UNIT 3 HIV/AIDS Flashcards
What is HIV?
Retrovirus that causes immunosuppression making persons more susceptible to infections
How is HIV transmitted?
Through contact with certain body fluids
- Blood
- Semen
- Vaginal secretions
- Breast milk
How is HIV spread through blood?
- Sharing drug-using paraphernalia
- Puncture wounds
3 Lesions in mouth/nose if drugs are snorted off spoon
Due to the extensive screening blood products are rarely a source of HIV transmission now.
True or false: HIV is spread through casual contact
False
How is HIV spread through perinatal transmission?
- Can occur during pregnancy, delivery or breastfeeding
- 25% of infants born to women with untreated HIV tested +
- Treatment can decrease rate of transmission to <2%
How is HIV spread through sexual transmission?
- Unprotected sex with an HIV- Infected partner is most common mode of transmission.
- Greatest risk is for the partner that receives semen
- Prolonged contact w/ infected fluids
- Women at higher risk
- Trauma increases likely hood of transmission
What is the patho of HIV?
HIV is a ribonucleic acid (RNA) virus
- Called retroviruses because they replicate in a backward manner going from RNA to DNA
- CD4+ T cell is the target cell for HIV
-type of lymphocyte- HIV binds to cell through fusion
What are the consequences of Integrase?
- Newly formed double-stranded DNA is infected with HIV because all genetic material replicated during cell division
- Viral DNA genome directs cells to make new HIV.
When do immune probelms start with HIV?
- When CD4 T cell counts are below <500
What is the normal range of CD4+T cell count?
800-1200
When do severe problems with HIV develop?
When CD4 + Tcell count is below 200
Insufficient immune response allows for what?
Opportunistic disease
An acute infection of HIV presents with what symptoms?
- Flu like symptoms- fever, swollen lymph nodes, sore throat, headache, malaise
When does the acute infection phase of HIV occur?
2-4 weeks after infection and is HIGHLY infectious
In the asymptomatic infection phase what would you expect your CD4+ tcells levels to be
- CD4+ t cell count > above 500 and viral load low— body is trying to fight back
What symptoms would you expect to see in the asymptomatic infection phase of HIV?
- Symptoms generally absent or vague– which can encourage high risk behaviors to continue
What happens if HIV is left untreated?
Develop AIDS occur in 10 years
In the symptomatic infection phase of HIV what would you expect your CD4+ T cells to look like?
- CD4+ T cells between 200-500 and increased viral load
How would you expect your symptoms to present in the symptomatic infection phase of HIV?
Symptoms become worse and HIV advances into a more active stage
What are the clinical manifestation and complications of the symptomatic infection phase of HIV?
- Shingles
- Persistent vaginal candida infections
- Herpes-oral or genital
- Bacterial infections
What is candida?
Yeast build up
- Common and persistent problem in HIV
- Oral thrush/vaginal candida
Very painful, difficulty eating, will need swoosh and swallow meds
What should we know about Kaposi Sarcoma
- Looks like a bruise initially then turns dark violet/black
- Invades skin on torsos & extremities and surface of organs
- May be painful
What do we need to know about oral hairy leukoplakia?
- Epstein bar virus
- Not painful
- Vertical stripping of tongue
- Most commonly occur during active phase of HIV
What are the diagnostic criteria established by the CDC that dx AIDS?
- CD4+ T cell < below 200 and or AIDS defining condition
- infections
- Malignancies
- Wasting syndrome- loss of weight by 10% along with diarrhea, chronic weakness and documented fever lasting for up to a month which can only be accounted for by HIV. Decrease in fat and lean body- responsible for weight loss.
- HIV-Related dementia (encephalopathy)
What do we need to know about Pneumocystis Jirovecii Pneumonia (PJP)
- Is caused by a yeast-like fungus
- Is an opportunistic infection & seen in weak immune systems or other predisposing health conditions
- Most commonly presents as an opportunistic infection in HIV infected patients (CD4+ tcell counts typically below 200)
- Since ART treatment has become more common PJP is seen less
What should we know about diagnostic studies used to detect HIV-specific antibodies or antigens?
- May take several weeks to detect antibodies (window period)
- Performed using blood or saliva
- Combination (4th generation) test can detect HIV earlier
- Negative results- restest in 6 wks.
HIV progession is monitored by?
CD4+ T-cell counts and viral load
What does CD4+ T-cell counts tell us about HIV?
- Provides a marker of immune function
What does our viral load tell us about HIV?
- The lower the viral load the less active the disease or vise versa
What abnormal blood tests can be see with HIV?
- decreased WBC counts
- Low platelet counts
- Anemia is associated with ART
- Altered liver function
What can resistance test tell us with HIV patients?
- Resistance tests can help determine if a patient is resistant to ART
What can assays help the HCP know in HIV treatment?
- Assays help HCPs know which medications may be effective
Genotype assay tells us what?
Tells us about the virus itself
Phenotype assay tells us what?
- Tell us what drug is most effective
Interprofessional care for HIV includes what?
- Monitor disease progression, immune function & manage symptoms
- Initiate and monitor ART
- Prevent, detect and/or treat opportunistic infections
- Prevent or decrease complications of therapies
- Prevent further transmission of HIV.
An HIV patients initial visit will include
- Gathering baseline data
- Begin to establish rapport and use patient input to develop a plan of care
- Initiate teaching about spectrum of HIV, Tx, Planning, transmission, improving health and family planning.
What are the main goals of drug therapy in HIV treatment?
- Decrease viral load
- Maintain/increase CD4+ T-cell counts
- Prevent HIV-related symptoms and opportunistic diseases
- Delay disease progression
- Prevent HIV transmission
What drug interactions should you look out for with HIV patients
- Herbal therapies- St. John’s wort
- OTC drugs- antacids, proton pump inhibitors, supplements
True or false: If a patient cant adhere to medication as directed it is better to wait to prescribe until they can?
True- Waiting until patient adherence can be guaranteed will decrease risk of a resistant strand of HIV.
True or false: opportunistic diseases complicate management of HIV so prevention is key?
True
True or false: onset cannot be delayed even with adequate measures?
False- Onset CAN be delayed with adequate measures
True or false: Effective management has significantly increased life expectancy
True
How can we prevent transmission of HIV?
- Pre-exposure prophylaxis (PrEP)
- Comprehensive strategy to reduce risk of sexually-acquired infection in adults at high risk
- Used in conjunction with proven prevention interventions
Candid conversations are…
important for effective management of HIV
What questions should we ask in our assessment to find out if our patient is at risk for HIV?
- Have they received blood transfusions or clotting factors before 1985?
- Shared needles with another person?
3 Had a sexual experience with your penis, vagina, rectum, or mouth in contact with these areas of another person?
- Had an STI?
Goals for care for HIV/AIDs pts are aimed at?
- Compliance w/drug regimens
- Adopting a healthy lifestyle
- Beneficial relationships
- Spiritual well-being regarding life and death
- Coping with the disease and its tx
How is HIV preventable?
- Avoid risky behaviors
- Modify risky behaviors
- Candid, culturally sensitive, language-appropriate, age-specific information and behavior changing couseling
How can we decrease risk of HIV through sexual intercourse?
- Abstinence
- Non contact safe sex
- Use of barriers
How can we decrease risk of HIV through drug use?
- Do not use drugs
- Do not share equipment
- Do not have sexual intercourse under the influence of any impairing substance.
- Refer for help w/substance abuse
How do you decrease the risk of HIV with perinatal transmission?
- Family planning
- Prevent HIV in women
- Appropriately medicate HIV-infected pregnant women
How do you decrease the risk of HIV at work?
- Adhere to precautions and safety measures to avoid exposure
- Report all exposures for timely treatment and counseling
- Post-exposure prophylaxis with combination ART can significantly decrease risk of infection.
True or false: Early intervention promotes health and delays disability?
True
How might a patient react with a positive HIV test?
Keep in mind the reaction would be similar to any life-threatening, chronic illness
Panic, anxiety, fear, guilt, depression, denial, anger, hopelessness
Antiretroviral therapy (ART) can significantly slow HIV progression but….
- Art is complex
- ART has side effects
- ART does not work for everyone
- ART is expensive
When should a patient start Antiretroviral therapy?
- Patient readiness is most important concern
- To avoid burnout and non-adherence, treatment is recommended when immune suppression is great.
Adherence to drug regiments are critical in preventing what in HIV?
- Disease regression
- Opportunistic diseases.
- Viral drug resistance
How can we support a healthy immune system for HIV pts
- Adequate nutrition
- Current vaccinations
- Health habits
4.Avoiding risky behaviors - Supportive relationships
HIV Infections—
- has no cure
- Continues for life
- Causes physical disability
- impairs social, emotional, economic and spiritual wellbeing
- ultimately leads to death
What are disease and drug side effects of HIV?
- Anxiety, fear, depression
- Diarrhea
- Peripheral neuropathy
- Pain
- N/V
- Fatigue***
What metabolic disorders should we consider with patient with HIV?
- Lipodystrophy: causes a person to lose fat from parts of body while gaining it in others including organs
- Hyperlipidemia
- Insulin resistance
- Hyperglycemia
- Bone disease
- lactic acidosis
- Renal disease
- Cardiovascular disease
What gerontologic considerations should we consider with HIV.
- increasing rates of HIV disease among older patients.
- Death rate from opportunistic infections increased
- People older than 60 are increasingly being infected
- Comorbidities
- Polypharmacy
