HIV/AIDS

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Prittyrick
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310325
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HIV/AIDS
Updated:
2015-10-26 21:09:49
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HIV
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  1. Review paper
  2. What is HIV
    • Human Immunodeficiency Virus 1983
    • Retrovirus, genetic material contains RNA (replicates backwards)
    • Infectious disease
    • mutates rapidly- no vaccine bc of this
    • to replicate, it must invade a living host
    • target: t lymphocytes (T4, CD4)
    • replicates backwards from RNA-DNA

    • fastly growing in elders
    • 1/5 don't know
  3. HIV Patho
    • HIV gp knobs on virus bind CD4 sites on the cell
    • bind and enter cell
    • - viral RNA and three enzymes
    • - reverse transcriptase
    • - integrase
    • - protease
    • 90% of the meds work on all three enzymes
  4. The enzymes that are used in HIV
    • 1. Reverse transcriptase: this is when RNA is transcribed into DNA
    • 2. Integrase: integrates into host cell- once intergrates HIV is now permanant
    • 3. protease- break off and pack and release
    • - helps to push this viral DNA- goes to another cell to replicate for them
  5. protease
    • new viral proteins leave cell by budding
    • - protease
    • - mature
    • - process starts again and it replicates
  6. Stages
    • primary infection:
    • - period between initial exposure to virus and appearance of HIV antibodies (window period- can transmit the virus)
    • - test negative HIV antibody (antibodies are not dectected can take weeks)- 1m-3m 3w-12w
    • - highly infectious (virus fast and furious)
    • - elevated HIV viral load, decreased CD4 and increased CD8 cells (t suppressors cells)- immune system is working but not enough
    • Viral set point (looking at this)- how much viral load do you have. incre in viral load means you will have a poor prognosis (in the early stages)
    • tx early

    the stages varies from person to person. someone could be asymptomatic for years whereas someone could show symptoms in weeks
  7. Primary infection
    • Acute Retroviral Syndrome (up to 90% get this flu, mono- nothing will let u know when u have HIV)
    • - nonspecific symptoms, fever, fatigue, lympadenopathy, rash
    • - fever, pharyngitis, myalgia (muscle weakens)
    • - nausea, vomiting, diarrhea
    • Usually appears within days/wks of exposure- last few days- months
  8. HIV test is negative but the patient is sick
    • Acute retroviral syndrome- think HIV
    • - fever 96%
    • -lymphadenopathy (incr lymph)
    • - pharyngitis- sore throat
    • - rash- diffuse
    • if you think mono, think HIV also
    • if you think flu, think HIV too
  9. HIV asymptomatic
    Stage 2
    • s/s of PHI (primary) resolve, viral load decreases
    • asymptomatic patients feels well
    • CD4 levels are high
    • - CD4 above 500
    • non specific symptoms once in awhile can last for months to years where u see no symptoms
    • mostly they are not aware but can transfer disease
    • depending on CD4 count- reg count CD4 800-1200
  10. HIV symptomatic
    stage 2
    • CD4 200-499
    • - develop symptomatic disease
    • - oral candidiasis, pneumocystic pneumonia (PCP), shingles
    • - many patients are dx at this stage
    • initial symptoms of primary stages will start to present but will be way worst like incr fatigue, night sweats, high fever, consist headache
  11. AIDS
    • Third Stage
    • Need to meet criteria defined by CDC
    • - CD4 level<200 or 14% of all lymphocytes
    • - positive antibodies for HIV
    • - dx with one or more AIDS defining illness, candiadiasis, PCP, HIV encephalopathy (chx in mental status), lymph, kaposi sacroma....
    • wasting syndrome- specific to AIDS
    • these opportunistic infections
    • dec immune system
    • once classified as AIDS it will always stay this way
  12. AIDS s/s
    • S/s widespread
    • fatigue, malaise
    • involuntary weightloss
    • opportunistic infection- which can be fatal bc immune system is compromise, and cancers
    • - virus, bacteria, fungi, protozoal
    • can be fatal
  13. S/s respiratory
    • PCP
    • MAC- myobacteriums Avium complex
    • myobacterium TB
    • - opportunistic infections
    • Assessments:
    • - change in LS
    • - SOB
    • - dec O2 stat

    • TX w/antibiotic progress rapidly could be fatal
    • becareful
  14. Oral Candidiasis
    • Thrush
    • tx with Nystatin
    • swish and spit but if in the esophagus then swallow
    • significant and severe they will use diflucan
  15. wasting syndrome
    • involuntary weightloss > 10%
    • rapid weightloss
    • chronic diarrehea- > 30%
    • chronic weakness with fever
    • protein energy nutrition- no protein (breaking down proteins)
    • Tx- megace:¬† oral progesteron incr appetitite, prompt weight gain, incr body weight and body fat stores, well tolerated
    • Marinol- activates compotent of marijuanna, relieves N/V, incre wt gain
    • Nx interventions
    • incre protein- fish
    • skin breakdown
    • monitor BUN/Cr
    • increa food intake- small intake
    • incre calorie count, low fats
    • monitor weight
    • I&O
    • oral care
    • vitamin
    • boost drinks
    • soft foods - no energy
    • TPN, PPN- last resort
  16. Oncologic
    Kaposi sarcoma
    • Most common HIV maligency involving endothelial layers of blood vessels, lymph nodes, viscera and mm
    • course variable
    • skin ulcer
    • localized vascular cutaneous lesions
    • - dark brown to deep violet in color
    • - multiple organs
    • Tx: palliative radiation0- even if u remove they come back
    • initially painless as time progressive....
    • bleed/obstruction
  17. AIDS neurological
    • peripheral neuropathy
    • usually distal
    • tx- gabapentin (neurotin)
    • well tolerated
  18. HIV encephalopathy
    • progressive decline in cogintive behavioral and motor function
    • HIV has a direct damage to the brain- lesser brain cells
    • s/s fatigue, memory gaps, h/a, difficulty concertrating, apathy, poor coordination
    • progresses: global cognitive deficits, delayed responses, hallucinations
    • lead to coma
    • ischemia to the brain
  19. Dermatologic
    • herpes simplex
    • opportunistic infection
    • virus- painful vesicles
    • shingles- CD4 cells

    atopic dermatis- autoimmune
  20. other complications
    • psychosocial
    • - depression
    • - isolation
    • cardiac disease hyperlipidemia- incr risk for MI
    • liver disease- high rate HIV (if u have liver disease b4 for this it will inc risk more) and hep b virus, HCV
    • renal disease- glomerulonephritis- drugs used can affect the organs
  21. DX
    • rapid testing
    • - orasure rapid HIV antibody test
    • - results within 30 mins
    • - high number of false positive
    • - need confirmatory testing ***

    • oraquick rapid HIV antibody test
    • - results within 30 minutes
    • - need confirmatory testing

    saliva and blood
  22. Dx
    • home based testing
    • - privacy
    • - technique/contamination
    • - # false positive/negative results
    • - need confirmatory testing ***
    • ¬†confirmatory testing is essential!!!
    • pre/post counseling
    • pt ed is essential
  23. HIV/AIDS testing
    • counseling, consent patient education and specific follow up plan
    • if high risk negative confirmatory
    • - plan to repeat in 4 weeks
    • - reccommended testing q 3-6 months
    • - does not mean 100% of the pt is negative, the body has not produced antibodies
  24. confirmatory dx
    • EIA (enzyme immunoassay)
    • - defects presence of antibodies
    • - gold standard
    • - you need positive EIA, then u take another one it is has to be positive
    • Western Blot Assay
    • - detects antibodies
    • - confirm EIA

    • 2 EIA and a western blot assay- confirms HIV
    • post test counseling, aware of reporting, privacy, partner notification
  25. other testing
    viral load, cd4
    • Viral Load:
    • - measure plasma HIV RNA
    • - used track response to Tx
    • - high viral load= active viral replication
    • if this is undetectable- it does not mean there is no HIV it is at the lowest amt we can detect

    • CD4 counts and T cells %
    • - extent of HIV damage to immune system
    • - < 200 high incidence of progression to AIDS
  26. other testing
    • CBC- WBC
    • chem studies including LFT (BUN, cr, electrolytes)
    • HIV drug resistancer testing- bc it mutates
    • STD screening
    • MRI/CT- damage complication
    • complete detail PE, assess s/s opportunistic diseases
    • psychosocial assessment- depression, isolation
  27. HIV management
    • indentification- who are at risk
    • testing
    • treatment- right away
    • pre exposure prophalytic- given to high risk people
  28. Treatment
    • patient education and counseling is essential
    • follow up care
    • community resources and support systems
    • nursing care
    • - accurate assessments, education
    • - assess and treat substance abuse
    • - stay aware and active in HIV education/policy
    • do the 30 mins test- to incre teaching
  29. medication therapy
    • lifelong
    • compliance (30-50% of patients)
    • to achieve viral suppression, combination therapy
    • treatment decisions are based on patients s/s CD4 counts, viral load
    • they are combining the drugs
    • decre viral load and incr CD4- med changes depend on this

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