HIV / AIDS

Question 1

Human Immunodeficiency Virus (HIV)

Def

Answer 1

A virus that attacks the immune system, specifically T-cells with CD4 receptors

Progressively weakens the host immune cells

Increase susceptibility to opportunistic infections & cancers (sarcomas)

Question 2

Modes of Transmission

(5)

Answer 2

1. Unprotected sexual activities - vaginal, anal, or oral
2. Shared needles or equipment - drugs, tattoos, sterioids
3. Motor to child transmission
   Three different mechanisms:
   - In uterine
   - During birthing if exposed to blood/mucus in birth canal
   - Breast milk
4. Occupational hazards - needle poke, acupuncture
5. Blood & blood products - blood transfusions (95% of contracting HIV if blood has a virus)

Question 3

Body fluids infectious for HIV…

(11)

Answer 3

1. Blood
2. Breast milk
3. Inflammatory exudate
4. Semen
5. Vaginal secretions
6. Cerebrospinal fluid
7. Amniotic
8. Pericardial
9. Peritoneal
10. Pleural
11. Synovial fluid

* Semen & vaginal secretions are ONLY infect fluids secreted by the body

Question 4

Body fluids NOT infectious for HIV…

Answer 4

1. Feces
2. Urine
3. Sweat
4. Tears

Things secreted by the body

Virus dies very quickly when it is exposed to the external environment

Question 5

Universal Precautions

(6)

Answer 5

1. Medical Hx & examination cannot reliably identify pt w/ HIV, t/f universal precautiouns should be used for ALL patients which there is a risk of blood exposure
2. Do not use unnecessary precautions - 1. insensitive & 2. sending the wrong message about transmission risk to others as HCP
3. Use gloves if you may come in contract with blood, body fluids, mucous membrane, or non-intact skin
4. Use mask & eye protection during procedures that are likely to generate droplets of blood or other body fluids
5. Use gown during procedures that may generate splashes of blood or other body fuilds
6. Refrain from all direct patient care if YOU have open wounds or skin lesions

Question 6

Diagnosis

Laboratory Testing & Values (3)

Answer 6

1. Blood antibody tests:
   - ELISA & Western blot test
   - Helps confirm if there are anti-HIV antibodies in the blood - 6-10 weeks for antibodies to be detectable in blood tests
2. CD4 Count
   - Normal: 500-1500 cells/m3
   - UP is good, DOWN is bad
   - Every year w/ HIV, CD4 counts get lower & lower ~ 50-100 cells/m3/yr
3. Viral Load Test
   - Detectable range: 50-500,000/ml
   - DOWN is good, UP is bad
   - < 50 is not detectable BUT does not mean the pt does NOT have HIV

Question 7

Acquired Immunodeficiency Syndrome (AIDS)

Def & Categorization

Answer 7

Category developed to identify advanced HIV progression

A person w/ AIDS must have:
- CD4 count <200/mm3
- 1 or more of the 26 indicator conditions

Question 8

Medical Management: HAART

Role & Function

Answer 8

Highly Active Antiretroviral Therapy (HAART)

• Interfere with virus life cycle - stops it from replicating
• Decreases viral load (cannot be fully eradicated - no cure)
• Preserves CD4 count - would DEC every yr w/o it
• Requires high compliance to be effective
  ** Low drug levels may cause drug resistance to develop
  ** Requires lifetime commitment - cannot take a “drug vacation”

Question 9

HAART: Side Effects

Answer 9

Mitochondrial Toxicity
1. Body composition changes:
Redisturbution of fat stores to abdomen, viscera posterior C/S (HALS = HIV-associated lipodystrophy syndrome &/or “Buffulo Hump”)
INC risk of CVD
INC risk of acute pancreatitis
2. Mitochondrial myopathy - leads to mm weakness & atrophy
3. Cardiomyopathy
4. Hepatic steatosis - ie fatty liver
5. Peripheral Neuropathy
Pattern is distal - proximal & symmetrical - “glove & stocking”
May be painful or painless - feet is very common - typical S/S of neuropathy = absent reflexes, sensory issues > motor

Skin Rash

CGI Symptoms
1. Diarrhea
2. Nausea
3. Abdominal pain
** Not mitrochondrial related

Dyslipidemia - abnormal amount of lipids (fat) in the blood
- INC bad fats - LDLs or triglycerides

Osteopenia/ Osteoporosis
Osteonecrosis - bone death = pain, DEC ROM, joint stiffness & mm spasms