Immunodeficiency Disease

Question 1

Define immunodeficiency

Answer 1

• immune response is absent or depressed

Question 2

Define primary immunodeficiency diseases

Answer 2

• congenital
• dysfunction involving T cells, B cells, or lymphoid tissues

Question 3

Define secondary immunodeficiency diseases

Answer 3

• 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

Question 4

Define Iatrogenic immunodeficiency

Answer 4

• caused by medical treatment

Question 5

Describe cytotoxic drugs

Answer 5

• kill immunocompetent cells while replicating (chemotherapy)

Question 6

Describe corticosteroids

Answer 6

• affect T cells in bone marrow & block tissue infiltration of neutrophils

Question 7

Describe radiation therapy

Answer 7

• cytotoxic to most lymphocytes, total lymph node irradiation

Question 8

Define splenectomy

Answer 8

• removal of the spleen
• spleen is an immune organ

Question 9

What are some consequences of a weakened immune system

Answer 9

• increased risk for infections
• normal defense mechanisms may be affected (respiratory & GI)

Question 10

Define human immunodeficiency virus (HIV)

Answer 10

• infection of the immune system, resulting in progressive & ultimately profound suppression

Question 11

Describe acquired immune deficiency syndrome (AIDS)

Answer 11

• 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

Question 12

What are the 4 distinct points of HIV infection

Answer 12

• acute infection
• asymptomatic HIV seropositive
• early symptomatic HIV
• HIV advanced disease (AIDS)

Question 13

How is HIV transmitted

Answer 13

• 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

Question 14

Pathogenesis of HIV

Answer 14

• 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

Question 15

How does stage 1 acute infection of HIV present

Answer 15

• 1-6 weeks after exposure
• viral load is high & antibody test is negative
• flu-like symptoms & lymphadenopathy

Question 16

How does stage 2 asymptomatic infection of HIV present

Answer 16

• positive antibody test
• 1-20 years very variable
• clinically healthy
• fatigue & lymphadenopathy
• CD4 count 500 cells/mm^3

Question 17

How does stage 3 symptomatic HIV present

Answer 17

• CD4 count 200-500 cells/mm^3
• immune system compromised
• months to years
• increased symptoms of lymphadenopathy & generalized symptoms

Question 18

How does stage 4 advanced HIV (AIDS) present

Answer 18

• CD4 less than 200 cells/mm^3
• neurological involvement
• opportunistic infections
• neurologic involvement, dementia, & skin conditions

Question 19

Pain syndromes seen in HIV infected individuals

Answer 19

• headache
• abdominal pain
• chest pain
• arthralgias
• myalgias
• women often experience greater pain

Question 20

Peripheral neuropathies seen in HIV infected individuals

Answer 20

• distal sensory polyneuropathy (DSP)
• causes parethsias, numbness, impaired sensation, burning, hyperalgesias, cramping, sleep disturbances, impaired ADLs, & balance

Question 21

Skin impairments seen in HIV infected individuals

Answer 21

• tines pedis (athletes foot)
• capos sarcoma (cancerous patches of abnormal tissue under the skin)

Question 22

Neuromusculoskeletal diseases seen in HIV infected individuals

Answer 22

• osteomyelitis, bacterial myositis, & infectious (reactive) arthritis
• osteonecrosis, osteopenia, osteoporosis, & AVN (avascular necrosis)
• musculoskeletal pain syndromes or HIV rating syndrome
• HIV associated myopathy

Question 23

Cardiopulmonary diseases seen in HIV infected individuals

Answer 23

• increased blood pressure & atherosclerosis
• myocardial infarction, cardiomyopathy, pericardial effusion, & pericarditis
• bacterial pneumonia, bronchitis, tuberculosis, & CMV
• emphysema, asthma, & pulmonary hypertension

Question 24

Ways to prevent HIV infection

Answer 24

• 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

Question 25

Treatment for HIV infection

Answer 25

• highly active antiretroviral therapy (HAART)
• helps to decrease the amount of virus in the blood to very low & even undetectable levels (CD4 counts)

Question 26

Purpose of physical therapy with regards to HIV infection

Answer 26

• 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

Question 27

Exercise recommendations for HIV/AIDS in the advanced stages

Answer 27

• 20 minutes 3-4x per week aerobic exercise at moderate intensity