grade fever.

Question 29

Management of diarrhea?

Answer 29

Relieve symptoms/reduce intestinal motility. Record frequency/colour/volume/consistency of stools. Record weight/monitor perineal area for skin irritation.

Question 30

Drug therapy for IBD?

Answer 30

First line treatment. It’s life long. Want to control inflammation and reduce it.

Question 31

Nutritions management for IBD?

Answer 31

Well balanced diet, not a cure, eliminate foods that are triggers. Can be NPO to allow bowel to rest/heal. Nutritional supplements for severe malnutrition.

Question 32

Surgical interventions for CD and UC?

Answer 32

CD- <50% require surgery at some time, not a cure
UC- less common (20%), remove large intestine and rectum will eliminate the disease

Question 33

What is an abscesses, fistula, intestinal obstruction?

Answer 33

A- pockets of infection internally that we need to drain
F- abnormal communications between intestine and somewhere else
IO- inflammation causes narrowed bowel lumen so stool can get stuck and cause obstruction

Question 34

Common surgery for CD?

Answer 34

Bowel resection. Remove inflamed area of intestine and then reconnect it.

Question 35

UC surgical procedure?

Answer 35

Protocolectomy with ileo-anal reservoir. Remove entire large intestine and create a pouch/put temporary ileo-ostomy. Once it’s healed they reconnect everything.

Question 36

What is intestinal obstruction and symptoms?

Answer 36

Occurs when there’s a partial/compelte blockage of intestine that prevents intestinal contents from passing through GI tract. S are nausea, vomit, abdominal,= pain, distension, inability to pass gas/stool, hyperactive bowel sounds.