Exam II - HIV/AIDS

How is HIV transmitted?

HIV is primarily transmitted through unprotected sexual activity, sharing needles, and from mother to child during pregnancy, childbirth, or breastfeeding. The virus is present in bodily fluids such as blood, semen, vaginal fluids, and breast milk.

How is HIV replicated in the body?

Once HIV enters the body, it targets CD4+ T cells, which are crucial for the immune system. HIV uses its reverse transcriptase enzyme to convert its RNA into DNA, integrating into the host cell's genome. This process allows the virus to replicate and produce new viral particles, which then infect other CD4+ cells.

How does HIV impact infection in the body?

The destruction of CD4+ cells impairs the immune system, making the body vulnerable to opportunistic infections and certain cancers

Initial Acute Phase

is the early stage of HIV infection, characterized by flu-like symptoms. During this phase, the virus rapidly replicates, and the immune system begins to respond, which can result in a high viral load and temporary decrease CD4

Chronic Asymptomatic(clinical latency)

uMay be unaware (no/few Sx)

uCD4 typically > 500

uUntreated - 10 years (though variable)

Chronic Symptomatic

uCD4 count typically b/w 200-500 – more Sx

uAtypical infections à i.e.: candida albicans

AIDS criteria

AIDS is diagnosed when a person with HIV has a CD4 count below 200 cells/mm³ or develops specific opportunistic infections or cancers

What will the nurse teach a patient about HIV Prevention?

—Abstain from sex

—Be faithful to partner if having sex  (monogamous)

—Condoms – use condoms if having sex

—Know the HIV-status of any partner(s)

—Do not inject illicit drugs

—If inject drugs: never share needles or other equipment, use only clean needles and equipment

—Make getting an HIV test part of regular medical checkup

What will the nurse teach a patient about HIV Treatment?

uNo cure!  No vaccine!

uMaintain a healthy immune system

uCompliance with treatment is vital!

uHealthy diet and lifestyle

uHighly Active Antiretroviral Therapy (HAART) (or ART)

uCombination of 3 or more ARDs = recommended

uLots of investigational drugs/clinical trials

uResources available when diagnosed

uGoal = COMPLIANCE

Risks factors for transmission (including pregnancy)?

uSexual Contact:  (Contact with HIV infected lymphocytes)

uMale-to-male: anal intercourse

uMale-to-female (or vice versa)

uFemale-to-female

u  Blood Exposure

uAny break in skin

uDirect Injection with contaminated needle:

uInjecting drugs / needle sharing / tattoos

uOccupational exposure

uMucous membranes

uTransfusion of blood products (rare)

uPerinatal:              

uIn utero, during childbirth, and/or breastfeeding

How is HIV diagnosed? What tests are done?

uTypes of tests; require blood or saliva sample

uAntibody tests – 3^rd generation

uAntigen/antibody tests – 4^th generation

uNEW:  antigen/antibody tests – 5^th generation (2015)

uNucleic acid amplification test (NAT) – uncommon, expensive

uRapid vs conventional testing

uRapid:  results available in 20-30 minutes (oral or blood).

uMany only check for antibodies (3^rd gen.)

u4^th gen. preferred if available – test for antibodies and antigens

uBoth very reliable.  Positive results require follow up test.  Negative results, but high risk, should be retested w/in 4 weeks.

uNAT – nucleic acid amplification test – looks for viral RNA in blood

How long before HIV antibodies and viral antigens

are detectable by lab?

2-4 weeks

How is HIV progression monitored? Think about S/Sx, labs to evaluate, etc.

uViral Load:  measures amount of HIV in a person's blood

uAfter diagnosis, then every 3-6 months

uBefore starting a new medication

u2-8 weeks after starting or changing medications

uIdeal result is <50, “undetectable”

uDoes not mean patient is cured or noninfectious

uCD4 – want high levels

uAssess the patient’s clinical manifestations

uOther:  HIV, opportunistic disease, and/or Tx may affect other labs:

uLeukocytosis à

uAnemia, thrombocytopenia, altered LFTs

CD4 levels and viral load. If worsening, viral load will increase and CH4 level will decrease. CBC (WBC)

Differentiate HIV from AIDs

HIV is a virus that attacks the immune system, while AIDS is a condition characterized by a severely weakened immune system due to HIV infection, leading to opportunistic infections and other health complications. (AIDS=CD4 level < or = 200)

What is pre- and post-exposure prophylaxis (PEP)?

What is pre- and post-exposure prophylaxis (PEP)?

PrEP: Pre-Exposure prophylaxis (Truvada-tenofovir/emtricitabine)

PEP: Post Exposure Prophylaxis - emergent for 28 days

How do HIV antiretroviral medications work (understand basic mechanisms of action)?

uReverse Transcriptase Inhibitors

uNucleoside Reverse Transcriptase Inhibitors (NRTI) – 1^st drug class to treat HIV :
zidovudine (AZT, ZDV, Retrovir)

uNucleotide Reverse Transcriptase Inhibitor (NtRTI): tenofovir (Viread)

uNon-nucleoside Reverse Transcriptase Inhibitors (NNRTI): efavirenz (Sustiva)

uEntry (fusion)Inhibitors: enfuvirtide (Fuzeon)

uCCR5 Antagonist: maraviroc (Selzentry)

uIntegrase Inhibitors (INSTI) raltegravir (Isentress)

Protease Inhibitors (PI): nelfinavir (Viracept

What would be priority teaching for the patient starting ART?

Patients should be educated about adherence to the medication regimen, potential side effects, and the importance of regular follow-ups and viral load monitoring.