Med Surg Chapter 52 Aids/hiv

Front 1

What test is used for HIV?

Back 1

EIA-enzyme linked immunosorbent assay, identifies antibodies directly against HIV
Western Blot Assay-used to confirm seropositivity when EIA is positive
Viral Load- used to tract response to treatment
CD4/CD8 ratio- immune impairment

Front 2

How is HIV transmitted?

Back 2

body fluids containing HIV or infected CD4+ T lymphocytes
blood, seminal fluid, vaginal secretions, amniotic fluid, breast milk
Most prenatal happens durning delivery

Front 3

What increases risk?

Back 3

breaks in skin and mucosa increase risk

Front 4

What are high risk behaviors for HIV?

Back 4

sharing infected needles, sexual relations with infected individuals

Front 5

What precautions should be followed?

Back 5

standard precautions, safer sex, latex condems, blood screening, avoid anal intercourse, do not ingest urine or semine, cross infection by HIV patients may increase severity of infections

Front 6

What are considerations for women and HIV?

Back 6

do not breast feed, estrogen contraceptives may increase risk of infection, and increase shedding of secretions, IUD may increase transmission

Front 7

What is transferred more often then HIV?

Back 7

Hepititis

Front 8

When was blood screeing instituted?

Back 8

1985

Front 9

If exposed what happens?

Back 9

prophylaxis starts immediately (after 72hrs thought to not help), for 4 weeks, may lead to drug resistance, expensive, side effects, follow up testing

Front 10

What are viruses?

Back 10

intracellular parasites

Front 11

What group does HIV belong to?

Back 11

retroviruses

Front 12

How do these viruses differ?

Back 12

They carry their genetic material in the form of RNA, and are surrounded by gylcoprotein envelope
for virus to enter viral envelope must be fused with plasma membrane of cell

Front 13

Describe the 8 steps of the HIV life cycle:

Back 13

1. GP120 & GP41 attach to CD4 cell surface and fuse with the cell membrane
2. viral contents are emptied into the host cell, "uncoating"
3. HIV reverse transcriptase copies RNA into DNA
4. double stranded DNA is spliced into cellular DNA
5. with use of provirus as blueprint cell makes new viral proteins and viral RNA
6. HIV protease cleaves new proteins
7. new proteins join viral RNA
8. New viral particles bud and start over

Front 14

Describe how the virus lays latent:

Back 14

lays dormant until infected cell is activated (antigen, cytomegalovirus, herpes, etc.), and cell is destroyed and HIV is released into the blood plasma and infects ther CD4+ cells

Front 15

What binding sites must HIV attach to?

Back 15

CD4 and CCR5 binding sites in order to infect CD+4 cells

Front 16

What are the stages of HIV disease and what are they based on?

Back 16

based on clinical conditions and CD4+ T-cell count
1. Primary infections
2. HIV asymptomatic
3. HIV symptomatic
4. AIDS

Front 17

Describe the primary infection stage

Back 17

period from infection with HIV to development of antibodies, intense viral replication and destruction of CD4+, no symptoms to flu-like, then CD4+ start to response and start to remove HIV = viral set point, steady state of infection

Front 18

Describe HIV asymptomatic stage

Back 18

Category A
viral set point has been reached, could last for up to 10 years, immune system will not fully eliminate virus but few if any symptoms, CD4+ (>500)remains high enough to preserve defense response to other pathogens

Front 19

Describe HIV Symptomatic stage

Back 19

Categorty B
CD4+ 200-499, condition results from HIV infection or defect in cellular immunity (shingles) or is complicated by HIV infection (peripheral neuropathy)
Once Category B always

Front 20

Describe AIDS stage

Back 20

Category C
<200 CD4+ T lymphocytes
anemia, opportunistic infections, multisystem involvement, etc.
once in category C always in cat. C

Front 21

How is HIV treated

Back 21

Management focuses on specific manifestations, CD4+ count, usually combo of antiretrovial meds are required
Four category of drugs:
1. NRTI-nucleoside reverse transcriptase inhib
2. NNRTI-non-nucleoside reverse transcriptase inhibitors
3. protease inhibitors
4. fusion inhibitors

Front 22

How often should T-cells and viral load be measured?

Back 22

T Cells- every 3-6 months
viral load- 3-4 months

Front 23

What are some of the side effects of HIV meds?

Back 23

HYN, DM, asthmas, lipodystrophy syndrome, CHO, gynocomastia

Front 24

What can cause drug resistance in HIV

Back 24

monotherapy, suboptimal treatment, poor adherence, late initiatio of therapy, HIV refuge in organ

Front 25

When can treatment be interrupted and when should it be reinstated?

Back 25

CD4+ at 500-800 treatment may be discontinuted
CD4+ 350-400 treatment should be reinstated

Front 26

What is the most bothersome symptom of AIDS reported?

Back 26

Fatigue

Front 27

What is the most common infection in people with AIDS?
What are the s/s of this?

Back 27

PCP, Pneumocystis pneumonia
s/s- nonproductive cough, fever, chills, shortness of breath, dyspnea, chest pain
Eventual resp failure

Front 28

What is the treatment of choice for PCP?

Back 28

TMP-SMZ (bactrum)- antibacterial
If CD4+ is <200 prophylatic TMP-SMZ should be used
Pentamidine- antiprotozoal is an alterative agent used but not as effective

Front 29

What is immune reconstitution syndrome?
How is this usually treated?

Back 29

worsening clinical manifestations (fever, etc.) of opportunistic infection or new infections after initiation of antiretroviral therapy
more common in patients with TB
Treated with NSAIDS, corticosteroids

Front 30

Describe MAC?

Back 30

Mycobacterium avium complex, opportunistic infection common with AIDs
Effects- resp, GI, lymph nodes, bone marrow

Front 31

What meds are used for MAC?

Back 31

clarithromycin or azithormycin
used prophylactically with CD4+<50

Front 32

What GI manifestations occur in AIDS patients?

Back 32

loss of appetite, anorexia, N/V/D, wasting syndrome, oral candidiasis (fungal infection)

Front 33

What is wasting syndrome?

Back 33

-weight loss > 10%, chronic diarrhea (30 days) or chronic weakness and fever without a cause
-protein-energy malnutrition (protein breakdown)
-cytokine inducted hypermetabolic state (unable to use lipids for energy so muscle protein is used instead)

Front 34

What is the treatment for chronic diarrhea?

Back 34

octreotide acetate- somatostatin inhibits gastrointestinal motility and secretions of water and electrolytes

Front 35

What is the treatment for oral candidiasis?

Back 35

mycelex troches or nystatin and ketoconazole

Front 36

What types of cancer are more frequent in AIDS patients?

Back 36

Kaposi sarcoma (most common)- skin, stomach, pancreas, rectum, bladder

Front 37

Explain Kaposi's sarcoma

Back 37

assoc with herpes virus 8
more aggresive in AIDs, ranging from localized cutaneous lesions and ulceration to multiple organ systems
ranges from pain and discomfort to organ failure, hemorrhage, infection and death (deadly if GI or pulmonary involvement)

Front 38

What category is Kaposi's sarcoma?
What is the treatment for Kaposi's sarcoma?

Back 38

Category C
localized surgical excision, radiation for pallative care, interferon to cease tumor progression

Front 39

What is the second most common malignancy occuring in AIDS patients?

Back 39

B-cell lymphomas
found commonly outside the lymph nodes (brain, bone marrow, GI)
multiple site organ involvment and related to opportunistic infections

Front 40

What is the treatment for B-Cell lymphomas?

Back 40

chemotherapy and radiation are short lived

Front 41

What nutritional therapy is suggested for AIDS patients?

Back 41

appetite stimulants- Megestrol acetate
antiemetic- Dronabinol
oral supplements- Advera

Front 42

What other skin infections are common in AIDs patients?

Back 42

herpes zoster, herpes simplex, molluscum contagiosum (viral infect/deformed plaque), seborrheic dermatitis (scaly rash), folliculitis (dry, flaky skin), drug rash from TMP-SMZ (red itchy macules and papules)

Front 43

What neurological manifestations might AIDs patients get?

Back 43

HIV encephalopathy- fatigue, depression, memory deficit, headache, psychosis, sz, etc
Cryptococcal Neoformans meningitis- fever, headache, malaise, etc
Progressive multifocial leukoencephalopathy
Peripheral Neutrophathy
Depression

Front 44

What is the treatment for the Neuro manifestations?

Back 44

meningitis- amphotericin B, fluconazole
CMV- ganciclovir, foscarnet, zidovudine
Dep- prozac, desipramine

Front 45

Assessment for Patient with AIDS

Back 45

physical, psychosocial, risk factors, immune fx, nutrition, kind, resp, neuro, F/E, knowledge

Front 46

To promote skin integrity

Back 46

frequent assessment, reposition, encourage rest/activity balance, use pressure reduction devices, use nondrying soaps, avoid adhesive tape, provide perianal skin care