HIV (ch.21)

Question 1

What cells do HIV hijack?

Answer 1

CD4 T-cell (aka CD4 cell, helper/inducer T-cell, or T4-cell)

Question 2

What do CD4 cells do?

Answer 2

Directs immune system defenses and regulates activity of all immune system cells.

Question 3

If HIV successfully enters CD4 cell, what happens?

Answer 3

More virus particles are created.

Question 4

What is the name of the viral family that HIV belongs to?

Answer 4

Retrovirus

Question 5

What do integrase inhibitors do?

Answer 5

Prevents viral DNA from integrating into cell’s normal human DNA

Question 6

What distinguishes HIV from AIDS?

Answer 6

The number of CD4 cells the patient has and whether any opportunistic infections have occurred.

Question 7

What is the normal CD4 count in a healthy adult?

Answer 7

800-1000 cells per cubic millimeter of blood.

The number of CD4 cells is reduced in someone with HIV disease.

Question 8

Manifestations of acute HIV infection?

Answer 8

Fever, night sweats, chills, headache, muscle aches.

But, because these are all symptoms of virus (namely flu), the HIV patients also have rash and sore throat .

Question 9

What is an opportunistic infection?

Answer 9

Infection caused by organisms that are present as part of the body’s normal environment and kept in check by normal immune function.

Question 10

What makes a diagnosis of AIDS?

Answer 10

Person is HIV positive and have either a CD4 count of

Question 11

What lab tests confirm HIV?

Answer 11

ELISA (enzyme-linked immunosorbent assay)
and
Western Blot Analysys
PLUS…
CD4 count or percentage and the presence or absence of the 26 AIDS-defining conditions.

Question 12

When are HIV patients most infectious?

Answer 12

Recently infected patient with high viral load and those at end stage without drug therapy are the most infectious.

**Note that they can transmit the virus at all stages of the disease, just that they are most infectious at the above stages.

Question 13

Stage 1 of HIV

Answer 13

Confirmed HIV infection and CD4 count of >500, or cell percentage of 29% or greater.
No AIDS-defining illnesses at this stage.

Question 14

Stage 2 of HIV

Answer 14

CD4 between 200 and 499, or percentage of 14%-28%.

No AIDS-defining illnesses at this stage.

Question 15

Stage 3 of HIV

Answer 15

CD4

Question 16

Stage 4 of HIV

Answer 16

Confirmed HIV infection, but no information regarding CD4 counts, or percentages, and AIDS-defining illnesses.

Question 17

What may be a first sign of HIV in women?

Answer 17

Recurring vaginal candidiasis.

Question 18

What body fluids contains HIV?

Answer 18

Blood, semen, vaginal secretions, breast milk, amniotic fluid, urine, feces, saliva, tears, CSF, lymph nods, cervical cells, corneal tissue, and brain tissue.

Highest concentrations of HIV are in semen and blood.

Question 19

Three most common ways HIV is transmitted

Answer 19

Sexual (genital, anal, oral)

Parenteral (sharing needles, receiving infected blood)

Perinatal (from placenta, contact with maternal blood and body fluids during birth, also from breast milk)

Question 20

Is HIV transmitted by sharing utensils, towels, linens?

Answer 20

Nope! It is not spread these ways. You can’t get it from sharing a utensil, sitting on the same toilet, being bitten by a mosquito, bumping in to an HIV patient….

Question 21

Safer sex methods for not getting HIV?

Answer 21

Abstinence
Be faithful
Condoms

Abstinence and mutually monogamous sex with a noninflected partner are the only absolutely safe methods of preventing HIV infection from sexual contact.

Question 22

What is the most risky sexual act to contract HIV?

Answer 22

Anal. Gross.

Question 23

What is viral load?

Answer 23

Amount of virus present in the blood and other body fluids.

Question 24

What is viremia

Answer 24

amount of virus in blood.

Question 25

What is HAART?

Answer 25

Highly Active Anti Retroviral Therapy

Question 26

Which vaginal gels contain antiretroviral agents?

Answer 26

tenofovir or raltegravir

Question 27

What are the main means of occupational-related HIV infections for health care workers?

Answer 27

needlestick or 'sharps' injuries.

Question 28

What is the best prevention for health care providers when working with HIV patients?

Answer 28

Consistent use of standard precautions for all patients.

Question 29

What are pathogenic infections?

Answer 29

Caused by virulent organisms and occur even among people whose immune systems are functioning normally.

Question 30

What are opportunistic infections?

Answer 30

Caused by organisms that are present as part of body's normal environment and are kept in check by normal immune function. They occur because of the profound immunosuppression of the person with HIV infection.

Question 31

Priority nursing action when caring for an HIV patient?

Answer 31

Continually assessing for presence of opportunistic infection and monitoring the patient's response to therapy.

Question 32

Do opportunistic infections pose a threat to immunocompetent health care worker caring for a patient with HIV or AIDS?

Answer 32

Nope! It is, however, important for health care personnel to use precautions appropriate to the specific disease to prevent disease spread.

Question 33

What is the most common opportunistic infection in an HIV patient?

Answer 33

Pneumocystitis jiroveci pneumonia (PCP)

Question 34

How to assess for PCP?

Answer 34

``` Dyspnea on exertion Tachypnea persistent dry cough low-grade, persistent favor. May report fatigue and weight loss. Listen for crackles ```

Question 35

How does an HIV patient contract Toxoplasmosis encephalitis?

Answer 35

Touching contaminated cat feces or ingesting infected, undercooked meat. Assess for subtle changes in metal status, neurological defects, headaches, fever. Also, difficulty speaking, gait, vision, seizures, lethargy, confusion.

Question 36

Intestinal infection in AIDS patients?

Answer 36

Cryptosporidiosis. Intestinal infection causing mild diarrhea to severe wasting with electrolyte imbalance. Diarrhea can result in loss of 15-20L/day.

Question 37

Fungal infections in AIDS patients?

Answer 37

Candiasis. | Occurs because weakened immune system can no longer control fungal (candida) growth.

Question 38

Most common bacterial infection in AIDS patients?

Answer 38

Mycobacterium avicum complex (MAC).

Question 39

The person with TB and a CD4 cell count below 200 may not have a positive TB PPD skin test because ____

Answer 39

of the inability to mount an immune response to antigen, a condition known as anergy.

Question 40

How would you test for TB in an AIDS patient?

Answer 40

Blood analysis by an interferon release gamma assay (IRGA).

Question 41

What is Kaposi's Sarcoma?

Answer 41

Most common AIDS-related malignancy. Small, purplish-brown raised lesions that are usually not painful or itchy.

Question 42

When is Western blot testing done?

Answer 42

When ELISA is positive.

Question 43

What kinds of drugs therapy is used to manage pain in HIV/AIDS patients?

Answer 43

NSAIDs and/or pregabalin (Lyrica) for arthralgia and myalgia For neuropathic paint: amitriptyline (Elavil) or other tricyclic antidepressants, anticonvulsant drugs such as gabapentin (Neurontin), phenytoin (Dilantin), carbamazepine (Tegretol), but these interact with antiretroviral drugs Stronger pain may be controlled with opioids such as oxycodone or codeine, and more intense pain is treated with morphine, hydromorphone (Diluaudid), or fentanyl

Question 44

Drug therapy for HIV/AIDS patients with candidaisis

Answer 44

ketoconazole (Nizoral), fluconazole (Diflucan) orally amphotericin B (Fungizone) IV

Question 45

What kind of diet should an HIV/AIDS patient eat?

Answer 45

High-calorie, high-protein, nutritionally sound diet. Teach to avoid dietary fat because fat intolerance often occurs as a result of disease and side effect of some antiretroviral meds. Should eat small, frequent meals.