HIV

HIV

Retrovirus that causes chronic immunosuppression

• Targets CD4 T cells that enters cell, replicates, releases virons and destroys the cells

• Immune system remains healthy untill there are <500

• Severe problems <200

HIV transmission

Spread through through contact with blood, semen, vaginal secretions, or breast milk

Sexual Transmission

• Contact with a person who has a high viral load

• Activities that cause trauma increase the risk

• General lesions such as herpes or syphilis increase the risk

• Risk is generally greater for a partner who receives due to longer exposure to infected fluids

Contact with blood and blood products

• Exposure from sharing drug paraphernalia such as needles/ syringes

• Blood transfusion transmission

• Puncture wounds as needlestick exposure

• Splash exposures with open lesion, lower risk with needlestick

Perinatal Transmission

• Transmission from mother to child during pregnancy, delivery, or breastfeeding

• 25% if untreated, drop to 1% with detection and treatment

Acute infection

2-4 weeks after exposure

• Flu-like symptoms

• Fever

• Swollen lymph nodes

• Sore throat

• Headache

• Malaise

• Nausea

• Muscle/ joint pain

• Diffuse rash

Most infectious during the time during to high viral load

Chronic Infection

Asymptomatic

• May have no S/S for years

• Time from infection to diagnosis of AIDS without treatment is 10 yers

Symptomatic

• CD4 count declines closer to 200 and viral load increases

• Persistent fever

• Night Sweats

• Diarrhea

• Recurrent HA

• Severe fatigue

Infection

• Oral candidasis( thrush)

• Shingles

• Persistent vaginal candidiasis

• Ora/ geneital herpes

AIDS

• Criteria established by CDC

• CD4 count less than 200

• 1 opportunistic infections

  • TB

  • Myobactericum

  • Candidiasis

  • Toxoplasmosis

• 1 opportunistic cancer

  • KS

  • Invasive cervical cancer

  • Lymphoma

• Wasting syndrome

  • Loss of >10% of ideal body weight

Diagnostic Studies

Screening

• HIV antibody/Antigen Screening

• Blood or saliva

Window period

• Can take 3 weeks- 3 months for test to be positive after exposure

Nucleic Acid Test

• Looks for actual virus in the blood

Genotype/ phenotype

• Can identify which therapy will work best

Monitoring Progression

• Viral Load

• CD4 count

Goals of Treatment

• Monitor HIV disease progression and immune function

• Starting and monitoring ART

• Preventing opportunistic infections

• Detecting and treating opportinistic infections

• Managing symptoms

• Preventing or decreasing treatment complications

• Preventing further HIV transmission

Antiretrovira Therapy Goals

• Decrease viral load

• Maintain or increase CD4 count

• Prevent HIV-related symptoms and opportunistic infections

• Delay disease progression

• Prevent HIV transmission

Antiretroviral Therapy considerations

Protease inhibitors, attachement inhibitors, entry inhibitors, integrase inhibitors, reverse transcriptase

Combination therapy

• Works at different point of HIV replication cycle

• Decreases risk for resistance

Available in combination form (2-3 meds in 1 pill)

Many interactions including herbal therapies, PPIs, antacids

Common SE include

• Heart

• Liver

• Kidney

• Skin reactions/rashes

PREP

Prevention method in which people who do not have HIV take HIV medication to reduce their risk for contracting HIV

• Should be used in combination with other methods such as condom use, risk reduction, and regular testing

• Approved agents ( combination pill taken orally)

  • Emtricitabine/ Tenofovir ( reverse transcriptase inhibitors)

PREP recommended for

• Sexual partner with HIV

• Inconsistent condom use

• Diagnosed with STI in past 6 months

• Have an injection partner with HIV

• Sharing needles, syringes, or other equipment to inject drugs

• Been prescribed Post-exposure prophylaxis and report continued risky behavior

Non-Occupational Post-Exposure Prophylaxis (nPEP)

• Combination ART given within 72 hours of potential exposure to reduce risk of HIV infection

• Can be given with unintentional exposure through sex, needlestick, or other blood borne exposure

• Treatment is given for 28 days after exposure

• Monitored with repeat HIV testing

• Efficacy

  • 99-100% within 24 hours

HIV and Occupational Exposure

• Wash area well with soap and water

• Make sure to get client name/ contact info/ provider

• Report exposure and follow agency policy, including incident report

• Post exposure prophylaxis 3 drug combo should. be given 72 hours of exposure

• Initial screening tests and follow-up post prophylaxis

• Until HIV infection. is ruled out, refrain from blood or organ donation engage in low/ no risk sexual activity, including use of barrier methods, and switch to formula feeds if nursing

Psychosocial Care

• Coping with diagnosis- reactions may include anxiety, panic, fear, depression, denial, hopelessness, anger, and guilt

• Stigma and discrimination associated with disease

• Social support evaluation

• Resolve issues related to life and death

• Advance care planning

No vaccine??

• HIV mutates to escape antibodies

• HIV integrated itself into host DNA, thus limiting the types. ofvaccines can. be used

• There have been over 250 vaccine trials, less than 10 have advanced to looking at efficacy

• Monoclonal antibody trails have shown promise n conferring immunity this requires infusions every 6 months