Immunodeficiency Disease Flashcards
Define immunodeficiency
- immune response is absent or depressed
Define primary immunodeficiency diseases
- congenital
- dysfunction involving T cells, B cells, or lymphoid tissues
Define secondary immunodeficiency diseases
- acquired
- result from an underlying disease or factor that depresses the immune response
- multiple, diverse, & nonspecific defects in immune responses due to infections, metabolic disease, cancer or treatment
Define Iatrogenic immunodeficiency
- caused by medical treatment
Describe cytotoxic drugs
- kill immunocompetent cells while replicating (chemotherapy)
Describe corticosteroids
- affect T cells in bone marrow & block tissue infiltration of neutrophils
Describe radiation therapy
- cytotoxic to most lymphocytes, total lymph node irradiation
Define splenectomy
- removal of the spleen
- spleen is an immune organ
What are some consequences of a weakened immune system
- increased risk for infections
- normal defense mechanisms may be affected (respiratory & GI)
Define human immunodeficiency virus (HIV)
- infection of the immune system, resulting in progressive & ultimately profound suppression
Describe acquired immune deficiency syndrome (AIDS)
- advanced HIV
- progressive destruction of cell-mediated immunity by destruction of T4 lymphocytes & changes in humoral immunity
- affects autoimmunity due to central role of the CD4+ T lymphocyte in immune reactions
- individual is susceptible to infections, cancers, & TB
What are the 4 distinct points of HIV infection
- acute infection
- asymptomatic HIV seropositive
- early symptomatic HIV
- HIV advanced disease (AIDS)
How is HIV transmitted
- transfer of body fluids containing infected cells (blood or semen)
- high risk behaviors
- unprotected sex
- non sterile needles
- not transmitted via shared or social contacts
- viral load impacts transmission of HIV
Pathogenesis of HIV
- HIV enters the body impacting T cells & thus immune response
- HIV vision (virus attached to the host cell) injects core proteins & 2 strands of viral RNA into the cell
- reverse transcriptase = copying of HIV RNA
- replication of the virus leads to cell death
- seroconversion (becoming positive for HIV) = begins 3 to 6 weeks after infection but may take 6 months to complete
- after seroconversion, less virus is in the blood, HIV antibodies are now detected in serum
- symptomatic HIV begins
- AIDS occurs when CD4 cells decline to less than 200 cells/mm^3
How does stage 1 acute infection of HIV present
- 1-6 weeks after exposure
- viral load is high & antibody test is negative
- flu-like symptoms & lymphadenopathy
How does stage 2 asymptomatic infection of HIV present
- positive antibody test
- 1-20 years very variable
- clinically healthy
- fatigue & lymphadenopathy
- CD4 count 500 cells/mm^3
How does stage 3 symptomatic HIV present
- CD4 count 200-500 cells/mm^3
- immune system compromised
- months to years
- increased symptoms of lymphadenopathy & generalized symptoms
How does stage 4 advanced HIV (AIDS) present
- CD4 less than 200 cells/mm^3
- neurological involvement
- opportunistic infections
- neurologic involvement, dementia, & skin conditions
Pain syndromes seen in HIV infected individuals
- headache
- abdominal pain
- chest pain
- arthralgias
- myalgias
- women often experience greater pain
Peripheral neuropathies seen in HIV infected individuals
- distal sensory polyneuropathy (DSP)
- causes parethsias, numbness, impaired sensation, burning, hyperalgesias, cramping, sleep disturbances, impaired ADLs, & balance
Skin impairments seen in HIV infected individuals
- tines pedis (athletes foot)
- capos sarcoma (cancerous patches of abnormal tissue under the skin)
Neuromusculoskeletal diseases seen in HIV infected individuals
- osteomyelitis, bacterial myositis, & infectious (reactive) arthritis
- osteonecrosis, osteopenia, osteoporosis, & AVN (avascular necrosis)
- musculoskeletal pain syndromes or HIV rating syndrome
- HIV associated myopathy
Cardiopulmonary diseases seen in HIV infected individuals
- increased blood pressure & atherosclerosis
- myocardial infarction, cardiomyopathy, pericardial effusion, & pericarditis
- bacterial pneumonia, bronchitis, tuberculosis, & CMV
- emphysema, asthma, & pulmonary hypertension
Ways to prevent HIV infection
- sexual activity & IDU education
- reduce/eliminate racial & ethic health disparities
- promote HIV counseling, testing, & referrals
- reduce stigma
- get annual routine screenings
- prophylactic use of antiretroviral drugs
- behavior change programs
Treatment for HIV infection
- highly active antiretroviral therapy (HAART)
- helps to decrease the amount of virus in the blood to very low & even undetectable levels (CD4 counts)
Purpose of physical therapy with regards to HIV infection
- consider quality of life issues, patient goals, work simplification, & activities of daily living
- management of neurologic involvement to optimize functional ability
- strength training
- joint & soft tissue mobilization or stretching
- gait/balance training
Exercise recommendations for HIV/AIDS in the advanced stages
- 20 minutes 3-4x per week aerobic exercise at moderate intensity
