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Nursing 304 > HIV/AIDS > Flashcards

HIV/AIDS Flashcards

1
Q

How many people are living with HIV today?

A

36.7 million (34.0-39.8)

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2
Q

Which population has the highest rates of new HIV diagnosis?

A

Men who have sex with men (58% in 2014)

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3
Q

What is the most common mode of transmission for HIV?

A

Sexual transmission (unprotected anal)

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4
Q

What are the known routes of transmission?

A

Sex, blood, blood products and other body components, mother to child

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5
Q

What are some modes of transmission that there is no evidence for transmitting HIV?

A

Tears
Saliva
Normal social contact
Insect vectors

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6
Q

What are the four stages of HIV infection?

A

Acute infection
Early chronic
Intermediate chronic
Late chronic/AIDS

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7
Q

What occurs during the acute infection stage of HIV infection? (and how long does it last)

A

HIV antibodies develop (seroconversion)
1-3 weeks after initial infection
Usually flu-like symptoms

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8
Q

What occurs during the early chronic stage of HIV infection? (And what is the CD4 count)

A

AKA asymptomatic disease
Fatigue, headache, low grade fever, night sweats, generalized lyphadenopathy
CD$>500

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9
Q

What occurs during the intermediate chronic stage of HIV infection? (And what is the CD4 count)

A

Symptomatic, weight loss, fatigue, diarrhea, candidiasis, herpes simplex and zoster, oral hairy leukoplakia
CD4 200-500

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10
Q

What occurs during the late chronic/AIDS stage of HIV infection?

A

At least one AIDS defining illness as defined by WHO

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11
Q

What are some important markers for detecting immune system function in HIV?

A

CD4 counts vary widely - affected by viral illnesses, vaccines, etc.
Trend is more important than the actual number.
CD4 fraction provides a better picture of the state of the immune system because it is a more stable number - should be above 15% - normal range varies by lab - generally around 27-60%
CD4 fraction is the percentage of total lymphocytes with the CD4 marker

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12
Q

What are some methods for HIV testing (what is the protocol)

A

Nominal or non-nominal
Reportable
HIV antibody diagnostic test (infection status) - ELISA and western blot

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13
Q

What is ELISA?

A

ELISA is the screening test that is initially done to test for HIV antibodies - it has high sensitivity and relatively low specificity
The first test applied is a third generation EIA test - if there is any reactivity, a fourth generation EIA test is conducted to confirm reactivity

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14
Q

What is the Western Blot?

A

Western Blot is an antibody test that is done to confirm reactivity - it has a sensitivity and specificity of 99.9%

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15
Q

What is a NAAT test?

A

If there is a weak signal on EIA or the Western Blot is non-reactive or indeterminate, an individual nucleic acid amplification test (NAAT) is done - if viral RNA is detected the individual is considered to have an acute infection

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16
Q

What is point of care testing?

A

In British Columbia, point of care testing is used in the outreach setting. It has a similar sensitivity to traditional third generation HIV testing. Confirmatory testing is required for indeterminate, invalid, and preliminary positive results. Point of care testing is insufficient to rule out acute HIV infection and is not recommended for those with a recent exposure.

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17
Q

What is the window period for the 3rd generation EIA test?

A

20-22 days

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18
Q

What is the window period for western blot test?

A

27-34 days but can take up to 6 to 8 weeks

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19
Q

What is the window period for individual RNA NAAT test?

A

6 to 8 days

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20
Q

What is the window period for P24 antigen test?

A

15 to 17 days

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21
Q

What is the window period for the individual DNA NAAT test?

A

8 to 10 days

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22
Q

What is the window period for the point of care HIV test?

A

Same or up to one week longer than 3rd generation EIA (which is 20-22 days)

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23
Q

What is the window period for the 4th generation EIA test?

A

16-18 days

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24
Q

What is the window period for pooled RNA NAAT test?

A

10-12 days

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25
Q

What is pooled NAT?

A

Targeted to clinics with a large MSM population
Has a diagnostic gain of 6.4% over 4th generation ELISA
25 of 54 MSM who got pooled NAAAT had a negative 3rd generation ELISA

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26
Q

Why has HIV been made reportable?

A

To improve and facilitate partner notification
To provide public health the opportunity to be directly involved with index cases and thus to add to case management resources
To enhance epidemiological surveillance

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27
Q

What is the purpose of pretest counselling?

A

Emphasize confidentiality and ensure understanding of non-nominal testing
Review transmission risks and prevention strategies
Describe partner notification process
Explore psychological preparedness, coping and support mechanisms
Emphasize need to return for result

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28
Q

What are the components of post-test counselling for non-reactive (negative) results?

A

Interpret:
Means either no infection or too early to test
Risks within the past 3-6 months dictate need for retesting, as necessary, 3 months after the last possible exposure
Reinforce:
Reduction of risks (avoid high risk activities, avoid sharing needles or other drug use equipment, use safer sex practises)

29
Q

What are the components of post-test counselling of positive (reactive) results?

A

Clarify difference between HIV and AIDS
Verify client’s understanding of test result
Emphasize importance of regular followup with primary care provider
Review what client should expect in terms of follow-up care (vaccines, lab tests, etc.)
Discuss partner notification process
Review transmission prevention strategies
Emphasize importance of finding support (friends, family, ASO, etc.)

30
Q

What is expanded testing in BC?

A

In BC, testing will be offered to all low risk adults once every five years – high risk adults once a year
Testing is also offered for all hospital admits at SPH, VGH, MSJ and UBC – this will also be expanded

31
Q

Is HIV/AIDS chronic or acute? (Why?)

A 
AIDS is a chronic disease. It fits a chronic disease trajectory:
Pre-trajectory
Asymptomatic
Symptomatic
AIDS defining illness
Downward and dying
32
Q

What makes HIV different from many other chronic illnesses?

A

HIV is different
Highly stigmatized
Uncertain trajectory
Patients often not well supported by family

33
Q

What are some psychosocial issues that may occur with HIV/AIDS?

A 
Anxiety
Isolation
Loss
Stigma
Anger
Decisional conflict
Depression
Hopelessness
Uncertainty
34
Q

What are some potential crisis points for a patient with an HIV diagnosis?

A

HIV diagnosis - anxiety, panic, depression, suicidal ideation and attempts
AIDS diagnosis - fear, anger, impulsive behavior, suicidal ideation
Treatment - depression, weakness, alienation, dysphoria, disability, pain
Treatment termination - anxiety, fear
New symptoms - anxiety, demanding/dependent behavior
Recurrence and relapse - depression, apathy, isolation, suicidal ideation, fear of abandonment
Awareness of dying - deterioration, decline, ambivalence, dependence, disinterest, resolution

35
Q

What are some interventions for HIV/AIDS patients?

A 
On the continuum of care:
Suicide assessment
Crisis intervention
Pharmacotherapy
Education
Stress reduction techniques
Support groups
Support assistance
Spiritual support
Legal assistance - estate planning
36
Q

What are some issues that the partners and spouses of individuals with HIV/AIDS face?

A

Fear of contagion
Guilt re: transmission
Anxiety, fear & depression > fatal maturity
Balance of relationship upset
Conflict regarding treatment decisions
Conflicts between family and/or care team
Anticipatory grief

37
Q

What are some individual socio-economic responses that occur due to HIV/AIDS?

A 
Individual
Loss of income
Housing
Social status
Social network
		HIV is a disease of poverty, of the 		marginalised, and the vulnerable
38
Q

What does HAART stand for?

A 
Highly
Active
Anti
Retroviral
Therapy
39
Q

What are the goals of HAART therapy?

A

Maximal and durable suppression of viral load
Restore/preserve immune function
Improve quality of life
Reduce HIV related morbidity/mortality
Treatment has led to a 94% drop in AIDS related deaths in Canada

40
Q

What is the impact of suppressed viral load?

A

Reduced transmission of virus – has led to treatment as prevention program in BC
New positive rate in BC declining across all populations including IDU
Higher rate of averted HIV cases than anywhere else in Canada

41
Q

When is antiretroviral therapy started for HIV patients?

A

ART is recommended and should be offered regardless of CD4 cell count
The strength of the recommendation increases as the CD4 count decreases
ART should be offered to all persons in the acute phase of primary HIV infection
Pregnant women, persons with chronic Hep B or Hep C infection, persons over the age of 60 and persons with HIV associated nepropathy should all be started on ART
ART should be started ASAP in persons with opportunistic infections
ART is recommended in all HIV infected persons with TB

42
Q

What is the impact of CD4 counts on life expectancy?

A

It has become clear that a normal life span can only be expected if CD4 cells recover to > 500
A partial reconstitution (between 350 and 500) is associated with non-HIV health problems (CV, renal, hepatic, cancers)
CD4s below 200 are associated with a lower probability of achieving optimal counts

43
Q

What is the average CD4 when HAART is started in Canada?

A

Average CD4 when HAART is started in Canada is 184 – CD4s below 200 are associated with a lower probability of achieving optimal counts

44
Q

What is considered a high viral load?

A

Above 50 000 - 100 000 copies/mL

45
Q

What is the risk of aids in the next 3 years if the CD4 count is >350 and viral load is >50 000?

A

3 year risk of aids is 40%

46
Q

What is the target viral load in patients on antiretral viral therapy?

A

Viral load is closely monitored for people on ART - goal is undetectable

47
Q

What are the medication classifications of drugs for HIV?

A

Nucleoside reverse transcriptase inhibitors (NRTI)
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Protease inhibitors (PI)
Integrase inhibitors
Entry inhibitors

48
Q

What are some common side effects of HIV treatment drugs (in general)?

A 
GENERALISED
LIVER TOXICITY
GI DISTURBANCES
MEDICATION INTERACTIONS
CNS DISTURBANCES
PERIPHERAL NEUROPATHY
RENAL DYSFUNCTION
49
Q

What are some side effects of protease inhibitors?

A

Dyslipidemias - increased triglycerides, total cholesterol
Risk of CAD increases by 25% with each year of exposure
Lipodystrophy
Osteoporosis
Torsades de Pointes (type of VT with prolonged QT interval)

50
Q

What are some side effects of integrase inhibitors?

A

Stevens-Johnson syndrome

51
Q

What are some non-physical side effects of HIV medications?

A 
Impact on daily activities 
Potential for unplanned disclosure
Psychological impacts
Changes in perception of health status
Treatment focused care - failure to see the whole person
52
Q

What are some ways to manage nausea that occurs as a side effect of anti retroviral medications?

A

Take with a meal or snack
Ensure orders for gravol etc. are available
Time permitting - check in 2-3 hours after dose to see if they need any PRNs
Try pre-medicating 30 to 60 mins prior to antiretrovirals with gravol or metoclopramide etc. if persisting
Reassure will subside within several weeks

53
Q

How can HIV patients manage the CNS side effects that occur due to anti retroviral medications?

A

Try taking at bedtime or vice versa

54
Q

What is the risk with antiretroviral drugs in the NNRTI class (efavirenz, nevirapine, ripilvirine, raltegravir) when even one or two doses is missed?

A

The HIV virus will develop resistance to these medications.

55
Q

What is given as pre-exposure prophylaxis, and to whom is it given?

A

Targeted at high risk populations - MSM who engage in unprotected anal intercourse, IV drug users who share and inject multiple times a day, sex trade workers.
Consists of tenofovir or truvada once a day as a preventative measure for HIV negative individuals.

56
Q

Why can’t we cure HIV?

A

Because virus persists in resting CD4 T cells and other body tissues
As soon as HAART is stopped this latent virus begins to replicate
A cure could be possible if you could eliminate the reservoir
There are trials looking at latency reversing agents that could achieve this

57
Q

How many people with HIV don’t know their status?

A

25-30%

58
Q

How many people are diagnosed with HIV after they should have already been on treatment?

A

60%

59
Q

How many patients are diagnosed with HIV very late in their illness?

A

Nearly a fifth of patients diagnosed very late in the course of their illness

60
Q

How often should individuals be tested for HIV?

A

HIV testing should be offered to all patients engaging with the health care system who had ever had sex and had not been tested in the last year.

61
Q

What are two assays testing for resistance to antiretroviral therapies?

A

Phenotype and Genotype

62
Q

What is the phenotype testing for HIV? (What does it look at)

A

Measures growth of the virus in various concentrations of antiretroviral therapies.
Similar to bacteria antibiotic sensitivity testing.

63
Q

What is the genotype testing for HIV? (What does it look at).

A

Detects drug resistant viral mutations present in reverse transcriptase and protease genes.
Usually done before first treatment is commenced.

64
Q

What does the drug regimen for antiviral therapy for HIV consist of?

A

Start on 3 drugs from different classes - usual first line treatment is two NRTIs and a boosted PI or two NRTIs and an NNRTI or two NRTIs and an integrase inhibitor.

65
Q

What are some important aspects of the drug regimen for patients with HIV? (goals)

A

Avoid resistance

Use combination of drugs to inhibit the virus in several ways

66
Q

What are the three predictors of durability of antiretroviral drugs? (durability = no resistance)

A

Potency
Adherence***
Tolerance

67
Q

What are the most common reasons for patients to stop antiretroviral therapies?

A

CNS side effects
GI side effects
Lipid issues
Renal impairment

68
Q

What are some common fungal infections that can be opportunistic in immunocompromised patients?

A 
Oropharyngeal candidiasis
Candida esophagitis
Vulvovaginal candidiasis
Cryptococcus - meningitis/pneumonia
Pneumocystis pneumonia (PCP aka PJP)
69
Q

Which slide did I stop at?

A

Slide #51

Nursing 304 (12 decks)

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