HIV

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Author:
tiffanydawnn
ID:
128874
Filename:
HIV
Updated:
2012-01-22 22:36:06
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HIV
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HIV
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  1. HIV
    • retrovirus transmitted by direct contact with body fluids
    • attaches to CD4 cells (T-helper)
    • sexual contact
    • needle sharing
    • transfusions
  2. body fluids
    • high risk
    • --blood
    • --CSF
    • --semen
    • moderate risk
    • --vaginal
    • --breast milk
    • low risk
    • --urine
    • --tears
    • --saliva
    • no risk
    • --stool
    • --sweat
  3. early HIV - infection
    • exposure
    • replication of viral DNA
    • blood test negative for first few weeks (up to 6 months)
    • still contagious
  4. seroconversion
    • antibodies produced
    • Ab detectable
    • CD4 cells infected
  5. stages of HIV
    • 1. transmission
    • 2. ARS - acute retroviral syndrome - flu like symptoms - days to weeks after infection
    • 3. seroconversion
    • **HIV disease - asymptomatic - CD4 > 500
    • **AIDS defined - CD4 < 200 or HIV+ with opportunistic infection
    • **Advanced AIDS - CD4 < 50
  6. AIDS dementia
    • most common cause of mental status change
    • early: memory loss, confusion, lethargy
    • late: dementia, ataxia, tremor, incontinence, paraplegia
  7. AIDS neuro manifestations
    • PNS: sensory neuropathy (pain, numbness), Guillian-Barre
    • CNS: opportunistic infections (toxoplasmosis [Zithromax], Non-Hodgkin's, cryptococcal meningitis, CMV)
  8. opportunistic infections
    • CD4 < 500 - immunodeficient
    • CD4 < 200 - opportunistic infections/cancers likely
  9. pneumocystis pneumonia
    • PCP/PJP
    • 75-80% of AIDS patients
    • 55% survive first episode
    • 25% survive second episode
    • **treated with pentamidine (prophylactic after first episode)
  10. tuberculosis
    • 4% of AIDS patients
    • PPD - > 5mm = positive because HIV+ patients can't mount immune response
    • dx with bronchoscopy (cannot sputum culture because lack of sputum)
  11. candidiasis
    • oral thrush
    • treated with nystatin
  12. mycobacterium avium complex (MAC)
    • 25% of AIDS patients
    • from fresh food (bac in soil)
    • causes "wasting syndrome"
    • CD4 < 50
  13. other infections
    • herpes simplex/zoster
    • CMV - blindness, GI tract, lungs
    • salmonella
  14. Kaposi's sarcoma
    • AIDS defined
    • 18 month prognosis
    • painless lesions, rapid growth
    • GI tract (bleeds)
    • dx with biopsy
  15. other cancers
    • Non-Hodgkin's lymphoma
    • lymphoma of the brain
    • cervical cancer (pap every 6 months)
  16. diagnostic tests
    • ELISA - repeat (same sample) if positive
    • Western blot - confirmation (same sample)
    • viral load - increases as HIV progresses
    • CBC - anemia, leukopenia, thrombocytopenia
    • CD4 count - monitor progress (s/b > 500)
    • PPD
    • MRI - brain lesions
    • cultures/serologies for infections
    • pap smears every 6 months
  17. Rapid HIV test
    • 20 minute
    • follow up with ELISA x2, Western Blot
  18. goals for care
    • early identification
    • health maintenance
    • prevent infections
    • treat complications
    • emotional support
  19. treatment
    • goals: decrease viral load and prevent opportunistic infections
    • H&P
    • CBC/chemistry
    • Viral load/CD4
    • treatment starts at CD4 <350
    • **client must be assessed for readiness for medication adherance (>95%)
  20. HAART
    • highly active antiretroviral therapy
    • multiple drug therapy
    • 3 or more antiretrovirals
    • stop HIV from replicating at multiple stages
    • discontinuation can be dangerous
  21. NRTIs
    • reverse transcriptase inhibitors
    • AZT
    • Retrovir
  22. NNRTIs
    • reverse transcriptase inhibitors
    • Viramune
    • Sustiva
  23. other meds
    • Protease inhibitors
    • Fusion inhibitors (last choice)
  24. complications of HAART
    • lactic acidemia
    • lipodystrophy (truncal obesity)
    • dyslipidemia
    • insulin resistance
    • cardiovascular disease
    • bone demineralization
    • peripheral neuropathy

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