Nursing 3Rd Semester: Exam 4 Hiv

Front 1

What are the 3 methods of HIV transmission? Which is the most common?

Back 1

Perinatal transmission
Blood/blood products- becoming more rare
Sexual transmission- most common

Front 2

The likelihood of contracting HIV depends on the _______ of the individual or the degree "intactness" of the immune system and the amount of the virus, such as the volume of fluid exposed, virulence and concentration of the virus, and the _____ of contact.

Back 2

The likelihood of contracting HIV depends on the SUSCEPTIBILITY of the individual or the degree "intactness" of the immune system and the amount of the virus, such as the volume of fluid exposed, virulence and concentration of the virus, and the FREQUENCY of contact.

Front 3

The ____ ____ is the number of HIV particles in the plasma.

Back 3

The VIRAL LOAD is the number of HIV particles in the plasma.

Front 4

Since the discovery of HIV infection, several important advances have been made including the development of laboratory tests to assess the viral load, the production of new drugs, the use of _____ drug therapy, the ability to test for antiretroviral drug _____, and treatment to decrease the risk of transmission from _____ to ___. In developed countries, the result has been decreases in the number of HIV-related deaths, improved quality of life, and a significant decrease in children born with HIV. Great progress has been made, but the epidemic in North America and around the globe still continues to expand.

Back 4

Since the discovery of HIV infection, several important advances have been made including the development of laboratory tests to assess the viral load, the production of new drugs, the use of COMBINATION drug therapy, the ability to test for antiretroviral drug RESISTANCE, and treatment to decrease the risk of transmission from MOTHER to BABY. In developed countries, the result has been decreases in the number of HIV-related deaths, improved quality of life, and a significant decrease in children born with HIV. Great progress has been made, but the epidemic in North America and around the globe still continues to expand.

Front 5

In America, the epidemic of HIV is growing at faster rates among what four groups?

Back 5

women
people of color
people who live in poverty
adolescents

Front 6

True or False: Since the beginning of the epidemic, sub-Saharan Africa has been the most devastated by HIV, and the Caribbean, Asia, Eastern Europe, and South America also have growing epidemics.

Back 6

true

Front 7

How soon after being infected with HIV can a person transmit the virus?

Back 7

within days, after that the ability to transmit remains for life

Front 8

Large amounts of HIV can be found in the blood, and to a lesser extent in the semen, during the first ___ months of infection and again during the earlier/later stages of the disease. Unprotected sexual intercourse or blood exposure to an infected individual during these periods is more risky, although HIV can be transmitted during all phases of the disease.

Back 8

Large amounts of HIV can be found in the blood, and to a lesser extent in the semen, during the first 6 months of infection and again during the LATER stages of the disease. Unprotected sexual intercourse or blood exposure to an infected individual during these periods is more risky, although HIV can be transmitted during all phases of the disease.

Front 9

Which of the following ways can HIV be transmitted?
hugging
dry kissing
childbirth
shaking hands
blood
sharing eating utensils
pregnancy
using toilet seats
tears
semen
saliva
urine
emesis
sputum
feces
sweat
breast milk
respiratory droplets
enteric routes
vaginal secretions
casual encounters

Back 9

childbirth
blood
pregnancy
semen
breast milk
vaginal secretions

Front 10

True or False: Health care workers have a low risk of acquiring HIV at work, even after a needle-stick injury.

Back 10

true


(p. 241)

Front 11

Which the most common mode of transmission of HIV today- heterosexual or homosexual contact? Who is more susceptible to getting HIV from heterosexual contact?

Back 11

heterosexual
Women (the receiver of the semen...)

Front 12

True or False: sexual activities that cause trauma to local tissues can increase the risk of transmission. The presence of genital lesions from other STD's like herpes or syphilis also significantly increases the risk of transmission

Back 12

true

Front 13

____ ____ are the most common means of work-related HIV transmission. The risk of infection after a needle-stick exposure to HIV-infected blood is 0.3 to 0.4 %. The risk is higher if the exposure involves blood from a patient with a high ___ ___, a ___ puncture wound, a needle with a ____ bore and visible blood, a device used for ____ or ___ access, or if the patient dies within __ days. Splash exposures of blood on skin with an open lesion present some risk, but it is much lower than from a puncture wound.

Back 13

PUNCTURE WOUNDS are the most common means of work-related HIV transmission. The risk of infection after a needle-stick exposure to HIV-infected blood is 0.3 to 0.4 %. The risk is higher if the exposure involves blood from a patient with a high VIRAL LOAD, a DEEP puncture wound, a needle with a HOLLOW bore and visible blood, a device used for ARTERIAL or VENOUS access, or if the patient dies within 60 days. Splash exposures of blood on skin with an open lesion present some risk, but it is much lower than from a puncture wound.

Front 14

HIV is a ribonucleic acid (RNA) virus. RNA viruses are called _______ because they replicate in a "backward" manner (going from RNA to DNA). HIV infects human cells with ____ receptors on their surfaces. These cells include lymphocytes, monocytes and macrophages, astrocytes, and oligodendrocytes, The immune dysfunction in HIV disease is primarily the result of damage to and destruction of ____ T cells which are also known as T ___ cells.

Back 14

HIV is a ribonucleic acid (RNA) virus. RNA viruses are called RETROVIRUSES because they replicate in a "backward" manner (going from RNA to DNA). HIV infects human cells with CD4 receptors on their surfaces. These cells include lymphocytes, monocytes and macrophages, astrocytes, and oligodendrocytes, The immune dysfunction in HIV disease is primarily the result of damage to and destruction of CD4+ T cells which are also known as T helper cells.

Front 15

True or False: HIV destroys about one thousand CD4+ T cells every day.

Back 15

False
HIV destroys about one BILLION CD4+ T cells every day. The body is able to produce enough new CD4+ T cells to replace the destroyed cells for many years. Eventually, however, the ability of HIV to destroy these cells exceeds the body's ability replace them. The decline in the CD4+ T cell count impairs immune system.

Front 16

Immune problems start to occur when the CD4 count drops below ___ cells/mcl and severe problems develop below ____.

Back 16

Immune problems start to occur when the CD4 count drops below 500 cells/mcl and severe problems develop below 200.

Front 17

When the CD4 count gets too low, _____ diseases (infections and cancers that occur in immunosuppressed patients that would not have occurred in a person with a healthy immune system) can develop.

Back 17

opportunistic

Front 18

______ ________ are the main cause of death, disease, and disability in HIV infections.

Back 18

Opportunistic infections

Front 19

Describe the acute infection phase of HIV

Back 19

Acute Infection- generally occurs 2-4 weeks after initial infection and lasts 1-2 weeks. Seroconversion (when HIV specific antibodies develop) is often accompanied by a mononucleosis-like syndrome of fever, swollen lymph nodes, sore throat, malaise, nausea, muscle and joint pain, diarrhea, and/or a diffuse rash. Some people develop neurologic complications such as aseptic meningitis, peripheral neuropathy, facial palsy, or Guillain-Barre syndrome. During this time, a high viral load is noted and CD4+ T cell counts fall temporarily but quickly return to baseline. Many people mistake acute HIV symptoms for bad case of the flu. (All Leanne says is 3 weeks after exposure and flu-like symptoms)

Front 20

Describe the early chronic infection phase of HIV

Back 20

CD4 counts remain above 500 (normal or slightly decreased) and the viral load in the blood is low.
Often asymptomatic, but fatigue, headache, low grade fever, night sweats, and persistent generalized lymphadenopathy (PGL), and other symptoms often occur. (Often patients in this stage have no idea they have the virus and aren't seeking treatment and could be transmitting the disease to others)

Front 21

The median interval between untreated HIV infection and a diagnosis of AIDS is about ___ years.

Back 21

11

Front 22

Describe the Intermediate Chronic phase of HIV

Back 22

CD4 count 200-500
increased viral load
severe flu like symptoms- persistent fever, frequent drenching night sweats, chronic diarrhea, recurrent headaches, and severe fatigue

Front 23

What are the most common opportunistic infections associated with the intermediate chronic phase of HIV?

Back 23

oropharyngeal candidiasis or thrush (most common)
shingles (varicella zoster virus)
oral or genital herpes
bacterial infections
Kaposi sarcoma (human herpes virus 8)
Oral hairy leukoplakia (an Epstein-Barr viral infection that causes painless, white, raised lesions on lateral aspect of tongue)
Oral hairy leukoplakia is also an indicator of disease progression

Front 24

The period of late chronic infection-- a diagnosis of AIDS cannot be made until the HIV-infected patient meets criteria established by the CDC. These criteria are more likely to occur when the immune system becomes severely compromised. What is the criteria for diagnosing AIDS?

Back 24

AIDS is diagnosed when the HIV infected patient develops at least ONE of the following:
CD4 count <200

Opportunistic infection (Fungal, Viral, Protozoal, or Bacterial - See chart p 245) mentioned in lecture: Pneumocystis jioveci pneumonia, (PCP), cryptococcal meningitis, cytomegalovirus (CMV), Mycobacterium avium
complex

An opportunistic cancer (Kaposi sarcoma, Burkett's lymphoma, primary lymphoma of the brain, immunoblastic lymphoma, invasive cervical cancer)

Wasting Syndrome (loss of 10% or more of ideal body mass)

AIDS dementia complex (ADC)

Front 25

How is HIV diagnosed?

Back 25

The diagnosis of HIV is done through studies of Enzyme immunoassay (EIA) x 2 >
Western blot (WB) or
immunoflurorsescense assay (IFA)
Rapid HIV antibody (quick results, needs confirmation)
CD4+ Count
Viral Load

Read more about it if you want page 246...

Front 26

What stage of HIV infection is described:
CD4+ T Cells 200-500

Back 26

intermediate chronic infection

Front 27

What stage of HIV infection is described:
flulike symptoms

Back 27

acute HIV infection

Front 28

What stage of HIV infection is described:
median length is about 11 years

Back 28

early chronic infection

Front 29

What stage of HIV infection is described:
HIV seroconversion

Back 29

acute HIV inefction

Front 30

What stage of HIV infection is described:
median length is 2 years

Back 30

intermediate chronic infection

Front 31

What stage of HIV infection is described:
CD4 count usually normal

Back 31

early chronic infection

Front 32

What stage of HIV infection is described:
temporary fall of CD4 cells

Back 32

acute HIV infection

Front 33

What stage of HIV infection is described: persistent fevers and night sweats

Back 33

intermediate chronic infection

Front 34

What stage of HIV infection is described: Cytomegalovirus retinitis or other severe opportunistic diseases or cancers

Back 34

AIDS or late chronic infection

Front 35

What stage of HIV infection is described:
Oral hairy leukoplakia

Back 35

intermediate chronic infection

Front 36

In diagnosing HIV, a highly sensitive _____ immunoassay (EIA) is done to detect serum _____ that bind to HIV _____ on test plates. Blood samples that are negative on this test are reported as... If the patient reports recent ____ behaviors, encourage retesting at ___ weeks, ___ weeks, and ___ months. If the test is positive, the patient should be _______.

Back 36

In diagnosing HIV, a highly sensitive ENZYME immunoassay (EIA) is done to detect serum ANTIBODIES that bind to HIV ANTIGENS on test plates. Blood samples that are positive/negative on this test are reported as NEGATIVE. If the patient reports recent RISK behaviors, encourage retesting at 3 weeks, 6 weeks, and 3 months. If the test is POSITIVE, the patient should be RETESTED.

Front 37

If the blood tested for HIV is repeatedly EIA-antibody positive/negative, a more specific confirming test such as the ___ ___(WB) or _____ ____ (IFA) is done.

Back 37

If the blood tested for HIV is repeatedly EIA-antibody POSTIVE, a more specific confirming test such as the WESTERN BLOT(WB) or IMMUNE FLUORESCENCE ASSAY (IFA) is done.

Front 38

______ ____ testing incubates serum samples with purified HIV ______ ____phoresed. If ______ in the serum is present, it can be detected.

Back 38

WESTERN BLOT testing incubates serum samples with purified HIV ANTIGENS ELECTROPHORESED. If ANTIBODY in the serum is present, it can be detected.

Front 39

___ ___ identifies HIV in _____ cells. Blood is treated with a fluorescent antibody against p17 or p24 antigen and then examined using a fluorsecent microscope.

Back 39

IMMUNE FLUORESCENCE ASSAY (IFA) identifies HIV in INFECTED cells. Blood is treated with a fluorescent antibody against p17 or p24 antigen and then examined using a fluorescent microscope.

Front 40

True or False: Blood that is reactive in a EIA, WB, or IFA test the results are reported as HIV-antibody positive.

Back 40

true

Front 41

If the results of the various HIV tests are indeterminate, the following steps are taken: If in-depth risk assessment reveals that the individual done not have a history of ___-___ activities, reassure the patient that HIV infection is extremely likely/unlikely and suggest retesting in __ months. If this assessment reveals that the individual does have a history of risky behaviors, consider tests that detect HIV ____.

Back 41

If the results of the various HIV tests are indeterminate, the following steps are taken: If in-depth risk assessment reveals that the individual done not have a history of HIGH-RISK activities, reassure the patient that HIV infection is extremely UNLIKELY and suggest retesting in 3 months. If this assessment reveals that the individual does have a history of risky behaviors, consider tests that detect HIV ANTIGEN.

Front 42

Rapid testing is strongly recommended by the CDC. Results are highly accurate, can be done in a variety of settings, and can be reported within what length of time? A major advantage is that patients can ....
Rapid tests are ____ing tests; they test for _____ and not for _____. Positive/negative rapid tests should be followed by a risk assessment to determine need for repeat tests. Can positive results be disclosed to the patient? Rapid testes are more/less expensive than older test methods. Rapid test kits have a relatively short/long shelf life. In addition, test sites must qualify for Clinical Laboratory Improvement Amendments (CLIA) waiver and ensure training for site staff. These conditions may prevent rapid test implementation in some test sites.

Back 42

Rapid testing is strongly recommended by the CDC. Results are highly accurate, can be done in a variety of settings, and can be reported within 20 MINUTES. A major advantage is that patients can get their results before leaving the test site.
Rapid tests are screening tests; they test for antibodies and not for antigen. NEGATIVE rapid tests should be followed by a risk assessment to determine need for repeat tests. Positive results can be disclosed to the patient, but need to be confirmed with more specific WB or IFA testing. This require a blood draw and a return appointment to get results. Rapid testes are MORE expensive than older test methods. Rapid test kits have a relatively SHORT shelf life. In addition, test sites must qualify for Clinical Laboratory Improvement Amendments (CLIA) waiver and ensure training for site staff. These conditions may prevent rapid test implementation in some test sites.

Front 43

What is the window period of HIV? Can an infected person transmit the virus during this time? What test allows diagnosis at this time?

Back 43

The window period is the time period between infection and development of antibodies. A person CAN still transmit HIV during the window period. The combined antibody/antigen test allows for diagnosis of HIV infection, especially during the window period.

Front 44

The progression of HIV infection is monitored by what two important lab tests?

Back 44

Viral Load
CD4 + T Cell counts

Front 45

CD4 + T Cell counts in monitoring HIV provide a marker for ___ ____. What is a normal CD4+ count?

Back 45

CD4 + T Cell counts in monitoring HIV provide a marker for IMMUNE FUNCTION. Normal is 800-1200

Front 46

True or False, the lower the viral load, the more active the HIV disease

Back 46

False, the lower the viral load, the less active

Front 47

What does an "undetectable" viral load mean?

Back 47

Undetectable indicated that the viral load is lower than the test is able to report, but DOES NOT mean that the virus has been eliminated from the body and the infection can still be transmitted to others.

Front 48

The combination of the CD4 + T Cell counts and viral load monitoring help determine....

Back 48

The combination of the CD4 + T Cell counts and viral load monitoring help determine when to initiate therapy, the effectiveness of therapy, and whether clinical goals are being met.

Front 49

What are some common complications caused by HIV, opportunistic diseases, or complications of therapy? (5)

Back 49

↓ WBC count
Neutropenia
Thrombocytopenia
Anemia of chronic disease (especially with ART)
Altered liver function

Front 50

Early identification of co-infection with ____ __ or ____ __ is extremely important because these infections have more serious course in patients with HIV, and may ultimately limit options for ART, and can cause liver-related morbidity and mortality.

Back 50

Early identification of co-infection with Hepatitis B or Hepatitis C is extremely important because these infections have more serious course in patients with HIV, and may ultimately limit options for ART, and can cause liver-related morbidity and mortality.

Front 51

Two types of tests can determine if a patient's HIV is _____ to drugs used in ART. They include the genotype and phenotype assays. These are especially useful in deciding on new drug combinations for people who don't respond to therapy.

Back 51

Two types of tests can determine if a patient's HIV is RESISTANT to drugs used in ART. They include the genotype and phenotype assays. These are especially useful in deciding on new drug combinations for people who don't respond to therapy.

Front 52

The goals of drug therapy in treating HIV infection are to decrease the ___ ____, maintain or raise the _____ and delay onset of HIV-related ____ and _____ diseases.

Back 52

The goals of drug therapy in treating HIV infection are to decrease the VIRAL LOAD, maintain or raise the CD4+ T Cell count and delay onset of HIV-related symptoms and opportunistic diseases.

Front 53

True or False: Treatment decisions should be individualized by risk for disease progression (higher viral loads and lower CD4+ T Cell Counts) and by a patient's desire for therapy.

Back 53

true

Front 54

Combination ART suppresses HIV _______ and limits the potential for ______, which is the major factor limiting treatment effectiveness. The most effective means to achieve this is using at least ____ effective antiretroviral drugs from at least ___ different drug classes in optimum schedules and at full dosages.

Back 54

Combination ART suppresses HIV REPLICATION and limits the potential for RESISTANCE, which is the major factor limiting treatment effectiveness. The most effective means to achieve this is using at least THREE effective antiretroviral drugs from at least TWO different drug classes in optimum schedules and at full dosages.

Front 55

Women should receive optimal ART regardless of ____ status.

Back 55

Women should receive optimal ART regardless of PREGNANCY status.

Front 56

ART can cause potentially lethal interactions with other prescription drugs, OTCs, or herbal supplements. For example, ___ ___ ____ is commonly used to relieve depression, but can interfere with ART. All herbal products should be used with caution in HIV infection.

Back 56

St. John's Wart

Front 57

Efavirenz (Sustiva) is an ART that is contraindicated for who? It should be taken when? Why?

Back 57

Efavirenz (Sustiva)
Contraindicated in pregnancy as large doses could cause fetal abnormalities

Once a day doses should be taken before bed to help patient cope with side effects of dizziness and confusion.

Front 58

Blood transfusions before the year ____ may carry some risk of HIV contamination.

Back 58

1985

Front 59

The current guidelines for starting ART are based on the degree of ....

What is the most important consideration for initiating therapy?

Back 59

The current guidelines for starting ART are based on the degree of immunosupression as measured by the CD4+ T Cell Count.

The most important consideration for initiating therapy is patient readiness.

Front 60

Most HCP's do routine labwork on patients with HIV infection to monitor the disease progression how often?

Back 60

every 3 to 6 months

Front 61

How many weeks after starting drug therapy or changing therapies is blood work usually done to check the viral load? This is done to test the effectiveness of the medication.

Back 61

2-4 weeks

Front 62

The goal of therapy for CD4 T Cell count is ___ to ___ . If reported in a percentage, the goal is above ___ %.

Back 62

The goal of therapy for CD4 T Cell count is 500-600. If reported in a percentage, the goal is above 14 %.

Front 63

True Or False: Missing even a few doses of ART can lead to viral mutations that increase drug resistance.

Back 63

true