HIV & AIDS Flashcards

1
Q

Human immunodeficiency virus (HIV) causative agent

A

Retrovirus is the causative agent

2 of 5 know. Human retroviruses

  • HIV-1: 80% of cases worldwide
  • HIV-2: mostly in west Africa
  • Both deplete T4 cells & subsequent cellular immunity
  • HSRV: foamy virus (not pathogenic in humans)
  • HTLV1: T cell leukemia and lymphoma
  • HTLV2: no known pathology, ? Hairy cell leukemia
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2
Q

HIV Epidemiology

A

Cases since 1976 but originally treated as Gay Related Immunodeficiency Disease (GRID)

1st AIDS cases reported in 1981

1993 new definition of AIDS: HIV &CD4 T-lymphocyte count of <200 per mm3- 1/5 normal level

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3
Q

Can HIV affect children?

A

13-48% perinatal transmission through gestation, delivery, and rarely breast milk

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4
Q

HIV Prevalence

A

Make>female in US; worldwide:50/50

> 2/3 cases are in African-Americans

417/100,000 in 2010-2015

CDC allocates all HIV & AIDS prevention planning project (ECHPP): 3 year demonstration project to maximize the impact of HIV prevention in the 12 metropolitan statistical areas with the highest AIDS prevalence in the US

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5
Q

HIV Transmission

A

Sexual contact

Parenteral exposure to blood, blood products, & blood containing body fluids

Mother to child

Body fluids: blood, semen, vaginal fluids

Not associated with casual contact

More than 1.1 million people in the US have HIV and almost 1 in 5 (18.1%) are unaware

About 38,000 new cases each year

Gay, bisexual, and other men who have sex with men are most seriously affected by HIV

~636,000 have died from AIDS in the US since the epidemic began

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6
Q

Who is at risk/ should be tested

A

Sexually active

Use injection drugs

Engaged in sex work

Had a partner who was at risk

Sexual encounters with men from high HIV incident countries

Transfusion between 1978-1985

Symptoms that could be HIV related

In a correctional institution

Routine prenatal screening

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7
Q

HIV Diagnostic tests

A

13 testing centers within 30 miles

“Window period”: most develop detectable antibodies within 3 months; average is 25 days; rare cases up to 6 months

HIV antibody testing (ELISA)

Western blot

Rapid assays

Viral load

CD4 count

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8
Q

Antibody detection facts

A

Most people form HIV antibodies within 3 weeks to 3 months after exposure but can lag up to 6 months

Lag period= window period

It is possible to detect anti-HIV antibodies 3 months after infection, even in asymptomatic individuals

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9
Q

ELISA

A

Enzyme-Linked ImmunoSorbent Assay

Highly specific & 99.6% sensitive for HIV-1 antibodies

False +:
Recent influenza or hep B vaccine
Multiparous women
After multiple blood transfusions 
Those with multiple myeloma
Alcoholic hepatitis 
Biliary cirrhosis
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10
Q

Western Blot and Rapid Assays

A

Western blot confirms + ELISA
More HIV-1 sensitive
Detects antibodies= not reliable in early stages of infection

Rapid Assays vary in time and $$$
Fast & cheap: immunochromatographic (lateral flow) strips. Results in <20 minutes, no refrigeration necessary, some can detect HIV 1 & 2

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11
Q

Viral load (HIV RNA levels)

A

Measure of HIV RNA levels: amount of virus

3 assays can measure it

Use to monitor effectiveness of antiretroviral therapy: administer 2 assays within 1-2 weeks to establish a baseline

Undetectable viral load does not mean that infection has been eliminated or that replication has been halted completely

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12
Q

CD4 Cell Counts

A

Measure extent of immune damage

Monitor the benefits of antiretroviral therapy

Predict possibility of disease progression with viral load

Baseline Q2-4 weeks on initial drug therapy; Q3-4 months when CD4 >350/ mm3

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13
Q

Interpretation of Viral Load & CD4

A

HIV RNA < 7000 copies/ml &
CD4 count >350/mm3
=
2% chance of progressing to AIDS within 3 years without treatment

HIV RNA >55,000 copies/ml &
CD4 count <200/mm3
=
85% chance of progressing to AIDS within 3 years

⬆️ viral load= ⬇️ CD4 count

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14
Q

HIV Staging

A

Initial exposure (asymptomatic)

Primary HIV Infection (acute infection): flu-like symptoms; HIV replicates; develop antibodies to HIV in 6-12 weeks

Clinical latency or asymptomatic HIV infection (HIV seropositivity; latency): infections but no evidence of illness except +HIV antibody test; CD4+ T-cell count >500 cells/mm3; HIV continues to replicate

Late symptomatic stage (symptomatic infection): CD4<200 cells/mm; viral load >100,000 copies/ml; opportunistic infections (AIDS defining illness)

Advanced HIV Disease (AIDS): opportunistic infections CD4 <50

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15
Q

What are opportunistic infections?

A

1: pulmonary infections (often the first manifestation of AIDS

Pathogens that take advantage of low immunity to progress disease

Most likely to develop when CD4 <200

Can people other than HIV+ get opportunistic infections? YES! Ofc- anyone with a compromised immune system can

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16
Q

HIV ➡️ AIDS

Opportunistic infections

A

Bacterial and mycobacteria: Mycobacterium avium (MAC)

Viral: cytomegalovirus, herpes simplex

Protozoans: cryptosporidium (watery diarrhea)

Fungal: candida, crytococcosis (pneumonia and meningitis), histoplasmosis (pneumonia), pneumocystis carinii (pneumonia)

HIV related cancers: Kaposi’s sarcoma

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17
Q

AIDS Signs & Symptoms

A

Severe fatigue (>several weeks)

Sudden weight loss (>10 lbs in <2 months)

Night sweats, fever

Diarrhea

Bruising/bleeding

Coughing, SOB

Skin rashes, spots

Persistent Generalized Lymphadenopathy

Oral thrush

Neuro problems

Frequent infections

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18
Q

HIV Complications

A

Encephalopathy/ dementia

Anemia

Others

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19
Q

HIV Primary Prevention

A

Community education

20
Q

HIV Secondary prevention

A

Early diagnosis

Testing

21
Q

HIV Tertiary Prevention

A

Strategies to prevent opportunistic infection & reduce transmission

Good nutrition

Medications

Monitoring for side effects and signs of infection

22
Q

HIV Drug Treatment

A

HAART: Highly Active Antiretroviral Therapy (now called ART- Antiretroviral therapy)

3+ drugs from these categories:

  • nucleoside-Analog reverse transcriptase inhibitors
  • nonnucleoside reverse transcriptase inhibitors
  • protease inhibitors
  • fusion inhibitors

Drawbacks: not a cure; expensive & complicated; interaction with other drugs; side effects

23
Q

WHO Guidelines for ART (2013)

A

All individuals with CD4 <350 cells/mm3

CD4 >350 but <500 cells/mm3

Regardless of CD4 if:

  • active TB
  • co-infected with HBV
  • if the person had an uninfected partner to decrease the incidence of transmission
  • all pregnant and breastfeeding women with HIV
  • all children with HIV if <4 years old
  • those >5 years old with CD4 <500 cells/mm3
24
Q

HIV/AIDS Meds

A

Monitor for drug effectiveness, interactions, and education

25
Q

Reverse transcriptase inhibitors: Neucleoside Analogs

A

Limit HIV replications of HIV early in its life cycle

Most common: zidovudine (AZT, ZDV, Retrovir), Didanosine (ddi, Videx), Combivir (contains Lamivudine and AZT)

Side effects: GI, bone marrow suppression, peripheral neuropathy, hypersensitivity

26
Q

Reverse transcriptase inhibitors: Non-Neucleoside Analogs

A

Inhibit reverse transcriptase

Not recommended as mono therapy

Most common: Etravirine (Viramune), Delavirudine (Rescriptor)

Interactions with other drugs: rifampin, antacids, phenytoin, phenobarbital, etc.

27
Q

Protease inhibitors

A

Prevent replication and the release of viral particles

Indinavir (Crixivan)

Saquinavir (Invirase)

Nelfinavir (Viracept)

Side effects: GI, interactions with meds, rash

28
Q

Fusion inhibitors

A

Early inhibitors that block the fusion of HIV with host cells

Enfuvirtide (fuzeon)

SQ injection

Drug interactions, hypersensitivity, local injection site reactions

Teach pts to report dyspnea, fever, and purulent mucous

29
Q

Antifungal Meds

A

Amphitericin B

Diflucan

30
Q

Antiprotozial meds

A

Pentadamine

31
Q

Antiviral meds

A

Ganciclovir

Acyclovir

32
Q

Antibacterial meds

A

Azithromycin

Bactrim

33
Q

MAC

A

Clarithromycin

Rifabutin

34
Q

Other meds for HIV/AIDS

A

Antineoplastics

Appetite stimulants

Antiemetics

35
Q

NIH Panel Guidelines for use of AVR drugs

A
  1. HIV infection is always harmful; true long-term survival free of immune dysfunction is unusual
  2. Regular, periodic measurements of HIV RNA levels and CD4 T cell counts are needed to determine the risk for disease progression
  3. Treatment decisions should be individualized based on #2 and WHO guidelines
  4. Maximum achievable suppression of HIV replication should be the goal of therapy
  5. Women should be treated, regardless of pregnancy status
  6. Same Tx principles are utilized with HIV infected children although unique pharmacological considerations may be needed to be taken into account
  7. Individuals with viral loads below detectable limits should still be considered infectious
36
Q

HIV/AIDS Health History

A

Risk factors: forms of transmission

Sexual Hx

Clinical manifestations: weight loss, low-grade fever, fatigue, night sweats, painful lymph nodes, nausea, headache

Symptoms: relief, exacerbations

Meds and Alternative remedies

ADL functional status

Concurrent med problem

Support system

Advanced directives

37
Q

HIV/AIDS physical exam

A

Check weight < ideal for height

Abnormal VS

Check: non-elastic skin turgor, excoriated mucous membranes

Respiratory: cough, dyspnea, crackles, wheezes

GI: diarrhea, distention, tenderness

Fluid

38
Q

HIV/AIDS NRSG plan of care: infection, risk for

A

communicable disease management

infection control

infection management

surveillance

39
Q

HIV/AIDS NRSG plan of care: nutrition

A

Nutritional monitoring

Nutritional therapy

Nausea management

40
Q

HIV/AIDS NRSG plan of care: fatigue

A

Energy management

Sleep enhancement

Mood management

41
Q

HIV/AIDS NRSG plan of care: anxiety

A

Anxiety reduction

Presence

Coping enhancement

42
Q

HIV/AIDS NRSG plan of care: individual coping, ineffective

A

Anxiety reduction

Coping enhancement

Decision-making support

Support group

Teaching: individual

Financial concerns

43
Q

HIV/AIDS NRSG plan of care: family processes, altered

A

Counseling

Emotional support

Support system enhancement

Family integrity promotion

44
Q

Nursing diagnosis

A

Ineffective therapeutic regimen management

Teaching, counseling, coping, decision-making

45
Q

How do healthcare workers protect themselves?

A

Standard precautions

Post-exposure prophylaxis for healthcare providers