Lecture 4 pt 2 Flashcards
Definition of AIDs
chronic, life-threatening disease caused by the human immunodeficiency virus, resulting in progressive and ultimately profound immune suppression
HIV vs AIDs
HIV infection & AIDs refer to different stages along the disease spectrum
HIV = used for virus and early stages of disease process
AIDs = later stages of HIV infection
Epidemiology of AIDS
Epidemic in many countries
Since late 90s, significant declines in number of new cases. # of people living with AIDS has increased
prevalence is increasing, incidence is decreasing
Transmission of HIV
occurs by exchange of body fluids, especially blood and semen
viral load is highest in blood and semsn
Risk factors for infection of AIDs/HIV
unprotected sex with multiple partners
unprotected sex w/someone who is HIV+
having another STD
sharing needles
accidental needle sticks with infected blood
received blood transfusion btwn 77-85
newborns or nursing infants w/HIV+ mothers
MSM most common, injection drug use
Ways HIV is not transmitted
ordinary contact with someone who is positive
contact with sweat or tears
sharing food, utensils, towels, swimming pool, telephone, toilet seat
being bitten by mosquitoes
kissing someone who has HIV/AIDS
donating blood
Pathogenesis of HIV/AIDS (DNA level)
retroviruses = single stranded RNA
binding of HIV to host cells that contain CD4 marker on surface–> helper T-cells
binding results in springing open of lipid bilayer of host cell, viral/host cell then fuse together
copied DNA enter the cell nucleus, the virus helps the DNA enter the chromosomal DNA
integrated DNA virus may remain latent in host cell for hours to years before becoming active through transcription
CD8 cells and HIV replication
CD8 inhibit HIV replication both directly (killing infected cells) and indirectly (producing interferons)
HIV/AIDS progression
HIV infection/acute infection –> early asymptomatic HIV infection –> symptomatic HIV infection –> AIDs
HIV progression is monitored by measuring the number of ______ in the blood
CD4 lymphocytes
<500 –> indicate some immune impairment
<200 –> imminent risk of opportunistic infections
Why is CD4 count important?
depletion is hallmark of HIV infection
useful marker for HIV/AIDS staging
correlates w/risk of opportunistic infections
main criterion for clinical decision making for treatment –> when to start ART and prophlatic treatment
AIDS diagnosis is made when a person is:
HIV positive AND CD4 count <200 cells
HIV positive AND/OR diagnosed w/aids-defining illness
AIDS defining illness
Candidiasis of bronchi, trachea, esophagus, lungs
coccidiodomycosis disseminated
encephalopathy
cytomegalovirus
pneumonia
lymphoma
wasting syndrome
tuberculosis
TB infection
means TB is in the body, but the body’s immune system has it under control
people with TB infection are non-infectious
TB disease
develops when the body’s immune system cannot keep the TB under control, begins to multiply
people with disease are infectious
Clinical Presentation of AIDS
there may be no symptoms for up to 10 years
eventually, mild infections or chronic symptoms begin (swollen lymph nodes, diarrhea, weight loss, fever, cough, rash)
Late phases of HIV infection
development of opportunistic infections
soaking night sweats
shaking chills or fever
chronic diarrhea
headaches
blurred/distorted vision
weight loss
unexplained fatigue
Diseases related to AIDS
HIV associated dementia
peripheral neuropathy
HIV wasting syndrome (cachexia)
Prevention for HCWs
blood into open cut or mucous membrane
being stuck with needles containing HIV-infected blood
most exposure is caused by SPLASH, but blood is more infectious
Pre-exposure prophylaxis
there is no vaccine for HIV
PrEP to reduce likelihood of HIV infection for high risk individuals
Pharmacotherapy
NO cure for AIDS
with antiretroviral therapy, HIV can be controlled
ART
combination of antiretroviral drugs from different classes that must be taken every day
each drug class inhibits enzymes involved in different steps during HIV replication
combo drugs = greater clinical effectiveness, prevention, delay of viral drug resistance
Medication adherence
taking medications exactly as prescribed
helps to avoid treatment failure
reduce risk that HIV will mutate and produce drug resistant HIV
decrease transmission of drug resistant HIV
Who should take ART?
recommended for everyone with HIV asap
often initiated when CD4 <500 cells
What is the goal of ART?
cannot cure HIV/AIDS
reduce a person’s viral load
reduce risk of transmission
does not completely eradicate HIV from body
Nonpharmacological treatment for AIDS
exercise, nutrition, mental health, complementary medicine
can help relieve pain, fatigue and medication ADRs, strengthen immune system, reduce stress
Exercise in HIV/AIDS may help
provide pain relief
increase appetite
reduce muscle atrophy
regular bowel habits
counter ADRs
Promoting self-care
regular exercise
avoid smoking/drug use
eat healthy
avoid foods that increase risk of infection
clean water
sufficient sleep
good hygiene
Beware of risks associated with companion animals
tinea corporis (ringworm)
toxoplasmosis –> cleaning litter box and touching mouth/face afterwards
Rheumatoid Arthritis Definition
chronic systemic inflammatory disorder in which immune system cells attack healthy tissues
characterized by polyarticular, symmetrical joint involvement, extra-articular involvement
Epidemiology and Risk factors for RA
female
onset is frequently 30-60yr
caucasians
1-2% of USA population
Pathogenesis of RA
no single factor or agent is known to cause RA
some unknown antigen triggers B cells to produce RF
Rheumatoid Factor (RF)
autoantibodies against IgG
What type of hypersensitivity is RA?
Type 3–> immune complex mediated disease
excessive immune complexes are deposited in tissues
resulting in vasculitis, which damages tissues
Immune complexes cluster in ______
synovial fluid
stimulate complement system, WBCs go into synovium
will cause development of pannus
Pannus
destructive mass of fibroblastic, vascular, inflammatory cells
dissolves collagen, cartilage, bone
prevents the synovium from lubricating the joint and providing nutrients to articular cartilage
results in irreversible joint instability, deformity, fusion/ankylosis
Clinical presentation of RA
symmetrical and bilateral joint
ligament laxity
warm, painful, stiff joints
wrist, MCP, PIP, knees, feet, cervical spine
Common deformities of fingers in RA
swan neck
boutonniere
Tendon/ligament involvement of RA
tendinitis of rotator cuff and palmar flexor
finger deformities
claw toes
instability of ligaments in cervical spine, specifically C1/C2
Extra-articular involvement of RA
firm, subcutaneous masses in areas with mechanical pressure
usually asymptomatic
may appear in viscera (lungs, heart, GI)
Nodules in organs
eyes –> scleritis
heart –> pericarditis
lungs –> effusion
nerve –> carpal tunnel
vessels –> vasculitis
Diagnosis of RA
prolonged morning stiffness in involved joints, weight loss, anorexia, fatigue, swelling in joints, RA hand changes, RF factor in blood
OA features
Wear/tear of joints
increasing age, sex depends
1 joint, hip/knee
no inflammation
not prolonged stiffness
years for onset
no systemic presentation
RA features
unknown/autoimmune
30-60 yr old, more common in females
bilateral joints. Usually in toes, fingers, cervical
inflammation
prolonged stiffness
onset is weeks to months
systemic presentation
Treatment for RA
no cure
medications, surgeries, patient education on self-care, PT, OT
Pharmacotherapy for RA
DMARDs = disease modifying antirheumatic drugs
includes methotrexate
only class of drugs that alters/slows course of RA
Prognosis of RA
must have good response to treatment and early responses to medication
Indications of Poor prognosis with RA
extra-articular disease carriers, greater risk of CVD
tons of invovled joints
poor functional status
elevated SED rate
erosions
RF present
RA and PT
avoiding cervical flexion
educate on progression
rest periods –> decreases fatigue and protects joints
focus on resistance training, ROM, no stretching, assistive devices
exercise can help reduce stiffness, but should not produce pain that last longer than an hour
modalities –> superficial heat (no deep heat), skin condition is usually poor
Fibromyalgia definition
chronic widespread musculoskeletal pain syndrome characterized by chronic pain and tenderness at specific locations, often associated with persistent fatigue, cognitive/mood/sleep disorders
Epidemiology of fibromyalgia
prevalence is about 2-4% of population
more are females, and symptoms are between 20-55 years of age
Risk factors for fibromyalgia
female
prolonged anxiety, emotional stress
trauma
rapid glucocorticoid withdrawal
hypothyroidism
infections
minimal to moderate aerobic fitness level
Etiology and pathogenesis of fibromyalgia
UNKNOWN
most accepted hypothesis : neurologic disorder of central pain processing that causes pain perception in response to stimuli that would not typically be painful
Clinical presentation of fibromyalgia
chronic and diffuse aching pain often involving entire body with prominence around neck, shoulders, low back, hips. physical exam is often normal
minor exertion aggravates pain & increases fatigue
visual problems
morning stiffness
cognitive problems
depression/anxiety
sleep disturbances
IBS
chronic headaches
Diagnosis of fibromyalgia
widespread pain >7
generalized pain, 4 or 5 regions
symptoms for at least 3 months
tender points are controversial and not accepted
fibromyalgia may be considered a ______ of _______
diagnosis of exclusion
pt must meet all 3 criteria
Treatment of fibromyalgia
there is no cure
patient education, stress management, work simplication
medications = anti-depressants
CBT
exercise
Prognosis of fibromyalgia
good, though most have persistent symptoms for years or lifetime
Exercise for fibromyalgia
people with fibromyalgia fatigue quickly, low tolerance for exertion
stop with increased pain
Exercise prescription for fibromyalgia
F: 1-2 days a week
I: very light
T: start with 10 min a day
T: low impact, non weight-bearing
gentle stretching for flexibility
