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Flashcards in HIV and AIDS Deck (34):
1

Acquired Immune Deficiency Syndrome (AIDS)

Caused by the human immunodeficiency virus (HIV).

2

Human Immunodeficiency Virus (HIV)

-Affects the bodies ability to fight off infections and disease
-Ultimately results in death
-Effective interventions are now available
-Is one of the most important health threats of modern time

3

HIV Transmission

Transmitted from person to person through infected body fluids:
-Sexual contact
-Needle and syringe sharing
-Contaminated transfusions
-Transmission before and during birth
-Through breast feeding

4

HIV Retrovirus

Contains RNA, is transcribed to dual strand DNA and integrated into the host cell DNA to reproduce. Invades the CD4+ cells and causes progressive depletion of CD4+ cells, leads to immunodeficiency.

5

HIV CD4+ Cells

Principal agents involved in protection against infection.

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Biomarkers Used to Assess HIV

-Viral load
-CD4+ count

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4 Clinical Stages of HIV

1. Acute HIV infection
2. Clinical latency
3. Symptomatic HIV
4. Progression of HIV to AIDS

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Acute HIV Infection

Time of transmission to the host until production of detectable antibodies. Half of individuals experience symptoms of fatigue, fever, malaise, or swollen lymph glands 2-4 weeks following infection. Nonspecific.

9

HIV Acute Stage

Virus replicates rapidly. If testing is done before seroconversion (production of detectable antibodies against the virus) occurs, will produce false negative results.

10

Clinical Latency or Asymptomatic HIV Infection

Further evidence of the disease may not occur for up to 10 years. Virus is still active and replicating.

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Symptomatic HIV Infection

CD4+ cells fall below 500 cells/mm3. Signs and symptoms develop: fever, chronic diarrhea, weight loss, and fungal infections.

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Progression to AIDS

CD4+ cells drop to less than 200 cells/mm3 or documentation of an AIDS defining condition with increased risk of opportunistic infections (OIs).

13

Opportunistic Infections (OIs)

Oral candidiasis, herpes simplex, hepatitis C, Kaposis sarcoma, lymphoma, pneumonia, toxoplasmosis of the brain, and TB.

14

HIV CD4+ Count

-Used to determine ART initiation
-Strongest predictor of disease progression
-Monitored every 3-4 months

15

HIV Antiretroviral Therapy Drugs (ART) Goals

-Achieve/maintain viral suppression
-Reduce HIV related morbidity and mortality
-Improve QOL
-Restore and preserve immune function

16

HIV Adverse Effects of ART

-Toxicities
-Metabolic complications
-Non adherence can lead to drug resistance

17

HIV 6 Mechanistic Classes of ART Drugs

1. Nucleotide reverse transcriptase inhibitors (NRTIs)
2. Non-nucleotide reverse transcriptase inhibitors (NNRTIs)
3. Protease inhibitors (PI)
4. Fusion inhibitors
5. Chemokinase receptor 5 antagonists (CCR5)
6. Integrase strand transfer inhibitors (INSTIs)

18

HIV ART Food and Drug Interactions

Pt needs to report ALL vitamins, supplements, medications and recreational substances they are using. Interactions can influence the efficiency of the drugs.

19

HIV Side Effects of ARTs

-Nausea
-Emesis
-Fatigue
-Insulin resistance
-Dyslipidemia
-Must be taken on a schedule

20

HIV Energy and Fluid Intake

-Difficult due to issues of wasting, obesity, HALS
-Asymptomatic HIV increases energy expenditure by 10%
-After OI, requirements increase by 20-50%

21

HIV Protein Requirements

-.8g/kg of body weight sufficient
-After an OI additional 10% intake in protein recommended due to increased protein turnover
-Renal insuff, cirrhosis, pancreatitis are present, adjust protein accordingly

22

HIV Fat Requirements

-General heart healthy guidelines
-Increase omega 3 intake

23

Micronutrients in HIV

Deficiencies common due to malabsorption, drug nutrient interactions, altered gut barrier function, gut infection and altered metabolism.

24

Micronutrients and HIV Infection

-Low levels of vitamin A, B12, and Zn associated with faster disease progression
-Higher intakes of vitamin C and B have been associated with increased CD4 counts and slower disease progression
-Vitamin A, Zn and selenium are low in response to infection
-Recommended balanced healthy diet with multivitamin meeting 100% of DRI

25

HIV Wasting

-Unintentional weight loss
-Loss of lean body mass (LBM)
-Associated with disease progression and mortality
-Related to inadequate intake, malabsorption, increased metabolic rate, and complications of the disease

26

HIV Obesity

-Continuous weight gain is not protective against wasting or progression of disease
-Monitor for dyslipidemia, insulin resistance and diabetes
-Encourage physical activity to achieve healthy weight and LBM

27

HIV Associated Lipodystrophy (HALS)

Metabolic abnormalities and body shape changes seen in HIV.
-Fat deposition in abdominal region, dorsocervical fat pad, breast hypertrophy
-Loss of subcutaneous fat in extremities, face and buttocks

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HIV HALS Metabolic Changes

-High triglycerides, high LDL, low HDL and insulin resistance
-Varies in pts
-Each part may occur simultaneously or independently

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HIV HALS Multifactorial Causes

-Duration of disease
-Duration of ART
-Age
-Gender
-Race
-Ethnicity
-BMI

30

HIV HALS Nutrition Intervention

-Aerobic exercise
-Resistance training
-Overall adequate diet
-Increased fiber intake
-Omega 3 fatty acid may reduce inflammation and improve depression and decrease triglyceride levels

31

HIV Complementary and Alternative Medicine (CAM)

-Dietary supplements
-Yoga
-Meditation
-Acupuncture
-Herbal treatments
-Megavitamins
-Only 1/3 of pts disclose CAM`

32

HIV Nutrition Diagnosis

-Inadequate food and beverage intake
-Involuntary weight loss
-Food-medication interaction
-Food and nutrition related knowledge deficit

33

HIV Nutrition Interventions

-Nutrition educations regarding methods to increase nutrient density for all foods
-Consume smaller, frequent meals
-Add high calorie and protein beverage between meals
-Recommend multivitamin daily

34

HIV Monitoring and Eval

-Monitor weight and nutrition assessment indices
-Evaluate 24 hour recall for nutrition adequacy