Unit 2 - HIV/AIDs

HIV

a virus that damages the cells in your immune system & weakens the ability to fight everyday infections & disease

HIV transmission

-blood

-semen

-vaginal secretions

-breast milk

sexual transmission

-unprotected is most common

-person who receives semen is at higher risk

-women at higher risk

-trauma increases likelihood of transmission (genital lesions of other STIs)

blood transmission

-sharing drug paraphernalia

-blood donations (all blood is tested)

-puncture wounds are most common in the work place

perinatal transmission

-occurs during pregnancy, delivery or breastfeeding

HIV patho

-replicates from RNA to DNA

-CD4 T cell is target (lymphocyte)

-all daughter cells infected

-destruction of T cells

-CD4 count is strong predictor of survival

-<500 cells/mcL immune problems start

-<200 cells/mcL AIDS state

Normal CD4 count

800-1200

*helps immune system to fight

CD4 >500

HIV asymptomatic, possible lymphadenopathy

CD4 > 200

HIV symptomatic

CD4 < 200

AIDS

integrase consequences

-newly formed double strand DNA is infected w. HIV because all genetic material is replicated during cell division

-viral DNA in gnome directs cell to make new HIV

*HIV destroys 1 billion CD4 cells/ day

viral load

the amount of HIV present in an infected person's blood

*how active the disease is in the body

acute infection

mono s/s (fever, swollen lymph nodes, sore throat, HA, malaise, nausea, muscle & joint pain, diarrhea, and/or a diffuse rash)

-occurs 2-4 wks after infection

-highly infectious

asymptomatic infection

•Left untreated, a diagnosis of AIDS is made about 10 years after initial HIV infection

•Symptoms are generally absent or vague

•High risk behaviors may continue

symptomatic infection

CD4 cells decline closer to 200

-HIV advances to more active stage

-symptoms become worse (persistent fever, frequent night sweats, chronic diarrhea, recurrent HA, severe fatigue)

*oral thrush

complications

-oral thrush

-shingles

-persistent vaginal candida infections

-oral or genital herpes

-bacterial infections

-oral hairy leukoplakia

-Kaposi's sarcoma

-AIDs dementia complex

-wasting syndrome

-skin changes

oral thrush

fungal infection

-most common in symptomatic phase

-dry mouth, decreased appetite, difficulty swallowing, dehydration, weight loss

oral hairy leukoplakia

White raised lesions of the lateral tongue

Kaposi's sarcoma

-most common AIDS related malignancy

-risk r/t co-infection with herpes virus

-small purplish brown, raised lesions-non painful

-lesions can occur anywhere in the body

*diagnoses by BIPOSY

wasting syndrome

targets GI tract to cause loss over 10% of body weight

-20 to 30 diarrheas/ day

AIDs diagnosis

-CD4 < 200

-presence of opportunistic infection

diagnostics

-antibody/antigen from blood or saliva

-CD4 count

-viral load (lower=less active)

-resistance tests (determine if pt is resistant to ART)

-assay (genotype & phenotype)

abnormal labs

-decreased WBC (lymphopenia & neutropenia)

-low platelet counts

-anemia

-altered liver function

interprofessional care

-Monitor disease progression, immune function, and manage symptoms

-Initiate and monitor ART

-Prevent, detect and/or treat opportunistic infections

-Prevent or decrease complications of therapies

-Prevent further transmission of HIV

drug therapy goals

-Decrease viral load

-Maintain/increase CD4+T counts

-Prevent HIV-related symptoms & opportunistic diseases

-Delay disease progression

-Prevent HIV transmission

antiretroviral therapy

Only inhibits viral replication and does not kill the virus

-cocktails uses (more than one)

ART evaluation

good results measured by reduced viral loas & improved CD4 lymphocytes counts

-viral load checked immediately prior to & again at 2-8 wks after initiation of ART

-viral load should drop to below detectable levels in 16-20 weeks

attachment/entry inhibitors

prevents attachment/entry of CD4 T cell

-delays progression

-decreases viral loas by 90-99%

integrase inhibitors

bind to the integrase to prevent HIV from incorporating genetic material to host CD4 cell

protease inhibitors

prevents protease from cutting HUV strands into dispensable strands

NNRTIs

non-nucleoside reverse transcriptase inhibitors

-prevents reverse transcriptase from changing HUV RNA to HIV DNA

NRTIs

nucleoside reverse transcriptase inhibitors

-insert a new piece of DNA into HIV DNA making the HIV DNA incomplete

NtRTIs

NucleoTide reverse transcriptase inhibitors

-combines with reverse transcriptase to block HIV RNA to DNA

drug interactions

-herbal therapies- St. Johns wort

-commonly used drugs

-OTC - antacids, proton pump inhibitors, supplements

preexposure prophylaxis

-reduces risk of acquiring HIV infection in person at risk

-taking an HIV ART daily

-used in conjunction with other prevention interventions (condoms, HIV testing)

*Truvada & Descovy

at risk questions

-received blood transfusion or clotting factors before 1985?

-shared drug using equipment?

-had sexual experience with your penis, vagina, rectum or mouth in contact with these areas of another person?

-had a STI?

Goals for care are aimed at

Compliance with drug regimens

Adopting a healthy lifestyle

Protecting others from HIV

Beneficial relationships

Spiritual well-being in regard to life and death

Coping with the disease and its treatment

nursing management

preventions is key, along with health promotion

when prevention fails

-disease results

-early intervention is facilitated by health promotion practices

prevention

-avoiding risky behaviors

-teaching appropriate for patient at risk

-become comfortable with talking about sensitive topics

-increase safer sexual practices

-decrease risks r/t drug use

-decrease risks r/t perinatal transmission

-decrease risk r/t work environment

PEP

post exposure prophylaxis

-start ASAP, not more than 72 hrs after exposure

-28 day cycle

ART disadvantages

-complexity

-has side effects

-does not work for everyone

-EXPENSIVE

adherence to drug therapy

is critical to prevent:

-disease progression

-opportunistic disease

-viral drug resistance

*individualized plan is best

promoting a healthy immune system

-Nutritional support

-Moderating or eliminating alcohol, tobacco, and drug use

-Keeping up to date with vaccinations

-Getting adequate rest and exercise

-avoiding exposure to infectious agents

-counseling and support groups

HIV infection

-Has no cure

-Continues for life

-Causes physical disability

-Impairs social, emotional, economic, and spiritual wellbeing

-Ultimately leads to death

*as immunity decreases, more problems will erupt

side effects

-anxiety, fear, depression

-diarrhea

-peripheral neuropathy

-pain

-nausea, vomiting

-fatigue

long term ART

can develop:

-renal disease

-CVD

-hyperlipidemia

-insulin resistance

-hyperglycemia

-bone disease

-lactic acidosis

-lipodystrophy

Lipodystrophy

atrophy of subcutaneous fat

end of life care

-patient comfort

-facilitating emotional & spiritual acceptance of finite nature of life

-helping significant others deal with loss

-maintaining safe environment