HIV/AIDS

dont need to know particular meds, cART need three dif meds from two dif classes and expensive, know PJP

what is HIV?

a retrovirus that causes immunosuppression

how is HIV transmitted?

contact with body fluids (semen, blood, vaginal secretion, breast milk)

how is HIV not transmitted?

• casual contact

• urine

• tears

• saliva

• urine

• emesis

• sputum

• feces

• sweat

• respiratory

what is the most common mode of transmission? and who is at greatest risk?

unprotected sex with an HIV infection person. the person who receives semen is at highest risk

how does blood transmission occur?

• sharing drug paraphernalia (needles, syringes)

• puncture wounds (most common work-related transmission)

• splash of blood on skin

how does perinatal transmission occur?

transmission during pregnancy, delivery, or breastfeeding. routine testing and treatment can reduce rate of transmission to less than 2%

what is the pathophysiology of HIV?

• retroviruses replication from RNA to DNA

• CD4 T cell is the target cell

• HIV binds to the T cell through fusion

• HIV destroys 1 billion CD4 T cells q day

when do immune problems begin to develop?

when CD4 T cell count is 500 or below, allowing for opportunistic disease

what is the normal CD4 T cell range?

800-1200

what is the viral load during the acute infection stage of HIV?

high viral load, CD4 count drops temporarily and returns to baseline. HCP may mistake this as flu

what are the s/s of an acute infection?

• flu like

• fever, swollen lymph nodes, sore throat, HA, malaise, nausea, muscle/join pain, diarrhea, rash

when does the acute phase of HIV occur?

2-4 wks after infection, high infectious stage

what is AIDS?

• severe immunocompromise

• CD4 count 200 or less

what are the complications of AIDS?

infections, malignancies, wasting, and HIV related cognitive changes occur

what is pneumocystis jiroveci pneumonia (PJP?

an opportunistic infection associated with HIV

what do diagnostic tests detect?

HIV specific antibodies/antigens in blood or saliva. may take several weeks for antibodies to be detected

what makes combination antibody and antigen tests useful?

they decrease the window period to within three weeks after infection

what lab studies will be monitored?

• CD4 T cell count

• viral load (lower load = less active disease)

what abnormal blood tests will you see as a result of HIV and its complications?

• dec WBC

• dec PLT

• anemia from ART or chronic disease

• dec liver fxn

why is it important to identification a co-infection of hep B or C early?

hep b/c are more serious in HIV patients, limiting ART options, and causing liver related morbidity/mortality 

what will resistance tests help determine?

it will detect resistance to ART

what are assays used for?

genotype and phenotype assays are used for antibiotic selection

describe the interprofessional care for HIV patients

1. monitor progression and immune fxn

2. initiate and monitor ART

3. prevent opportunities infection

4. manage symptoms

5. prevent transmission

can HIV be cured?

no :(

what are the goals of ART?

delay progression by decreasing viral replication (usually 90-99% with adherence)

what is the advantage of using drugs from different classes?

inhibits viral replication in different ways, making it difficult for the virus to recover and reduces chance of drug resistance

what is a disadvantage of the drugs used in ART?

• resistance can develop quickly

• many have dangerous/lethal interactions (ask about prescribed/OTC drugs)

  • e.g. st john’s wort, antacids, PPIs

as a nurse, what should you assess?

• assess risk, behaviors, knowledge, PMHx, meds, health patterns, s/s

• do not make assumptions about behaviors

• sexual contact with HIV partner?

• blood transfusions/clotting factors before 1985?

• shared needles?

• had an STI?

what health promotion activities will you implement?

• avoid  and modify risky behavior

• abstinence, no contact safe sex, barriers (condoms, dental dams)

• avoid drugs, sharing equipment, or sex under the influence

• family planning, HIV, HIV antibody testing

• prevent HIV in pregnant women

• appropriate therapy for HIV-infection pregnant women

• use PrEP (prophylactic HIV pill that must be taken every day)

• decrease work risk

• post exposure prophylaxis

what is post-exposure prophylaxis?

antiretroviral therapy initiated soon after HIV exposure to prevent HIV infection (not guaranteed). it uses at least three drugs

what are the cons are ART?

• complex

• side effects

• not for everyone

• expensive

adherence problem, then drug resistance

when is ART initiated?

when there is a great degree of immunosuppression, which avoids burnout and nonadherence

what is the importance of supporting a healthy immune system?

delays HIV progression with or without ART

interventions to support a health immune system

adequate nutrition, current vax, avoid risky behaviors, adequate rest/exercise, reduce stress, avoid exposure to new infection, counseling, regular appointments

disease and drug side effects

• anxiety, fear, depression

• N/V/D

• peripheral neuropathy

• pain

• fatigue

what metabolic disorders may develop from long time HIV and ART?

1. lipodystrophy

2. HLD

3. insulin resistance

4. hyperglycemia

5. bone disease

6. lactic acidosis

7. renal disease

8. CVD

what is lipodystrophy?

redistribution of fat in abd, upper back, breasts, and fat loss in arms, legs, and face 

what will you consider for end of life HIV patients?

• treatment may not work

• HIV may be resistant to all available drugs

• patients may forego treatment altogether

what is the focus of end-of-life care in HIV patients?

• comfort

• promote acceptance of finite nature of life

• help s/o deal with loss

• maintain safe environment

gerontologic considerations for HIV patients

• increasing rate in 60+

• may develop comorbidities early or are at a higher risk

• may feel ashamed to recieve care

• polypharmacy may have drug interactions with HIV meds