immune mediated diseases Flashcards
- HIV disease/AIDS
- Cancer
- Rheumatic diseases
- Asthma
immune mediated diseases
– Retrovirus that is implicated in development of AIDS
– Primary target is the CD4 lymphocyte (helper T cell)
– Causes cell death of CD4 T cells
hiv
– Progressive impairment of the immune system by the
human immunodeficiency virus (HIV)
– A diagnosis is based on
• Low CD4 counts 5000 copies per ml
• The presence of one or more specific opportunistic infections or malignancies
aids
• First appearance is unknown
– Central Africa
– First confirmed case was in the Congo in 1959
– Spread rapidly through heterosexual population
• High rate of extramarital sex
• Low rate of condom use
• High rate of gonorrhea
• Medical clinics reused needles to promote vaccinations
aids history
• End of 2012: Living with HIV/AIDS
– 35.3 million people were living with HIV
• 2.3 million people became newly infected
• 1.6 million died of AIDS-related causes
• Nearly 1 in every 20 adults in Sub-Saharan Africa are living with HIV
(69% of all people with HIV)
• In the US, > 1.1 million people are living with HIV
– Almost 1 in 5 (18.1%) are unaware of their infection
• More than 25 million deaths over the past 3 decades
aids brief history
• HIV is a retrovirus
– Attacks immune system, especially the helper T cells (CD4’s) and macrophages
– Transmitted by exchange of cell-containing bodily fluids, such as semen and blood
– Highly variable time between contracting virus and developing AIDS symptoms
how we get aids: virus
-drug users, homosexual men, heterosexual population, transmission from mother to child
aids transmission
• Acute HIV infection
– Within a week or so
– Mild early symptoms: Fever, sore throat, flu-like
symptoms
• 3 to 6 weeks
– Infection abates, asymptomatic period
• Amount of virus gradually rises: HIV Disease
– Immune system compromised
– Opportunistic infections (viruses and parasites) and malignancies, such as Kaposi’s sarcoma, occur
– Common symptom for women: Gynecologic infection
how hiv infection progresses
• Actions taken to decrease morbidity and
mortality from disease
• Primary
– Avoid development of disease
• Secondary
– Early disease detection to prevent progression
and symptom development
• Tertiary
– Reduce negative impact of established disease
prevention
• Taking measures to combat risk factors for
illness before an illness ever has a chance to
develop
• Two general strategies
– Employ behavior-change methods to alter
problematic behaviors
– Keep people from developing poor health habits in the first place
primary preverntion
– Early detection/screening
– Teach patients behaviors to prevent spread of HIV
– Antiretroviral drug therapy to keep HIV disease from occurring
secondary prevention
– Antiretroviral drug therapy and adherence training
– Cognitive behavioral therapy
tertiary prevention
– Dramatically improved health of those with HIV
– Treatments are complex: combinations of drugs
– Adherence is critical
– Side effects unpleasant
– Adherence is variable
highly active antiretroviral therapy (HAART)
• Test positive for HIV, not yet AIDS – People live with a threatening event – Live with uncertainty and fear • Initial response – Psychological distress – Sharply curtail HIV risk-related behaviors – Make positive changes in health • Interventions that reduce depression are valuable
Psychosocial Impact of HIV
Infection
– Major barrier to controlling spread of HIV: Not disclosing HIV status – Those who don’t disclose: Less likely to use condoms – \_\_\_ has benefits • Positive health consequences • More CD4 cells than non-disclosers • \_\_\_\_ of sexuality – Also linked to HIV outcomes – Remaining “in the closet” associated with • Faster progression of HIV disease
disclosure
• Education
• Health Beliefs and AIDS Risk-Related Behavior
– One must perceive oneself as capable of controlling risk-related activity
– Behaviors become integrated into ‘sexual styles
Interventions to Reduce the
Spread of HIV/AIDS
• Targeting IV Drug Use
– Needle exchange programs
• Cognitive-Behavioral Interventions
– Decrease distress among HIV+ individuals
– Buffer psychological/immunologic consequences
– Improve surveillance of opportunistic infections
• HIV Prevention Programs
– School-based interventions about safe sex
– Communication & condom use skills
– Target behaviors associated with high-risk sex
(alcohol, drugs)
– Target norms (monogamy, abstinence)
Interventions to Reduce the
Spread of HIV/AIDS
• HIV disease/AIDS is now a chronic disease – Employment • Men with HIV continue working • Unemployed may not return to work – Fear and prejudice • Many have an intense fear of AIDS • Many blame the victims for their disease: Especially gay and IV drug users • Coping Skills – Coping effectiveness training – Perceived control & self-efficacy • Social Support
Coping with HIV+ Status and Aids
• HIV-infected gay men
– Rapid course of disease for those with more
stress
– Slower course of disease with more social support
• Negative beliefs about self
– Correlated with decline in helper T cells
• Finding meaning and optimism associated
with better outcomes
• Writing interventions promoting optimistic
thinking about the future
– Led to greater reported adherence to medication
– Less distress from side effects
Psychosocial Factors that Affect its Course
-set of >100 diseases
- all result from dna dysfunction
• Neoplastic growth
– Rapid cell growth and proliferation (unlimited)
– Cancerous cells provide no benefits to body
– Cancerous cells sap the body’s resources
• Neoplastic cells may be:
– Benign
– Malignant
cancer
remain localized and usually less threatneing
benign neoplastic cells
more dangerous; invade and destroy surrounding tissue and may metasasize
malignant neoplastic cells
– Carcinomas
– Sarcomas
– Leukemias
– Lymphoma
malignant growths of cancer
- Cancers of the epithelial tissue
* Skin, stomach lining, mucous membranes, etc.
carcinomas(malignant)
- Cancers of the connective tissue
* Bone, muscles, cartilage, etc.
sarcomas(malignant)
- Cancers of the blood cells
* Stem cells, white blood cells
leukemias(malignant)
- Cancer of the lymphatic system
* Rarer
lymphoma(malignant)
- Many cancers are species-specific
- Develop in different ways in different species
- Many cancers have long/irregular growth cycles
- High within-species variability
why is cancer hard to study
many cancers have genetic basis and some are ethnically linked
– Overall, African-Americans have a 40-50% greater incidence of and mortality from cancer than do European Americans
– Hispanic Americans, Asian Americans, and Native Americans have lower rates than African- and European-Americans
– Most differences are attributable to
• Access in medical care
• Adherence to treatment
• Knowledge
• Attitudes about cancer
• Socioeconomic status
cancer risk factors beyond control
– U.S. Anglo men > bladder cancer rates
– U.S. Anglo men > malignant melanoma rates
– U.S. Hispanic women > cervical cancer
– African American men > prostate cancer
– Japanese Americans > stomach cancer
– Chinese Americans > liver cancer
– African American women > mortality breast cancer
examples of ethnic differences with risk factors
• Age(Strongest risk factor) • Environment: – Exposure occurs at work or home – Radiation – Asbestos – Radon – Pesticides – Motor exhaust – Chemicals[ Arsenic, benzene, chromium, nickel, vinyl chloride, etc]
risk factors for cancer
poor diet and
tobacco use– Lung, breast, head and neck cancers
– Additive or synergistic effect with
• Socioeconomic level, occupation, ethnicity, building materials of home, birth control pills
cancer Behavioral Risk Factors
• Carcinogenic foods
– Natural foods aren’t necessarily safer than ones with preservatives
– Spoiled food causes stomach cancer
– Dietary fat is risk factor for colon and breast cancer
– High cholesterol is risk factor for testicular cancer
– Preserved/charred/smoked meats are a risk factor for colorectal cancer
– Salt-cured meats are a risk factor for stomach cancer
– Obesity and diet receive a lot of attention as risk factors for colorectal cancer and many others
Foods That May Cause Cancer
– Haven’t identified specific foods or nutrients
– Beta-carotene
• Form of vitamin A in sweet potatoes and carrots
– Vitamin C, Folate, Calcium
– Selenium
• Trace element found in grains and grain-fed meats
– Flavonols
• Product of plant metabolism and antioxidants
• Apples, onions, garlic, scallions, leeks, tea, string beans,
broccoli, green peppers, blueberries
– Water
Protective foods
– Healthy diet and weight control • High fiber • High in fruits, vegetables, whole grains, low-fat dairy products, fish, poultry • Low in red meat, refined grains – Vitamin and mineral supplements
protective foods
• Alcohol
– Cancers of the tongue, tonsils, esophagus, pancreas, breast, and liver
– Synergistic effect with smoking
• Sedentary lifestyle
• Ultraviolet light exposure
– Cumulative exposure and occasional severe sunburn are risk factors for skin cancer
– Especially important for light-skinned, fair-haired, blue-eyed people
Behavioral Risk Factors
– AIDS-related carcinomas
• Kaposi’s sarcoma
• Non-Hodgkin’s lymphoma
– HPV infection and cervical and head & neck cancers
– Early age at first intercourse and large number of partners
• Cancers of the cervix, vagina, ovary, prostate
sexual behavior risk factor
• Negative emotionality & tendency to repress or deny emotions • Uncontrollable stress & feelings of helplessness • Other, weaker risk factors – Experience of serious loss – Low level of social support – Chronic depression – Negative emotional states – A “fighting spirit” – Life events – Fatalistic view of the world – Active coping style
psychosocial risk factors
• Psychological stress
– Adversely affects ability of NK cells to destroy tumors
– NK cells activity is important in survival rates for
certain cancers, such as breast cancer
• Ways that patients cope with cancer stress
– Associated with inflammatory processes (IL-6) that play a role in tumor progression
Stress and Coping
Approximately 68% of cancer victims live at least 5 yearsafter their diagnosis • Surgery • Radiation • Chemotherapy • Hormonal treatments • Immunotherapy
Cancer Treatments
• Coping with physical limitations – Pain and discomfort – Downregulation of immune system,vulnerability to other disorders – Fatigue • Treatment-related problems – Cosmetic problems:Surgical removal of organs – Body image concerns – Use of prosthesis – Conditioned nausea and immune suppression
Adjusting to Cancer
• Intermittent and long-term depression • Restriction of usual activities • Issues involving social support cancer because it increases their own risks • Marital and sexual relationships • Psychological adjustment( PTSD) • Self-presentation
Cancer:
Psychosocial Issues
amount of psychological problems (with the
exception of depression) experienced by cancer
patients Is significantly less than people suffering from psychiatric disorders
• Finding meaning in cancer
• Optimism associated with better outcomes
coping with cancer
• Pharmacologic Interventions center on
– Nausea /vomiting, eating difficulties, emotional disorders, pain
• Cognitive-Behavioral interventions focus on
– Stress, pain, appetite control, side effects
– Distraction, relaxation & guided imagery helps coping with chemotherapy
– Also Mindfulness-based stress reduction interventions & Exercise
– Enhance social support
• Psychotherapeutic interventions involve
– Meeting psychosocial and informational needs
– Individual, family, or group
• Support groups
cancer interventions
• Autoimmunity: A condition in which the body
produces an immune response against its own
tissue constituents
– Most prevalent autoimmune disorder
– means “inflammation of a joint”
• Three major forms
– Rheumatoid, osteoarthritis, gout
arthritis
• Crippling form of arthritis believed to result from
an autoimmune process
– Usually attacking small joints of hands, feet, wrists, knees, ankles, and neck
• Primarily affects :40-70 age group/ Women
• Main complications are Pain, limitations in activities, need to be dependent on
others
• Depression
rheumatoid arthritis
– Development of disease
• Negative life events (in the past 2 years) may precede disease onset
– Aggravation of disease
• Increases in interpersonal stressors in the previous week predicts increases in disease activity
• Better spousal relationships buffer the effects of interpersonal stress on RA
• Following a hurricane, RA patients were classified in later stages of disease and had more flares than compared to before the hurricane
• Mediated by immune system
rheumatoid arthritis stress
– Aspirin, NSAIDs & Cox-2 inhibitors to relieve inflammation and pain – Rest – Supervised exercise • Cognitive-behavioral interventions – Enhancement of perceived self-efficacy – Optimism – Relapse prevention strategies • Juvenile RA appears between 2 and 5 years
rheumatoid arthritis treatment
• Form of arthritis that results when the articular
cartilage (smooth lining of a joint) begins to
crack or wear away because of overuse of a
particular joint
– May also result from injury or other causes
– Usually affects weight-bearing joints
– Common among athletes and the elderly
– More common in women
• Treatment
– Keeping weight down, exercise, aspirin (NSAIDs), steroids
Osteoarthritis
• A form of arthritis produced by a buildup of uric acid in the body (kidneys can’t excrete the acid) – More prevalent in men than in women – Uric acid build up produces crystals that become lodged in the joints – Most commonly affected area - big toe • Blood supply cannot carry away crystals
gout
– Avoid alcohol and certain foods; maintain proper weight, exercise, fluid intake; no aspirin since it slows uric acid removal – Untreated, gout can be deadly
gout treatment
Untreated can lead to – Kidney disease – High blood pressure – Coronary heart disease – Stroke • Triggers – Foods – Stress – Infections – Some antibiotics – Diuretics
gout
alcohol, anchovies, sardines in oil, fish roes, herring, yeast, organ meat, meat extracts, concomme, gravies
gout: purinecontaining foods to be avoided
hearts , herring, mussels, yeast, smelt, sardines, sweetbreads
foods high in purines
• High fat foods and foods containing trans
fat (partically hydrogenated vegetable oils)
• Drink plenty of fluids/water, exercise and maintain a healthy body weight. Diets
designed for quick or extreme weight loss can
increase uric acid levels in the blood and worsen
symptoms.
other food to avoid when have gout
• More severe allergic reaction
• Triggers
– Dust, dander, pollens, mold, fungi
– Animal dander, cockroaches
– Respiratory infections, smoke, other air pollutants –perfume
– Stress or exercise
• Produce bronchial spasms & hyperventilation
• Muscle constriction, swelling, & inflammation of
airtubes → ↑mucus → bronchiole obstruction → ↓O & ↑CO2
asthma
• Dramatic increase in past 20-30 years • 1 in 10 children may have \_\_\_ • Reasons are not fully known – >130 million worldwide have it – More in industrialized countries – More in urban than rural areas – Paradoxical Issue: Correlation: Children with lots of childhood infectious diseases are LESS LIKELY to develop allergies • Improved hygiene → ↑allergies?
asthma
– Traditional view
• Allergic reaction to substances in environment
– Genetic vulnerability
• Diathesis-stress model
• Genetic vulnerability for immune system to overreact to certain environmental agents if exposed
– Hygiene hypothesis
• Result of cleanliness
• Immune systems haven’t been exposed to many allergens so when exposed overreact
– Refinement of hygiene hypothesis
• Combines it with diathesis-stress and people are either sensitized or protected
asthma theories
• Trouble breathing or can’t breathe
– Associated with fear and anxiety
• Frequent attacks leads to decreases in self efficacy for management of the disease
• Can cause respiratory failure and death
Asthma Attacks
– Patient needs to be active in management
– Track Peak Expiratory Flow Rate and identify warning
range
– Take preventive medications
• Usually anti-inflammatory corticosteroid inhalers
• Adherence is a problem
– Use emergency inhalers when you have an attack
• Bronchodilators
develop management plan for asthma
