Management of Patients with Immune Deficiency Disorders: HIV/AIDS

5 math questions for test

Incidence 2021

36,136 in the US

Incidence 2023

39,000 in the US

prevalence at the end of HIV in 2023

1.1 million living with HIV in U.S. (only 87% new they had HIV)

mortality of HIV in 2023

4,496

Identify risk factors and modes of transmission

Using dirty needles, unprotected sex, mom to baby, transfusions

Misconceptions with transmission

what does HIV need

a host such as T helper cells, B cells, and macrophages

primary target is T helper cells

what is HIV attracted to on T helper cells and why

CD4 molecule

HIV attaches to protein of CD4 cells process known as fusion

what is HIV

a retrovirus which possesses RNA & DNA

what is the process HIV uses to change a cell

reverse transcription

HIV RNA enters cell and changes DNA

what is integrase

when new DNA enters nucleus of cell & integrates into the cells DNA

what is protease

Long strands of viral RNA copied and cut

how many CD4T cells does HIV destroy in as day

billions

–Body can replace for awhile

–Eventually the body will not be able to replace what is being destroyed

what happens with lowered CD4 count

¥Impaired immune system

¥More susceptible to infections

¥Reactivate old infections (e.g. shingles)

¥Immune problems increase when CD4 below 500

CD4 <200 severe problem

Opportunistic infection, dx of AIDS 

timeline for HIV

acute infection (1-3 weeks)

HIV antibody test becomes positive (3 weeks to 3 months)

then you get symptomatic infection

CD4 less than 200: AIDS

viral load

tests how fast the virus is replicating

want a low count

how long does HIV antibodies take to show up

2-4 weeks after initial infection

called seroconversion

what are HIV symptoms

may mimic flu or Mono and include:

Stage 1 HIV infection

¥CD4 > 500

¥Symptoms vague to asymptomatic

¥low grade temp, night sweats, generalized lymphadenopathy

can transmit HIV with no symptoms/without knowing you have it

Stage 2 HIV infection

CD4 declines closer to 200-499, viral load increases

Early symptoms worsen- persistent fever, drenching night sweats, diarrhea, HA, fatigue, lymphadenopathy

Stage 3 HIV infection

AIDS

CDC criteria for Diagnosis of AIDS

Must meet criteria to be classified as AIDS, client has one of the following:

¥CD4 below 200

¥One of the listed opportunistic infection

¥One of the listed opportunistic cancers

¥Wasting syndrome (losing weight, memory loss)

testing for HIV

¥Serum, saliva and urine tests

¥Rapid tests need to be confirmed with another test

¥Enzyme immunoassay (EIA)- detects HIV antibodies

¥ Antigen/Antibody test- confirm diagnosis,

(Western blot test -Detects HIV viral gene proteins)

¥Nucleic Acid Test (NAT)- detects virus RNA

Normal CD4 count 

800-1200mm/3

CD4 < 200mm/3 increases rate of acquired infection, will also see:

Decreased WBC count esp. lymphocytes

Decreased skin test reactivity

Worse prognosis if:

Lower socioeconomic status

HCP with little experience treating HIV/AIDS

Lacking access to care

Anti-retroviral therapy (ART)

–Antiretrovirals only inhibit replication & does not kill the virus, but makes it dormant

–If taken correctly = viral load ”90-99%

–Adherence is essential

PEP-post exposure prophylaxis

what people exposed w HIV can take to take precaution

¥Within 24 hours is best

¥3 drug combination for 3 days

¥Follow up testing- 6 weeks, 12 weeks, 6 months

Biktarvy

(Bictegravir- integrase inhibitor, Emtricitabine- NRTI, Tenofovir- NtRTI)

Truvada

(Emtricitabine- NRTI, tenofovir disoproxil fumarate- NtRTI)

How effective is PrEP?

Reduces the risk of HIV transmission thru SEX by 99%

Reduces the risk of HIV transmission thru IVDA by 74%

Common Side Effects Of Meds

¥GI-nausea, vomiting, diarrhea

¥Hematology- anemia, neutropenia, thrombocytopenia

¥Liver- hepatitis, elevated liver enzymes

¥Metabolic-hyperglycemia, hyperlipidemia

¥General- fatigue, headache

¥Skin- lipoatrophy

Pneumocystis jiroveci pneumonia (PCP) treatment and symptoms

S/s- fever, cough, SOA, severe hypoxia

Treatment- improve oxygenation and admin abx

what does pt. need to take of CD4 is <200

prophylaxis

¥Trimethoprim+sulfamethoxazole (Bactrim or Septra) sulfa based antibiotic (check for allergies)

¥Pentamadine (IV, po or aersol)- may be used if patient’s have sulfa allergy

what does PPD test

tests exposure for TB, doesn’t mean you have the disease

Quantiferon test for TB

blood more accurate but only for exposure

what is a AFB test for TB

a culture to confirm TB

wasting syndrome

o10% loss of total body mass (unintended weight loss)

oHypermetabolic state - excessive calories are burned (resting energy )

oinadequate dietary intake

oAlternative nutrition- may consider TPN or enteral feedings

difference between oral thrush and oral hairy leukoplakia

oral thrush is painful, leukoplakia is not