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148 Cards in this Set

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Generally, what groups of people are contracting AIDS?
IV drug users
women
heterosexuals

(homosexual men are still a big group)
How does HIV/AIDS relate to people over 50?
Current estimates are that 20-30% of people over 50 are acquiring the HIV disease
Women over 50 years of age acquire HIV infection primarily through heterosexual contact.
What cells are infected more readily by the HIV virus?
T helper cells
How are the T helper cells depleted?
1. once inside the host, HIV attaches to the target cell membrane by way of its receptor molecule, CD4
2. The virus is uncoated, and the RNA enters the cell.
3. The enzyme known as reverse transcriptase is released, and viral RNA transcribed into DNA
4. This newly created DNA moves into the nucleus and the DNA of the cell
5. A provirus is created when the viral DNA integrates itself into the cellular DNA or genome of the cell.
6. Once the provirus is in place, its genetic material is no longer pure cell but is part virus
7. The cell may function abnormally
8. The host cell dies, and viral budding occurs.
The main target for HIV is the ________ cell; however the "glue" to which HIV is attracted is the ____ molecule, which acts......
The main target for HIV is the T4 helper cell; however the "glue" to which HIV is attracted is the CD4 molecule, which acts as the receptor for HIV on the T4 helper cell
What is the average lab range for the CD4, T-cell count?
500-1600 mm cubed
What is a considerably low CD4 count, and what happens when the count is low?
In the adult, CD4 cell counts below 200 are considered dangerously low and infection is likely to develop.
What are lab changes that indicate immune function besides CD4 count?
An overall decline in the total numbers of white blood cells.
Decreases in both the total number and percentage of lymphocytes
Significant changes in the CD4/CD8 ratio
Decreased CD4 T-cell test findings
Absent or Decreased skin test reactivity
Increased immunoglobin levels.
How fast does the HIV virus replicate
HIV replicates at a rapid rate. It may produce 10 million new virions daily
How do Antiretroviral drugs help an HIV patient
Antiretroviral drugs play a key role in interrupting the HIV disease process by inhibiting the ability of the virus to replicate, thus reducing the amount of circulating virus in the body and halting its destructive activity. Once this happens, the immune system begins to heal and restore itself, as noted by rising CD4 cell counts.
Sustaining the beneficial effects from antiretroviral therapy entails many challenges. The greatest problem is HIV's ability to mutate and become resistant to antiretroviral drugs. When this drug failure occurs, plasma viral load rises and the CD4 cell count decreases.
what cofactors accelerate immunodeficiency?
malnutrition
continued substance abuse
allergic conditions
genetics
age
pregnancy
gender
presence of infections
What factors link to mortality and morbidity of HIV infected people
lower socioeconomic status
lack of access to adequate care
receiving care in a hospital with limited AIDS experience
being treated by a physician with little experience in AIDS care.
what does HAART stand for
Highly active antiretroviral therapy
Uses varying combinations of drugs from three different classes of antiretroviral medications.
Combined with prophylactic treatment for commonly occurring oportunistic infections, HAART has led to HIV disease changing form a rapidly fatal disease to a chronic, more manageable condition.
Long term progression of the illness-Signs of perfectly healthy HIV infected people
Documented evidence of HIV infection for more than 10 years
Lack of manifestations
Normal, stable immune profiles
Never required any treatment for HIV disease
Long term non progressors appear to produce vigorous amounts of serum antibodies that keep HIV activity at extremely low levels, thus preventing damage to the immune system.
What systems of the body does the HIV virus damage, what does this cause?
Immune system
Cranial and peripheral neuropathies
uveitis
cardiomyopothy
pneumonitis
malabsorption in the small intestine
nephritis
cervicitis
arthritis
psoriasis
gonad dysfunction
adrenalitis
damage to the hemotologic system which is due in part to impaired blood cell production, commonly results in anemia, granulocytopenia, and thrombocytopenia throughout the course of disease
what are pre-existing comorbid conditions seen in HIV infected clients
alcoholism
drug dependence
liver disease
kidney disease
psychiatric illness
history of STDs
What are the two monitoring parameters used to follow a client to classify the HIV disease
1. Laboratory data (CD4 cell counts)
2. Clinical presentation (the person's clinical manifestations of diseases).
A community health nurse has been asked to educate a group of high-risk adolescents on the prevention of the transmission of HIV. When planning this workshop, the nurse recognizes that the primary mode of transmission for HIV is which of the following?
1. Sharing needles during drug injections
2. Sexual contact
3. Blood transfusions
4. From mother to fetus
2.Sexual contact

The primary mode of transmission for HIV is sexual contact. Contact with infected blood on needles shared during drug injection, and lateral infection from mother to fetus are also modes of transmission. A small number of cases contract the virus through blood transfusions.
Planning; Health Promotion and Maintenance; Analysis
A client with HIV is receiving 4 antiretroviral drugs under the highly active anti-retroviral therapy (HAART) protocol. The client asks why she must take 4 different medications when she doesn't feel sick. The nurse's best response will be based on the knowledge of which of the following?
1. The combination therapy helps to reduce the incidence of drug resistance in the HIV client.
2. The combination therapy is necessary since there is no way to identify which drug will be effective.
3. The combination therapy helps to prevent opportunistic infections.
4. The combination therapy is used to treat opportunistic infections.
1. The combination therapy helps to reduce the incidence of drug resistance in the HIV client.

Highly active anti-retroviral therapy (HAART) is the new treatment protocol that combines three to four of the antiretroviral drugs to reduce the incidence of drug resistance. These drugs do not treat or prevent opportunistic infections.
Implementation; Physiological Integrity; Application
A client with HIV has a CD4 cell count of 190. The nurse anticipates the client will be treated prophylactically for which of the following potential infections in the HIV client?
1. Mycobacterium avium complex
2. Pneumocystis carinii pneumonia (PCP)
3. Tuberculosis
4. Kaposi's sarcoma
3. Pneumocystis carinii pneumonia (PCP)
Prophylactic treatment for pneumocystis carinii (PCP) is begun when the CD4 cell count falls to less than 200. Prophylactic treatment for mycobacterium avium complex is begun with CD4 cell counts of less than 100. Kaposi's sarcoma is a cancer and there is no prophylaxis for this disease. The client is treated prophylactically for tuberculosis in the event the client is exposed to the disease.
Planning; Physiological Integrity; Analysis
A client with HIV is being seen in the health clinic for follow up lab analysis. Which of the following assessments by the nurse would indicate the client has likely progressed to AIDS?
1. Weight loss of 4 pounds in the past 3 months
2. Lymphadenopathy of the cervical chain
3. Violet lesions over the client's nose and pinnae of the ears
4. Complaints of decreased appetite
3. Violet lesions over the client's nose and pinnae of the ears


The presenting symptom of AIDS is often Kaposi's sarcoma (KS), a tumor of the endothelial cells lining small blood vessels. The tumor presents as vascular macules, papules, or violet lesions that affect the skin and viscera. The 4 pound weight loss and decreased appetite may be attributed to the stress of having a fatal disease and does not necessarily indicate AIDS. Lymphadenopathy of the cervical chain may be seen in some clients with HIV.
Assessment; Physiological Integrity; Analysis
A client with HIV is asymptomatic. She informs the nurse that her live-in boyfriend is aware of her infection, and they practice "safe sex". The nurse knows that the client requires further teaching when she makes which of the following statements?
1. "We use latex condoms for vaginal and anal sex."
2. "We use latex condoms for oral sex."
3. "We use Vaseline for lubrication."
4. "We use nonoxynol-9 spermicide."
3. "We use Vaseline for lubrication."
Latex condoms and nonoxynol-9 spermicide for lubrication are recommended for reducing the risk of transmitting HIV. Vaseline is not recommended for lubrication.
Evaluation; Health Promotion and Maintenance; Analysis
2. A 25-year old man is admitted to the hospital with a diagnosis of acquired immune deficiency syndrome (AIDS). He is being treated for pneumocystis carinii pneumonia. The nurse evaluates the care provided to this patient by other members of the health care team. The nurse should intervene in which of the following situations?





A. A housekeeper cleans up spilled blood with a bleach solution

B. A nursing student takes the patient’s blood pressure wearing a mask and gloves

C. A technician wears gloves to perform a venipuncture

D. A nurse attendant allows visitors to enter his room without masks
B. A nursing student takes the patient’s blood pressure wearing a mask and gloves – CORRECT: inappropriate practice; mask and gloves necessary only when possibility of contact with blood and body fluids; when taking a BP very low risk for contact with blood and body fluids, behavior insensitive to patient’s feelings, does not promote trust
Which of the following are unique characteristics associated with human immunodeficiency virus (HIV) infection in the older person?
1. HIV infection in the older person most likely is underdiagnosed and underreported.
2. Healthcare workers often do not take sexual histories of older patients or recommend HIV testing.
3. Symptoms of memory loss and weight loss related to HIV often are treated as common age-related health problems.
4. Older persons are contacting HIV infection through heterosexual and homosexual activities.
1. HIV infection in the older person most likely is underdiagnosed and underreported.

Healthcare workers often do not take sexual histories of older patients or recommend HIV testing.

Symptoms of memory loss and weight loss related to HIV often are treated as common age-related health problems.

Older persons are contacting HIV infection through heterosexual and homosexual activities.
A nurse has been instructed to place an IV line in a patient that has active TB and HIV. The nurse should where which of the following safety equipment?
A: Sterile gloves, mask, and goggles
B: Surgical cap, gloves, mask, and proper shoewear
C: Double gloves, gown, and mask
D: Goggles, mask, gloves, and gown
(D) All protective measures must be worn, it is not required to double glove.
What are the etiologies and risk factors for HIV
Etiology
First identified in 1983
HIV-1 (worldwide) mostly U.S. and Europe
HIV-2 (mostly in West African nations)
Risk Factors
Modes of Transmission
-Certain sexual practices
-Exposure to blood
-Perinatal (Vertical) transmission
In the past 20 years, what has changed in the transmission Patterns of HIV/AIDS?
1980s vs. 1990s
-Significant>IV drug users, women, and heterosexuals
-Most Americans with HIV are MSM (men who have sex with men), but overall number has decreased considerably
-Decrease is in white men only, other races and ethnicity groups continue to increase
Gender Bias Transmission-explain
Transmission is:
-More efficient from man to woman than woman to man
-Related to number of infectious particles in body fluid
-Related to volume of fluids exchanged
-Related to surface area coming in contact with infected body fluid
How are women and HIV connected
3rd leading cause of death for all women between the ages of 25-44
The leading cause of death for African American women in this age group
92,242 cumulative AIDS cases had occurred in adult and adolescent women in the US by the middle of 1997
Women comprise approximately 15% of the total number of adult and adolescent AIDS cases.
How are youth, sex, and drugs connected to HIV?
Half of the 40,000 people diagnosed with HIV in the United States each year are adolescents
3 million contract a sexually transmitted disease
Nearly 10% of students had tried cocaine or crack in the previous month
80% of the students had tried alcohol
1/3 of these having had 5 or more drinks in the past month
Nearly ½ had used marijuana in the previous month
African American students were significantly more likely to use condoms than Hispanics and whites
48% of more than 16,000 students aged 10-24 surveyed have had sex
-7% of the sexually active students were under the age of 13
-16% reported having had at least 4 sex partners
58% reported that either they or their partner had used a condom during their last sexual encounter
What is the Pathophysiology of HIV
HIV is a retrovirus
HIV infects T helper cells (T4 lymphocytes), macrophages and B cels
T helper cells are infected the most readily
Glue to which HIV is attracted is the CD4 molecule (acts as receptor on T helper cell)
Clinicians refer to T4 helper cells as CD4 cells
Clinical Manifestations of HIV
What are the 2 monitoring parameters used to follow a client
2 monitoring parameters used to follow a client
1. Laboratory data (CD4 cell counts), viral load testing
2. Clinical presentation (the person’s clinical manifestations of diseases)
Asymptomatic HIV infection
Signs and Symptoms
Fatigue, Night sweats
Low grade fevers, diarrhea, H/A
CD4 Cell counts
Anergy Panel
Symptomatic HIV Infection
Lymph nodes
Skin assessment
Thrush
Diarrhea
Oral candida
Oral hairy leukoplakia
Herpes Simplex
Varicella Zoster
Why does CD4 cell count jump around
The CD4 count often jumps around because the determination can often be inaccurate
Lab. Variations can occur within the same sample.
It can change
-based on the time of day
-if patient smokes before venapuncture
-If patient has a current illness such as cold or flu
Diagnosis of HIV
Diagnostic tests of AIDS
ELISA indirect measurement of antibodies, incredible false + rate
-Western Blot More reliable test for HIV, used to confirm + ELISA, More time consuming
-p24 antigen produces a lot of false, only + when virus is dividing. Helpful in monitoring disease progress and effectiveness of therapy.
-Viral cultures very expensive and difficult to grow on culture.
Medical Management of HIV:
What are the desired outcomes when HIV is managed?
Desired Outcomes:
Maintain the person’s health
Initiate and maintain an effective antiretroviral regimen
Prevent infectious complications
Current Directions in HIV Disease Management
Perform viral load testing and CD4 count to assess disease progression and treatment efficacy
Initiate therapy upon diagnosis of HIV infection as appropriate?? More conservative approach recommended by most experts
Combination therapy should be utilized
What do people with HIV need to do to maintain their health
Detailed laboratory and clinical assessment
-CBC, chemistry panels, urinalysis
-Annual TB test, Chest X-Ray
-Pregnancy tests, PAP smear
-STD screening annually
-Hepatitis antibody testing
-Serologic tests to detect exposure to pathogens that can cause opportunistic infections
-CD4 counts, viral load testing
What is Viral Load Testing
Quantitative HIV RNA by PCR or by DNA (Viral load) is a direct measurement of circulating HIV virions in plasma.
It is the best predictor or long term clinical course.
The higher the viral load value (in copies of HIV RNA/ml) the higher the risk of progression to AIDS

Recent studies also indicate it is an important factor associated with perinatal HIV transmission.
Guidelines for using viral load assays in practice
Measure HIV RNA when first seeing pt to estimate baseline
Estimate prognosis and make TX decisions, baseline in conjunction with, physical exam, and CD4 cell count.
Strongly consider antiretroviral TX if level of HIV RNA is > 30,000 copies /ml regardless of CD4 count
Measure HIV RNA 2-4 wk after starting or changing tx; dc regimens that fail to reduce HIV RNA at least 3-10 fold or undetectable level
Monitor pts q 3-4 mo. For evidence of drug failure, which is indicated by a rise in HIV RNA
Guidelines for Using Viral Load Assays in Practice
Do not overreact to changes in HIV RNA that are less than 3-fold because that degree of variation could be due to assay variation alone.
Use the same kind of collection tube, the same assay, and the same laboratory to minimize variation in results
Numbers of Infected Cells in Clinically Silent Phase of HIV disease
1 billion actively replicating infected cells
1 billion covertly infected cells
1 trillion lymphocytes

Viral load increases continuously and eventually overwhelms the immune system
If HIV infection is a war between the virus and the immune system
“CD4” estimates the number of casualties
HIV RNA estimates the strength of the enemy
Antiretroviral Therapy
Current guidelines from the US department of HHS
-Symptomatic clients: treat
-Asymptomatic with CD4 count < 200: Treat
-Asymptomatic with CD4 counts 200-350: Therapy should be offered
-Asymptomatic with CD4 counts >350: Defer or consider therapy if viral load is high.
Drug Therapy of HIV
Antiretrovirals
Antiretrovirals
-Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI’s)
-Nonnucleoside Reverse
Transcriptase Inhibitors (NNRTI’s)
Protease Inhibitors (PI’s)
Entry Inhibitors
Antiretrovirals: NRTI’s and NNRTI’s
Explain what these drugs do
Agents that interfere with the virus’s ability to replicate
Only work after the virus has infected the cell
Goal is to raise the T cell count so the body can deal with the infection
Zidovudine (AZT, ZDV, Retrovir)
Antiretroviral, Nucleoside Analogue

Dose, route, implications, adverse effects
Administration:
200 mg. po tid
300 mg po bid
With or without food

Major adverse effects
Nausea and headache at initiation
Decreases over weeks
Anemia
Neutropenia
Lactic acidosis/hepatoegaly with steatosis
Myopathy
Didanosine (ddi, Videx)
Antiretroiral Nucleoside Analogue

Dose, route, implications, adverse effects, Directions for taking
Administration:
>60 kg:200 m po bid (tablets); 250 mg po bid (powder)
<60kg: 125 mg po bid (tablets); 167 mg po bid (powder)
Formulated with an antacid buffer
Major adverse effects
-pancreatitis
-peripheral neuropathy

Directions:
May be taken on an empty stomach
Adults should take 2 tablets/dose
Palatability can be improved by simple measures (taking drug with cold water)
Liver failure
Retinal depigmentation
Antiretrovirals: Protease inhibitors
explain how these drugs help treat HIV
Since 1995, combination therapy has greatly improved prognosis
Primary goal of ART is to drive viral load below the level of detection
Indinavir (Crixivan)
Antiretroviral Protease Inhibitor
Dose, route, implications, adverse effects
Administration:
800 mg po tid
-Give one hour before or 2 hours after a full meal; or give with a light meal
Drug interactions
-rifabutin
-terfenadine
-astemizole
-Medazolam
-Triazolam

Major adverse effects
-Nephrolithiasis
-Hyperbilirubinemia (not clinically significant)
-Headache
-Rash
-Diarrhea
-Nausea
Saquinavir (Invirase)
Antiretroviral: Protease Inhibitor
Administration:
-600 mg PO tid (adjust for CrCl <50 ml/min)
-Should be given within 2 hours after a full meal
Drug interactions
Terfenadine
Astemizole
Rifampin
Rifabutin
Phenobarbital
Phenytoin
Dexamethasone
Carbamazepine

Major Adverse Effects
-Diarrhea
-Abdominal discomfort
-Nausea
Antiretrovirals: Entry Inhibitor
The only antiretroviral to work Before the HIV enters the cell
Blocks HIV from entering the cell.
Fuzeion, T-20
Must be given BID in SQ injection
Adverse Reactions
-Bacterial pneumonia or allergic reactions
Injection site infections
Diarrhea, nausea, fatigue.
Combivir
Antiretroviral: 2 Nucleoside Analogues combined
Combination of existing drugs
-Retrovir (AZT) 300 mg
-Epivir (3CT) 150 mg
Dosage
One tablet twice a day
Trizivir Combination drug
Combination of 3 drugs:
-AZT 300 mg
-3TC 150 mg
-Abacavir 300 mg
Take 1 BID
Cost: 987.88/month
Required AIDS Medications
Antibiotic: Trimethoprim sulfamethoxazole (Bactrim DS)
Antifungal: Fluconazole (Diflucan)
Antiviral:
Acyclovir (Zovirax)
Antiretrovirals:
Nonnucleosides
Zidovudine (ADV, AZT, Retrovir)
Antiretrovirals: protease Inhibitors
-Sequinavir (Invirase)
What drugs are used Prevent Infections
Often give prophylactic medications to patients with CD4 cell counts <200
Antibiotics
Antifungals
Antivirals
Perinatal and HIV
Explain the implications of a pregnant HIV woman, what can be done to protect the baby?
All babies born to HIV+ mother will be + a birth (could be a false +)
ELISA needs to be checked at 15 months, again in 18 months if inconclusive
Studies have shown it is imperative to offer antiretrovirals (AZT) to mother to decrease transmission to baby
Doctors urged to counsel ALL pregnant women
Although 43% of physicians routinely advise universal HIV screening for prenatal patients, 90% agree with the practice
Only 10% of prenatal patients were actually screened for HIV
Female physicians were more likely to test for HIV
Zidovudine Monotherapy Common Among HIV infected women
By the 3rd trimester:
61% of HIV1 + pregnant women were being treated with AZT monotherapy
39% received combination therapy
Antiretroviral treatment naïve patients: 42% received the recommendation of AZT monotherapy
25% combination antiretroviral therapy
33% individually tailored tx recommendations
Maternal Viral Load “Powerful” Predictor of HIV vertical transmission
Estimated Rates of transmission
2% at 1,000 HIV RNA copies/ml
11% at 10,000 copies
40% at 100,000 copies
These findings extend the information from natural history studies which demonstrate that viral load is more effective in predicting progression of HIV disease than CD4 cell count.
Pediatric HIV/AIDS
HIV in Infants: the disease often produces severe bacterial and lung infections not seen in adults
An estimated 93% of children with HIV have developmental disabilities that result in some degree of physical or mental impairment
The mean total lifetime charges for care of children with HIV infection were $491,936
When does HIV become AIDS
Opportunistic Disease
Cancers
HIV wasting
HIV dementia
CD4 or T4 cell counts <200 if asymptomatic or <500 and AIDS indicator condition
Medical and Nursing Management of AIDS
Prevent and treat opportunistic infections
Treat Neoplasms
Treat other conditions specific to AIDS
Opportunistic Infections
Protozoal
-PCP (pneumocystitis carinii pneumonia)
Cryptosporidiosis
Bacterial
TB
Mycobacterium Avium Complex (MAX)
Salmonella
Recurrent Bacterial Pneumonia
Pneumocystis Carninii Pneumonia (PCP)
Parasite
Etiology
-Usually AIDS clients get if T4 count drops below 200.
-Ubiquitous, exist in lungs of animals and most humans
-Most children have acquired PCP infection by 4 years of age
Up to 80% AIDS clients may develop PCP
Pathophysiology for
Pneumocystis Carninii Pneumonia (PCP) parasite
-Reactive of latent infection
-Reported in adrenals, bone marrow, skin, ears, eyes, thyroid, liver, kidney, and spleen
Pneumocystis Carninii Pneumonia (PCP)
Manifestations
-fever, fatigue, weight loss, cough, dyspnea, 6% asymptomatic initially.
-Sputum may look clear with PCP.
-May get a false- on chest X-ray
Pneumocystis Carninii Pneumonia (PCP)
Diagnosis
-Sputum washing, bronchial alveolar lavage, lung biopsy, ET suction
Pneumocystis Carninii Pneumonia (PCP)
Pharmacology
Prophylaxis
Nursing Interventions
-Bactrim is the drug of choice
-50% get skin rash with bactrim
-May choose to treat with benadryl
-2nd choice is Pentamidine then Dapsone

Prophylaxis
If T4 drops to less than 200, prophylaxis is recommended
-Bactrim, Pentamidine, Dapsone

Nursing Interventions
-Treat Cough, SOA, fever, Fatigue
Cryptosporidiosis (Protozoon)
Etiology
Pathophysiology
-Self limiting in normal person, but in HIV usually causes death.
-Animal to human handling infected animals)
-Waterborne or contaminated food
-Anal-oral sex

Pathophysiology (GI Tract infection)
Cryptosporidiosis (Protozoon)
Manifestations
Diagnosis
-Voluminous diarrhea (10-25 l/d)
-Cramping, flatulence, steatorrhea, malabsorption, fatigue, dehydration, electrolyte imbalance, myalgia, n/v, weight loss, anorexia, fever, malnutrition, dehydration
Diagnosis
-Microscopy
Cryptosporidiosis (Protozoon)
Pharmacology
Spiramycin, Eflornithine, diclazuril, trimetrexate, somatostatin, bovine grensfer factor, hyperimmune bovine colostrum, cow’s milk, flobulin
-not really an adequate drug TX though ay be tried.
Nursing Intervention
Cryptosporidiosis (Protozoon)
Prevention: chlorine does not kill this and swimming pools can be a problem. Need ammonia to kill.
Treat diarrhea, pain, weight loss, fatigue, fever, stomatitis, skin breakdown, enteric precautions, household cleaning and body image
Nurses can get this from not using universal precautions (hand washing/gloving)
Salmonelosis (bacteria)
Etiology
Contaminated food, water, medication, or fecal-oral
Salmonelosis (bacteria)
Pathophysiology
GI tract to blood and spreads to lungs and throughout body
Salmonelosis (bacteria)
Manifestations
Fever, chills, night sweats, weight loss, anorexia, diarrhea, fatigue, abd. Pain
Salmonelosis (bacteria)
Diagnostic tests used to diagnose
Bacterial culture, stool culture
Salmonelosis (bacteria)
Pharmacology
Antibiotics
Ampicillin
Chloramphenicol
Amoxicillin
Cipro
Bactrim
Salmonelosis (bacteria)
Nursing Interventions
Prevention-enteric precautions
Treat fever, diarrhea, skin breakdown, dehydration
Tuberculosis (TB)-explain disease and how it relates to HIV/AIDS
Pulmonary or extracellular (other than pulmonary) TB was added as diagnostic of AIDS in 1993 with positive HIV
Multidrug resistant TB (MDR-TB) is most evident in AIDS, closed environments, and large urban areas.
Infectious disease specialist should be consulted MDR-TB
Prevention and TX of MDR-TB requires concurrent admin. Of more drugs for a longer period of time (2 years or longer)
HIV/AIDS client may require TB therapy for the rest of their lives with the impaired immune system.
Mycobacterium Avium Complex (MAC)
Etiology
Etiology
-Found in H20, food, and soil throughout the U.S.
-Transmitted by inhalation of droplets of contaminated water.
Mycobacterium Avium Complex (MAC)
Manifestations
Fever
Night sweats
Fatigue
Anorexia
Weight loss
Abdominal pain
Mycobacterium Avium Complex (MAC)
Pathophysiology
Rarely causes significant disease in immuno-competent persons but causes an opportunistic pulmonary infection in about 50% of those with advance HIV.
Major cause of wasting syndrome with AIDS
Mycobacterium Avium Complex (MAC)
Diagnosis
As disease becomes disseminated through the body, chronic lung disease develops and the organism is found in blood, bone marrow, liver, lymph nodes, and other body tissues.
Mycobacterium Avium Complex (MAC)
Treatment
Combination of antitubercular drugs that were not effective due to high rate of drug resistance and relapse

Newer drugs used are:
Azithromycin, Clarithromycin, and Rifabutin

Life long prophylactic drug therapy of
Azithromycin or Clarithromycin
Opportunistic Infections
Cryptococcus (Fungi)
Etiology
Ubiquitous (pigeon droppings), nesting places, soil, fruit and fruit juice
Organism is aerosolized and inhaled
Opportunistic Infections
Cryptococcus (Fungi)
Pathophysiology
Can cause central nervous system, pulmonary and disseminated infection
Meningoencephalitis in HIV disease, reactivation of infection.
Opportunistic Infections
Cryptococcus (Fungi)
Manifestations
-CNS
-Fever, malaise, Headache, stiff neck, N/V, diarrhea, photophobia, altered mentation, focal deficits, seizures
Pulmonary
Cough, dyspnea, pleuritic chest pain
Opportunistic Infections
Cryptococcus (Fungi)
Diagnostic tests used to diagnose
Microscopy and/or culture
Opportunistic Infections
Cryptococcus (Fungi)
Pharmacology
Systemic antifungal like Amphotericin-B, Flucystosine, Fluconazole.
Opportunistic Infections
Cryptococcus (Fungi)
Nursing Interventions
Side effects of medications,
Impaired cognition, fever, cough, dyspnea H/A, mouth lesions
Opportunistic Infections
Viral Infections-Name
Cytomegalovirus
Herpes Simplex
Hepatitis
Cytomegalovirus (CMV) Virus
Etiology
Widely distributed throughout the world
Most primary infections occur perinatally, during preschool year, or with sexual activity.
Blood products, transplants, or organs.
Cytomegalovirus (CMV) Virus
Pathophysiology
Directly destroys tissue in the brain, lungs, liver, retina; causes hemolytic anemia, thrombocytopenia
Facilitates neoplastic transformation
Cytomegalovirus (CMV) Virus
Manifestations
Choriorentinitis
-Pneumonitis, Encephalitis, Adrenalitis, Colitis, Esophagitis, Hepatitis
Cytomegalovirus (CMV) Virus
Diagnostic test used to diagnose
Microscopy and/or culture
-Retina exam
Cytomegalovirus (CMV) Virus
Pharmacology
Ganciclovir
Foscarnet,
Cytomegalovirus (CMV) Virus
Nursing interventions
Teach the need to practice safer sex to prevent viral loading
Occupational concerns with vision loss
Diarrhea, fatigue, fever, weight loss
Hepatitis-Explain disease and how it relates to HIV
The leading cause of death among AIDS clients is now hepatic failure secondary to hepatitis B.
A dramatic increase in rates of co-infection with HIV and Hepatitis C.
Treatable with combination drug therapy/adds to complexity of therapy for those already on HAART.
Name 3 types of Neoplasms/Opportunistic cancers
Kaposi’s Sarcoma
Non-Hodgkin’s Lymphoma
Invasive Cervical Cancer
Opportunistic Cancers
Kaposi’s Sarcoma
Explain Kaposi’s Sarcoma and how it relates to HIV/AIDS
Kaposi’s Sarcoma (KS)
-A cancer of the lining of the blood vessels
Most common cancer associated with HIV/AIDS
Opportunistic Cancers
Lymphomas
Usually are aggressive tumors, growing and spreading rapidly.
-Primary lymphoma of the brain
-H/A and changes in mental status are common early symptoms
Non Hodgkin’s lymphomas-example
Opportunistic Cancers
Invasive Cervical Cancer
Of women with HIV, 40% have cervical dysplasia.
Cervical cancer develops frequently and tends to be aggressive. HIV + women with cervical cancer usually die from the cancer, not the HIV.
Recommended that women with HIV have PAP smear every 6 months and aggressive treatment of cervical dysplasia with colposcopic exam and cone biopsy
AIDS Specific Conditions-name 2
AIDS Dementia
(HIV encephalopathy)
HIV wasting syndrome
AIDS Dementia
Etiology
Spread of HIV to the brain occurs early and is widespread. Not correlated with disease progression
AIDS Dementia
Pathophysiology
HIV penetrates the blood brain barrier
HIV can be found in 75-90% of neurologically asymptomatic
Neural losses even in the absence of encephalitis
AIDS Dementia
Manifestations
-Cognitive dysfunction-difficulty with concentration and memory, impaired judgment, slow thinking
-Motor deficits—
Leg weakness,
ataxia,
clumsiness
Dropping things
Hand activities become slower and less precise.
Behavioral Changes-Apathy, reduced spontaneity, social withdrawal, irritability, anxiety, delirium.
AIDS Dementia
Stages/Diagnosis
5 stages
1-minimal S/S
5-nearly vegetative
Diagnosis: HIV + CSF
Grossly under diagnosed, may be misdiagnosed as depression
Antidepressants can exaggerate delirium
AIDS Dementia
Pharmacology
Antiretrovirals (Combination therapy preferred)
Psychotropics (caution)
AIDS Dementia
Expected Outcomes
-Client Safety prime concern. Protect from falls, medication misadministration
Independence for as long as possible.
HIV wasting syndrome
Etiology
Related to
Etiology-Occurs in >90% of AIDS clients
Related to:
-Reduced food intake
-Malabsorption of nutrients
-Altered metabolism of nutrients
-Low testosterone levels.
HIV wasting syndrome
Diagnosis
Profound involuntary weight loss > 10% total baseline weight with either chronic diarrhea or chronic weakness and fever
HIV wasting syndrome
Assessment
-Diet history, adequacy of protein/calorie intake. Substituting vitamins for intake.
HIV wasting syndrome
Pharmacology
-Nutritional supplements: Dronabinal, (the major psychoactive component of Marijuana
Increases appetite
Prevents vomiting
Megace, synthetic version of hormone Progesterone
Increases fat synthesis
Testosterone
Anabolic steroids
TPN as last resort
Human Growth Hormone (more successful than others)
HIV wasting syndrome
Goals
Prevent further weight loss
Stimulate appetite
Produce weight gain
Increase lean muscle mass
Nursing Diagnoses in HIV/AIDS
Impaired skin integrity
-Assess for lesions and breakdown
-Monitor for signs of infection/impaired healing
-Prevent skin shearing
-Monitor nutritional intake as well as albumin levels.

Altered Nutrition: Less than body requirements
Nutritional assessment for baseline
Assess for cause of altered nutrition
Administer medication for candidiasis and other manifestations.
Oral hygiene

Altered Sexuality patterns
Examine your feeling about sexuality
Provide factual information about HIV infection

Self care deficit related to systemic infection

Risk for injury: Recurrent infection, falls, medication compliance, family responsibilities, adequate nutrition

Ineffective individual coping

Altered thought processes.
Client and Family Teaching
about HIV/AIDS
Disease progression, treatment options, and how HIV is spread.
Guidelines for safer sex practices, even if HIV+
Inform all medical personnel of HIV status
Abstain from donating organs, tissue, or blood
Maintain optimum health: diet, exercise, rest, stress reduction, lifestyle changes, regular checkups, and hand-washing.
Proper medication administration, side effects, viral load, and CD4 counts
S/S of opportunistic disease and when to seek medical assistance.
How much does the medicine cost to treat HIV/AIDS
A lot!!!!
Nucleoside Analogues
Combivir $478.90 (3TC/AZT) 1X150 mg/300 mg tab TID
Epivir $220.90 (lamivudine/3TC) 1X150 mg tab BID
Videx $181.55 (didanosine/ddl) 2X100mg tab BID
Retrovir $258.10 (zidovudine/ZDV/AZT)
2X100 mg cap TID, 1X300 mg tab BID
Protease Inhibitors
Crixivan ($405.05) indavir $405.05
You get the picture
treatment of HIV/AIDS has had three stages: what are these stages?
(1) sequential monotherapy, (2) HAART (highly active antiretroviral therapy), and (3) the newest phase of boosting antiretroviral therapy with protease inhibitors (PIs) with ritonavir. Boosting with ritonavir prevents the liver from breaking down the drug as quickly, leaving a higher sustained blood level of the PI. This translates into easier dosing, because drugs that needed to be taken three to five times daily can now be taken twice daily with food. This will enhance adherence to therapy and reduce the development of resistant strains of HIV. Some boosted PIs are showing efficacy against strains resistant to PIs.
1. What are the two major subtypes of HIV-1?
A. HIV-1 major and HIV-1 minor
B. HIV-1 major and HIV-2 major
C. HIV-1 major and HIV-1 outlier
D. HIV-1 major and HIV-2 outlier
C: HIV-1 major and HIV-1 outlier
2. Sexual practices that are completely safe include which of the following?
A. Autosexual activities
B. Mutual, monogamous relationships
C. Abstinence
D. All of the above are correct.
D. All of the above are correct.
3. The average laboratory range for CD4+ T-cell count is:
A. 500 to 1600 mm3.
B. 500 to 1000 mm3.
C. 1600 to 2000 mm3.
D. 2000 to 2500 mm3.
A. 500 to 1600 mm3.
The most recent classification system for HIV disease in adults and adolescents is based on what two monitoring parameters?
A. CD4+ counts and clinical presentation
B. Enzyme immunoassay and CD4+ count
C. Clinical presentation and enzyme immunoassay
D. Western blot and CD4+ count
A. CD4+ counts and clinical presentation
In general, HIV test results are reported as:
A. positive and negative.
B. positive, negative, and determinate.
C. positive, negative, and indeterminate.
D. positive, negative, and controlled.
C. positive, negative, and indeterminate.
What are the three types of drug resistance concern in treating HIV?
A. Genotype resistance, phenotype resistance, and RNA resistance
B. Genotype resistance, phenotype resistance, and cross-resistance
C. Genotype resistance, phenotype resistance, and DNA resistance
D. Genotype resistance, phenotype resistance, and therapeutic resistance
B. Genotype resistance, phenotype resistance, and cross-resistance
Which of the following is not a main type of opportunistic infection?
A. Bacterial
B. Fungal
C. Viral
D. Congenital
D. Congenital
The drug that is used to treat HIV/AIDS that works by preventing the successful assembly and release of a new virus particle is:
A. reverse transcriptase inhibitors.
B. protease inhibitors.
C. entry inhibitor.
D. NNRTIs.
B. protease inhibitors.
__________ __________ is the capability of HIV to change its appearance or mutate very rapidly.
Genetic promiscuity
The principal mode of transmission of HIV throughout the world has been through __________ __________.
sexual exposure
HIV infection in the central nervous system is indirectly caused by __________ produced by infected macrophages.
neurotoxins
The main target for HIV is the __________ __________ __________.
T4 helper cell
The __________ __________ __________ __________ are the regulating cells in the immune system.
CD4+ T helper cells
Survival among clients with AIDS has been dramatic since the advent of __________ __________ __________ __________ __________, which uses varying combinations of drugs from three different classes of antiretroviral medications.
highly active antiretroviral therapy (HAART)
The period in which a person becomes infected with the HIV virus is referred to as __________ __________.
primary infection
If the enzyme immunoassay result is positive, a second test, the __________ __________, is performed to confirm a positive HIV status.
Western blot
In 1996 __________ __________ __________ became available to directly measure viral activity in a person with HIV.
viral load testing
The therapeutic intervention of trying combinations of four to six drugs in an effort to suppress HIV activity is commonly called __________ __________.
salvage therapy
__________ __________ __________, the precursor to cervical cancer, occurs at a high rate in women infected with HIV.
Cervical intraepithelial neoplasia
HIV-encephalopathy, also referred to as __________ __________ __________, appears to affect the very young and older HIV-infected clients.
AIDS dementia complex
CD4+ cell counts
Prognostic indicator to identify whether a client infected with HIV is at risk for developing opportunistic infections
HIV classification system for adolescents and adults
The CDC's classification system that is divided into laboratory and clinical categories
HIV illness trajectory
The course of the disease progression from caring for the person with HIV disease to AIDS
NNRTIs (non-nucleoside reverse transcriptase inhibitors): nevirapine (Viramune)
Works similar to nucleoside analogs; blocks RNA and DNA, disrupting the enzyme's site
5. NRTIs (nucleoside reverse transcriptase inhibitors): retrovir, AZT
Blocks HIV replication by protecting noninfected cells
PGL
Persistent, generalized lymphadenopathy
PIs (protease inhibitors): indinavir (Crixivan)
Renders HIV particles noninfectious
Viral load
Measures viral activity in a person infected with HIV