Human Immunodeficiency Virus notes with Answers.pdf

HIV

Human Immunodeficiency Virus

Classification of HIV

Type I – prevalent in US, Canada and Europe. Most responsive to drugs

Type II – more prevalent in 3rd world countries, ______________

Mode of Transmission

Sexual (____________________)

Blood Product Transmission

Perinatal Transmission

oDuring Pregnancy

oDuring Birth

oWhile Breastfeeding

Incidence of HIV

33 million worldwide

Approx. 1 million people in U.S. with HIV (Lewis & CDC reports)

Approx. 50,000 new newly infected each year

Most are men (but seeing more new cases of women and minority groups)

How does HIV work?

Retrovirus

Has RNA, no DNA, therefore needs host cell to duplicate

Attaches its gp 120 knobs to the cell’s CD4 receptor

What cells have CD4 receptors?

_____________________

Once Inside – then what?

The RNA makes viral DNA with “reverse Transcriptase

Viral DNA enters the cell’s DNA and alters the cell’s __________

The infected immune cell makes HIV infected cells

Phases of HIV

Acute Infection

Chronic Infection

oA____________ Infection

oS____________ Infection

oAcquired Immunodeficiency Syndrome (AIDS)

I. Acute Infection

Develop HIV specific antibodies

Headache, body aches, diarrhea, pharyngitis, lymphadenopathy, photophobia and / or a rash.

Some have meningitis or Guillian-Barre

Occurs ________ weeks after infection

Lasts 1-2 weeks

CD4 drops temporarily and then return to baseline

Viral Load _________________

II. Chronic Infection

Asymptomatic Infection

oAlso referred to as the Latent Phase

oFrom 1-2 Months - _____ Years

oViral load between ____________

oCD4 counts maintains above 500 cells/ul

oIntense disease proliferation

oASYMPTOMATIC Disease: fatigue, headaches, low grade fevers, night sweats and

generalized lymphadenopathy

II. Chronic Infection

Symptomatic Infection

oEarly Symptomatic Phase

oFrom Year 8 – Year 10

oCD4 T-cells between ________ cells/ul

oSymptoms of night sweats, fever, chronic diarrhea, headaches, fatigue, propensity to

infection, lymphadenopathy, neurological symptoms

II. Chronic Infection

Symptomatic Infection (cont)

oWorsening of symptoms, persistent night sweats and fever

oCandidiais (thrush)

oKaposi Sarcoma

oOral Hairy Leukoplakia – Epstein-Barr virus infection…sign of disease progression!

II. Chronic Infection (Diagnosis of AIDS)

Acquired Immunodeficiency Syndrome

oYear 10 + (untreated…maybe)

oCD4 below 200

oOpportunistic infections

oPneumocystis jiroveci

___________ (PJP)

oCryptococcal meningitis

oCytomegalovirus ________

oOpportunistic cancers

oWasting syndrome

oDementia (AIDS Dementia Complex)

Rapid Screening for HIV

OraSure Testing

oUses gum line

OraQuick

oUses a drop of blood

Both are 20 minute screens

Positives in either require EIA confirmation

Testing for HIV

Testing based on R____________

Fourth Generation Testing for both Antigens and Antibodies

oTen day eclipse or window period

oImmunoassay Testing

Testing for HIV Progression

Measure CD4 Counts and Viral Loads

CD4 normally between _________ cells/ul (without disease)

Viral Load is undetectable or negative if not HIV

Viral load between _________ means Early Chronic phase is stable

A High Viral Load between _____________ ….means the disease is progressing.

Drug Therapy

Antiretroviral Agents (ARTs)

oNRTIs – Nucleoside Reverse Transcriptase Inhibitors

oNNRTIs – Non-Nucleoside Reverse Transcriptase Inhibitors

oP_________ Inhibitors

oI__________ Inhibitors

oF_________ Inhibitors

Drugs to treat opportunistic infections

Goals:

oDecrease ____________

oMaintain or raise _________ Counts

oDelay the development of HIV related symptoms and opportunistic diseases

PrEP (pre-exposure prophylaxis) Drugs

Prescribed for those at risk for HIV

Taken ____________ getting HIV from sex or injection drug use.

Work by preventing integration into CD4

oReduces the risk of getting HIV from sex by about 99% when taken as prescribed

oReduces the risk of getting HIV by at least 74%

Truvada (both men and women)

Descovy (just men)

PEP (post-exposure prophylaxis)

Medicine to prevent HIV after a possible exposure.

Must be started within ___________of exposure

For emergency situations (not repeated exposures)

Combination of three ART meds for 28 days

oThe CDC recommends tenofovir, emtricitabine (one pill) and either raltegravir or

dolutegravir.

Nursing Management

Assessment

Ask at-risk patients

oReceived blood transfusion or clotting factors before 1985?

oShared needles, syringes, or other injection equipment with another person?

oHad a sexual experience with penis, vagina, rectum, or mouth in contact with these

areas of another person?

oHad a sexually transmitted disease (STD)?

Nursing Management

Diagnoses

Dependent on Stage

Prevention

Ongoing infection

Dying

Nursing Management

Planning

Main goals

oKeep _______________low

oMaintain immune function

oImprove quality of life

oPrevent __________________ and new infections

oReduce disability

Nursing Management

Planning

Interventions

oAdhere to drug regimens

oPromote healthy lifestyle

oPrevent transmission to others

oHave supportive relationships

oMaintain productive activity

oExplore spirituality

oCome to terms with living with disease, disability, and death

oCope with symptoms and treatments

Ethical issues

Treat or not – is there a choice

oThe Rehabilitation Act and the Americans with Disabilities Act both include language

that prohibits discrimination or the withholding of treatment.

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