Viral Infections + HIV

What is a virus?

very small microorganism, usually many times smaller than bacteria, unlike bacteria viruses can only replicate only inside cell of host

cannot replicate independently = are obligate intracellular parasite

How does a virus get into the body?

1. inhalation through respiratory tract

2. ingestion via GI tract

3. Transplacental via mother to infant

4. Inculation via skin or mucus membrane

What are some examples of viral illness?

Smallpox

COVID

Warts

Common cold (rhinovirus)

Influenza, RSV

Norovirus

Gastroenteritis

HIV/AIDS

Herpes

Hepatitis

What is HSV-1?

Herpes

Most common associated with perioral blisters

called oral herpes

What is HSV-2?

Herpes infection

associated with blisters on genitalia

Called genital herpes

What is Varicella-zoster virus (VZV)?

herpes virus

causes chicken pox in childhood

can remain dormant for many years

can reemerge later in adulthood as painful herpes zoster lesions

Shingles

What is the medication for Herpes?

Acyclovir (Zovirax)

orally, topical, injectable

drug of choice for herpes & shingles

What is influenza?

illness caused by influenza virus (flu) but many illness can caused flu like symptoms

What are flu symptoms?

fever

chills

aches and pain

cough

sore throat

(confirmed through a test)

Different illness pattern: mild common cold symptoms, typical flu, life threatening pneumonia, bacterial infection, other complications

What are ways to prevent flu?

Vaccination is primary way of preventing and controlling flu

handwashing

What is the treatment for flu?

uncomplicated flu: OTC medication, rest, plenty of fluids to lessen symptoms

Antiviral drugs: reduce time it takes for symptoms to improve

What are the antiviral medications for flu?

approved for treatment of acute uncomplicated flu and for preventive uses

Tamiflu (oseltamivir phosphate) + Relenza (zanamivir): FDA approved for use against recently circulating flue virus

Relenza (zanamivir): approved for patients 5 + years old

Tamiflu (oseltamivir phosphate): approved for use in patient 2 weeks of age and older

How does treatment differ for patient with the flu?

based on patient's disease severity/progression, age, underlying medical conditions, likelihood of flu, time since onset of symptoms: important for making antiviral treatment decision for high risk

Anti viral treatment should be ideally started within 48 hrs.

Antiviral treatment has benefit to patient with severe, complicated, progressive illness, hospitalized pt when started 48 hrs after illness onset

What are the types of HIV?

Human immunodeficiency virus type 1 (HIV-1)

Human immunodeficiency Virus type 2 (HIV-2)

both spread through bodily fluids and attacks body's immune system

both can turn to AID in 8-10 years (untreated)

What should be assessed for with HIV?

Risky Behavior

shared drug using equipment

unprotected sexual contact

sexually transmitted infection

had sexual contact with someone known to have HIV

What are the diagnostic test for HIV?

Viral Load: determines effectiveness of the medication regimen and progression of disease

ELISA + Western Blot: used lab test to confirm a positive HIV diagnosis: both detect antibodies to HIV

CD4 Count: indicator of immune function in patient living with HIV

What are the clinical manifestations of HIV?

Asymptomatic during first stage or may exhibit fatigue or skin rash

Later stages have variety of symptoms related to immunosuppressed state

What are the respiratory manifestation of HIV?

Shortness of breath

dyspnea

cough

chest pain

Pneumocystis pneumonia

Mycobacterium avium complex

TB

What are the GI Manifestations of HIV?

Loss of appetite

N/V

Oral candidiasis

Diarrhea

Wasting syndrome

What are the oncologic manifestation of HIV?

Kaposi Sarcoma

AIDS- related lymphomas

What are the Neurologic Manifestations of HIV?

Effect on cognition, motor function attention, visual memory, visusospatical function

Peripheral Neuropathy (numbness in finger + toes)

HIV encephalopathy

Fungal infection, Cryptococcus neoformans

Progressive multifocal leukoencephalopathy

Depression and apathy

What are the Integumentary manifestation of HIV?

Herpes zoster

Seborrheic dermaitits

What are the gynecologic manifestation of HIV?

Genital ulcers

Persistent, recurrent vaginal candidiasis

Pelvic inflammatory disease

Menstrual abnormalities

What is the treatment for HIV?

Early detection and intervention can promote health and limit disability

With arrival of HAART or ART, HIV-1 infection is now manageable as a chronic disease in patients who have access to medication and who achieve durable virologic suppression (when HAART therapy reduces viral load to an undetectable level)

HAART: Highly active antiretroviral therapy= treatment regimen typically

Customized combination of different classes of medications based on viral load and strain of virus

Goal is to maintain suppression of viral load and restore or preserve immunologic function

What should the patient be educated about for HIV?

Sexual Abstinence

Reduce risk: use of barriers during sexual contact

Abstain from drug use

Do not share or reuse injecting equipment

Teaching about advantages and disadvantages of new treatments

How and when to take prescribed medication

Danger of non- compliance with treatment plan

How to protect yourself at work?

Blood and body fluid precautions

Safety devices: safety devices on syringes

Postexposure prophylaxis (PEP) if an exposure occurs following institutional protocol