Porth Chapter 16

Question 1

Characteristics of AIDS

Answer 1

Profound immunosuppression ​

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Associated opportunistic infections​

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Malignancies​

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Wasting​

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Central nervous system degeneration

Question 2

AIDS Epidemic and Transmission of HIV

Answer 2

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

Question 3

Cells Affected by the HIV

Answer 3

A subset of lymphocytes called CD4+ T lymphocytes (also known as T-helper cells or CD4+ T cells)​

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Macrophages​

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Dendritic cells

Question 4

Functions of the CD4+ T Cells

Answer 4

Necessary for normal immune function​

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Recognizes foreign antigens ​

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Helps activate antibody-producing B lymphocytes​

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Orchestrates cell-mediated immunity​

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Influences the phagocytic function of monocytes and macrophages

Question 5

Life Cycle of the HIV-1

Answer 5

Attachment of the HIV to CD4+ receptor​

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Internalization and uncoating of the virus with viral RNA and reverse transcriptase​

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Reverse transcription, which produces a mirror image of the viral RNA and double-standard DNA molecule​

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Integration of viral DNA into host DNA using the integrase enzyme
Transcription of the inserted viral DNA to produce viral messenger RNA​

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Translation of viral messenger RNA to create viral polyprotein​

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Cleavage of viral polyprotein into individual viral proteins that make up the new virus​

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Assembly and release of the new virus from the host cell

Question 6

Three Phases of HIV Infection

Answer 6

Primary infection phase​

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Chronic asymptomatic or latency phase​

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Overt AIDS phase

Question 7

CDC HIV/AIDS Classification System

Answer 7

The clinical importance of the CD4+ cell count in the categorization of HIV-related clinical conditions ​

Category 1: >500 cells/μL​

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Category 2: 200 to 499 cells/μL​

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Category 3: <200 cells/μL

Question 8

Unique Opportunity for Treatment in the Primary Infection Phase

Answer 8

Reduce the number of long-living HIV-infected cells (e.g., CD4+ memory cells)​

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Protect the functioning of HIV-infected CD4+ T cells and cytotoxic T cells​

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Help maintain a homogeneous viral population that will be better controlled by antiretroviral therapy and the immune system

Question 9

Typical progressors

Answer 9

60% to 70% acquire AIDS 10 to 11 years after infection​

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Question 10

Rapid progressors

Answer 10

10% to 20% progress rapidly and acquire AIDS in less than 5 years ​

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Question 11

Slow progressors

Answer 11

5% to 15% are slow progressors, who do not progress to AIDS for more than 15 years​

Question 12

Long-term nonprogressors

Answer 12

1% have been infected for at least 8 years, are antiretroviral naive, have high CD4+ cell counts, and have usually very low viral loads ​

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Question 13

Consequences of CD4+ Death

Answer 13

Opportunistic infections​

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Malignant tumors​

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Nervous system manifestations​

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The wasting syndrome​

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Metabolic disorders

Question 14

Bacterial Opportunistic Infections

Answer 14

Bacterial pneumonia, TB, Salmonella bacteremia, Mycobacterium avium–intracellulare complex (MAC)

Question 15

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Fungal Opportunistic Infections

Answer 15

Candidiasis, coccidiomycosis, cryptococcosis, and histoplasmosis

Question 16

Protozoal Opportunistic Infections

Answer 16

Cryptosporidiosis, isosporiasis, pneumocystiasis, and toxoplasmosis

Question 17

Viral Infections

Answer 17

Cytomegalovirus (CMV), herpes, and progressive multifocal leukoencephalopathy (PML)

Question 18

Most Common Opportunistic Infections Affecting AIDS in the United States

Answer 18

Pneumocystis carinii pneumonia (PCP)​

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CMV​

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Oropharyngeal or esophageal candidiasis (thrush)​

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Infections caused by MAC

Question 19

Signs and Symptoms of Acute HIV Infection

Answer 19

Fever​

Fatigue​

Rash​

Headache​

Lymphadenopathy​

Pharyngitis
Arthralgia​

Myalgia​

Night sweats​

Gastrointestinal problems​

Aseptic meningitis​

Oral or genital ulcers

Question 20

Respiratory Manifestations Associated with AIDS

Answer 20

PCP​

Pulmonary tuberculosis (TB)​

CMV, MAC​

Toxoplasma gondii​

Cryptococcus neoformans​

Streptococcus pneumoniae​

Haemophilus influenzae​

Legionella pneumophila​

Kaposi sarcoma

Question 21

Diseases of the Gastrointestinal Tract Associated with AIDS

Answer 21

Diarrhea or gastroenteritis​

Cryptosporidium parvum​

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Esophagitis​

Esophageal candidiasis (thrush)​

CMV infection​

Herpes simplex virus infection

Question 22

Nervous System Manifestations Associated with AIDS

Answer 22

AIDS dementia complex (ADC)​

Toxoplasmosis​

PML​

These disorders can affect the peripheral or central nervous system (CNS).

Question 23

Cancers and Malignancies Associated with AIDS

Answer 23

Kaposi sarcoma​

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Non-Hodgkin lymphoma​

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Noninvasive cervical carcinoma

Question 24

Wasting Syndromes

Answer 24

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

Question 25

Metabolic and Morphologic Disorders Associated with HIV/AIDS

Answer 25

Lipodystrophy and mitochondrial disorders​ Hypercholesterolemia​ Hypertriglyceridemia​ Insulin resistance​ Impaired glucose tolerance

Question 26

Transmission of HIV and Prevention

Answer 26

Transmission​ Intravenous drug use​ Risky/unsafe sexual behavior​ ​ Prevention​ Personalized risk assessment ​ Prevention plan​ Education ​ Behavioral intervention

Question 27

Diagnostic Methods Used for HIV Infection

Answer 27

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

Question 28

Treatment for HIV Following Diagnosis

Answer 28

Baseline evaluation​ Complete history​ Physical examination ​ Baseline laboratory tests​ Routine follow-up care

Question 29

Criteria for Therapeutic Interventions for HIV/AIDS

Answer 29

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

Question 30

HIV Antiretroviral Medications

Answer 30

Nucleoside reverse transcriptase inhibitors​ Nucleotide analog reverse transcriptase inhibitors​ Nonnucleoside reverse transcriptase inhibitors​ Protease inhibitors​ Fusion inhibitors

Question 31

Psychosocial Issues Associated With HIV/AIDS

Answer 31

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

Question 32

HIV Infection in Pregnancy, Infants, Children

Answer 32

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.