Porth Chapter 16 Flashcards
Characteristics of AIDS
Profound immunosuppression
Associated opportunistic infections
Malignancies
Wasting
Central nervous system degeneration
AIDS Epidemic and Transmission of HIV
Caused by HIV
Occurs worldwide
There is no cure.
Transmitted through blood, semen, vaginal fluids, and breast milk
Not spread by casual contact or insects
Is infectious, even if the person is asymptomatic
Cells Affected by the HIV
A subset of lymphocytes called CD4+ T lymphocytes (also known as T-helper cells or CD4+ T cells)
Macrophages
Dendritic cells
Functions of the CD4+ T Cells
Necessary for normal immune function
Recognizes foreign antigens
Helps activate antibody-producing B lymphocytes
Orchestrates cell-mediated immunity
Influences the phagocytic function of monocytes and macrophages
Life Cycle of the HIV-1
Attachment of the HIV to CD4+ receptor
Internalization and uncoating of the virus with viral RNA and reverse transcriptase
Reverse transcription, which produces a mirror image of the viral RNA and double-standard DNA molecule
Integration of viral DNA into host DNA using the integrase enzyme
Transcription of the inserted viral DNA to produce viral messenger RNA
Translation of viral messenger RNA to create viral polyprotein
Cleavage of viral polyprotein into individual viral proteins that make up the new virus
Assembly and release of the new virus from the host cell
Three Phases of HIV Infection
Primary infection phase
Chronic asymptomatic or latency phase
Overt AIDS phase
CDC HIV/AIDS Classification System
The clinical importance of the CD4+ cell count in the categorization of HIV-related clinical conditions
Category 1: >500 cells/μL
Category 2: 200 to 499 cells/μL
Category 3: <200 cells/μL
Unique Opportunity for Treatment in the Primary Infection Phase
Reduce the number of long-living HIV-infected cells (e.g., CD4+ memory cells)
Protect the functioning of HIV-infected CD4+ T cells and cytotoxic T cells
Help maintain a homogeneous viral population that will be better controlled by antiretroviral therapy and the immune system
Typical progressors
60% to 70% acquire AIDS 10 to 11 years after infection
Rapid progressors
10% to 20% progress rapidly and acquire AIDS in less than 5 years
Slow progressors
5% to 15% are slow progressors, who do not progress to AIDS for more than 15 years
Long-term nonprogressors
1% have been infected for at least 8 years, are antiretroviral naive, have high CD4+ cell counts, and have usually very low viral loads
Consequences of CD4+ Death
Opportunistic infections
Malignant tumors
Nervous system manifestations
The wasting syndrome
Metabolic disorders
Bacterial Opportunistic Infections
Bacterial pneumonia, TB, Salmonella bacteremia, Mycobacterium avium–intracellulare complex (MAC)
Fungal Opportunistic Infections
Candidiasis, coccidiomycosis, cryptococcosis, and histoplasmosis
Protozoal Opportunistic Infections
Cryptosporidiosis, isosporiasis, pneumocystiasis, and toxoplasmosis
Viral Infections
Cytomegalovirus (CMV), herpes, and progressive multifocal leukoencephalopathy (PML)
Most Common Opportunistic Infections Affecting AIDS in the United States
Pneumocystis carinii pneumonia (PCP)
CMV
Oropharyngeal or esophageal candidiasis (thrush)
Infections caused by MAC
Signs and Symptoms of Acute HIV Infection
Fever
Fatigue
Rash
Headache
Lymphadenopathy
Pharyngitis
Arthralgia
Myalgia
Night sweats
Gastrointestinal problems
Aseptic meningitis
Oral or genital ulcers
Respiratory Manifestations Associated with AIDS
PCP
Pulmonary tuberculosis (TB)
CMV, MAC
Toxoplasma gondii
Cryptococcus neoformans
Streptococcus pneumoniae
Haemophilus influenzae
Legionella pneumophila
Kaposi sarcoma
Diseases of the Gastrointestinal Tract Associated with AIDS
Diarrhea or gastroenteritis
Cryptosporidium parvum
Esophagitis
Esophageal candidiasis (thrush)
CMV infection
Herpes simplex virus infection
Nervous System Manifestations Associated with AIDS
AIDS dementia complex (ADC)
Toxoplasmosis
PML
These disorders can affect the peripheral or central nervous system (CNS).
Cancers and Malignancies Associated with AIDS
Kaposi sarcoma
Non-Hodgkin lymphoma
Noninvasive cervical carcinoma
Wasting Syndromes
Factors that contribute to wasting
Anorexia
Endocrine dysfunction
Malabsorption
Cytokine dysregulation
Characteristics
Involuntary weight loss of at least 10% of baseline body weight, presence of diarrhea, more than two stools per day, chronic weakness, and fever
Metabolic and Morphologic Disorders Associated with HIV/AIDS
Lipodystrophy and mitochondrial disorders
Hypercholesterolemia
Hypertriglyceridemia
Insulin resistance
Impaired glucose tolerance
Transmission of HIV and Prevention
Transmission
Intravenous drug use
Risky/unsafe sexual behavior
Prevention
Personalized risk assessment
Prevention plan
Education
Behavioral intervention
Diagnostic Methods Used for HIV Infection
Laboratory methods to determine infection
HIV antibody test
Western blot test
OraSure test
Polymerase chain reaction (PCR)
Clinical methods to evaluate the progression of the disease
Treatment for HIV Following Diagnosis
Baseline evaluation
Complete history
Physical examination
Baseline laboratory tests
Routine follow-up care
Criteria for Therapeutic Interventions for HIV/AIDS
Determined by the level of disease activity based on
the viral load
the degree of immunodeficiency based on the CD4+ cell count
the appearance of specific opportunistic infections
HIV Antiretroviral Medications
Nucleoside reverse transcriptase inhibitors
Nucleotide analog reverse transcriptase inhibitors
Nonnucleoside reverse transcriptase inhibitors
Protease inhibitors
Fusion inhibitors
Psychosocial Issues Associated With HIV/AIDS
The dramatic impact of this illness is compounded by complex reactions on the part of the person with HIV or AIDS; his or her partner, friends, and family; members of the health care team; and the community.
Hidden lifestyle impact on support persons
Depression
Anxiety disorders
Alcohol
Drug problems
HIV Infection in Pregnancy, Infants, Children
HIV can be passed from mother to infant.
During labor and delivery
Through breast-feeding
Diagnosis of HIV infection in children born to HIV-infected mothers is complicated by the presence of maternal HIV antibody, which crosses the placenta to the fetus.
The course of HIV infection is different for children than adults.
