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HIV/AIDS
BC4 - HIV/AIDS
| Question | Answer |
|---|---|
| Patho of HIV/AIDS | retrovirus (rereplicates"backwards" RNA-DNA; Needs host cell to reproduce - affinity for CD4 molecule; Mainly T helpers |
| What cells have CD4? | lymphocytes, monocytes/macrophages, astrocytes and oligodendrites |
| What cells are in the CNS | astrocytes & oligodendrites |
| Viral Replication | Large amounts; rapid replication contributes to mutation; |
| How long do infected T cells live | 2 days (normal 100 days); 1 billion destroyed daily |
| How HIV kills Cells | Budding-damages cell membrane; Infected cells fuse with other cells - die; Antibodies kill infected cells |
| Transmission of HIV | Blood; Semen; CSF; Vaginal Secretions; Breast Milk; Saliva, urine in very minute amounts (Blood transfusions & Needle sticks) |
| What are the 3 major routes of transmissiosin | Sexual contact; Parenteral; Perinatal |
| Riskiest form of transmission | intercourse - unprotected anal sex |
| Perinatal Transmission | During Pregnancy; At delivery; Breastfeeding; |
| Diagnosis of HIV/AIDS | Doubly reactive ELISA/EIA ; Positive Western Blot; PCR |
| EIA tests for | Antibodies (detectable antibodies in blood) |
| Cost of Western Blot and PCR | very expensive |
| If an HIV test is inconclusive what test is performed | PCR - it is a viral culture - they are looking for the virus |
| After an initial negative test when are additional tests performed | 3 weeks; 6 weeks; 3 months |
| Who needs tested for HIV | Pregnant women; risky sexual behavior; people with STD's;people being evaluated for TB; In jail; has drug-using partner; |
| When do you test after last exposure | 6 weeks; retest if negative |
| Mandatory testing for | Military; federal prison; entry into some countries; insurance companies for policies over $100,000 |
| Rapid Tests include | SUDS; RLAA; Home kits; Saliva test (Ora Sure); Urine tests are also available; If these are positive - they need the EIA |
| Tests to monitor an HIV/AIDS patient status | CBC with Diff - (Neutrapenic); Chemistry panel; CD4 cell count; Immune comples; Viral load; Viral genotyping |
| CD4 Cell count | 800-1050; <700 abnormal; lose 100 cells/year if untreated |
| Viral Load | measures amount viral RNA - correlates with rate of progression - varies daily, shows success of treatment |
| What is the most important test for monitoring HIV/AIDS | CD4 |
| Tests for Secondary Conditions include | TB testing; Toxoplasmosis serology, RPR (syphilis); Hep B; CMV serology, MRI (brain changes); Cultures/serology for infection, PAP smear Q 6 mos.; Preg testing; Liver fnct |
| Phase 1 = | Acute Retroviral Syndrome |
| CD4 during phase 1 | 750-1000 |
| When is Phase 1 | 2-6 weeks after exposure |
| Testing during Phase 1 | Negative result - needs retested |
| SEroconversion during Phase 1 | 95% within 6-12 weeks (can take up to 6 months) |
| S/S during Phase 1 | Mild, flu-like; sometimes neuro complications |
| Phase 2 = | Asomptomatic Infection (Early Chronic) |
| CD4 during Phase 2 | 500-750 |
| S/S during Phase 2 | Vague - fatigue, HA, night sweats, enlarged nodes, fever |
| What is happening to the virus during Phase 2 | It is reproducing in the lymph - viral load is relatively low (This is the stage that people are staying at) |
| Phase 3 = | Early Symptomatic Infection - Interrmediate Chronic |
| CD4 during Phase 3 | <500 |
| S/S during Phase 3 | Thrush (candidiasis), Abnormal PAP, Recurrent STD's, Oral hairy leukoplakia, skin disorders, idiopathic thrombocytopenia purpura, Diarrhea, night sweats, fever |
| Candidiasis | Fungal infection, white patches - mouth, esophagus, stomach |
| AIDS | Late Chronic |
| CD4 for Dx of AIDS | <200 |
| Opportunistic Infections associated with AIDS | PCP (Pneumonia), CMV, TB, Chronic recurrent herpes, Recurrent bacterial pneumonia, Women -PID; HIV dementia, Wasting syndrome |
| Cancers associated with AIDS | Kaposi's sarcoma and lymphomas |
| CD4 of Advanced AIDS | <50 |
| Life expectancy of a patient with advanced AIDS | 12-18 months - they have more virulent persistent infections |
| Pneumosystis carinii Pneumonia | Fungal infection; 60% first s/s of AIDS |
| S/S of Pneumosystis carinii pneumonia | non-productive cough (immune system not working) Respiratory failure w/o treatment |
| Macobacterium avium Complex (MAC) | Bacterial group of infections |
| MAC affects | lungs, GI tract, lymph nodes, bone marrow |
| MAC is associated with | TB |
| S/S of MAC | chills, fever, night sweats |
| Tuberculosis | Drug-resistant strains; occurs early in HIV (or late) |
| S/S of TB | bloddy sputum |
| Diarrhea | 50-90%; Direct action of virus or pathogens or from medications |
| S/S of Toxoplasmic encephalitis | Cognitive dysfunction, Motor impairment, feverr, Altered LOC, HA, Seizures, Sensory change |
| Kaposi's sarcoma | manifests on the skin |
| HIV Encephalopathy (AIDS Dementia Complex) | attacks astrocytes in the brain |
| How many people with AIDS gets AIDS Dementia Complex | 2/3 |
| What happens in HIV Encephalopathy | HIV invades brain/CSF via infected monocytes/macrophages, toxins hinder neurotransmitter function |
| Dx of HIV Encephalopathy | CT, MRI may show atrophy |
| Cognitive/Motor Complex Symptoms | Confusion, Vacant staring, Disorientation, Organic psychosis, seizures, mutism, incontinence, hemiparesis, blindness, delirium, coma |
| Cytomegalovirus (CMV) affects | retina and GI tract |
| CMV in the GI tract causes | Stomatitis, Esophagitis, Gastritis, Colitis |
| Human Papillomavirus (HPV) | veneral warts - precursor to cervical cancer |
| AIDS Prevention | Teaching, safer sex - use barriers esp male condom, needle exchange programs |
| Prophylactic Tx of HIV/AIDS | AZT - Zidovudine, Retrovir within 72 hours of exposure |
| Triple Drug Therapy | 3 drugs to treat the virus |
| HAART | highly active antiretroviral therpay |
| Who benefits most from treatment | Naive patients - those who have never had tx |
| Long term effects of HIV/ AIDS medications | lipodystrophy, fat loss (face, arms, legs), Fat gain (abdomen) |
| Immunizations for HIV/AIDS | Pneumococcal vaccine, Influenza, Hep B, MMR, H. influenza type B |
| Factors that decrease adherence to treatments | complexity of treatment regimen, side effects, depression, alcohol/drug use, young age, money |
| Ways to increase adherence | begin when pt is psychologically ready, simplify regimen, control s/e, good communication, continuity of care, trust, use of aids - timer, pagers, pill box, etc., |
| HIV Wasting | Many causative factors, Hypermetabolic state - using alot of calories, Diarrhea, anorexiaq, Malabsorption, anorexia, compounds other problems of AIDS |
| Nursing care of Wasting Syndrome | Dietary supplements, enteral feedings and drugs |
| Drugs used for wasting syndrome | Megace - appetite stimulant, Marinol, steroids |
Created by:
okrecota