ch 10 human immunodeficiency virus

HIV

infectious agent responsible for HIV infection and acquired immunodeficiency syndrome AIDS

HIV is characterized by

progressive immune system impairment

destroys t cells aka cd4 cells

attacks macrophages

HIV is an RNA-based retrovirus

that requires a human host to replicate

HIV infection 3 stages

acute HIV infection

latent or chronic HIV infection

AIDS

hiv is transmitted in 3 ways

through contact w infected blood or blood products or sharing needles

through contact with infected body fluids such as semen and vaginal fluids

during unprotected sex- anal intercourse esp dangerous bc it causes mucosal trauma

across placental barrier from an infected pregnant person to a fetus through cervical or blood contact at delivery or breast milk

hiv infection classification two main measures

viral load count

cd4 cell count

viral load

indicates amount of viral replication

cd4 cell count

predicts progress of disease and effectiveness of treatment

when cd4 cell count is less than or equal to 200

individual is susceptible to AIDS

HIV symptoms

no symptoms or flu-like illness then no symptoms initially

may develop an opportunistic infection

repeated infections overwhelm weakened immune defenses, invading every body system

AIDS is diagnosed when CD4+ count is less than or equal to 200 and

there is evidence of an opportunistic infection

opportunistic diseases associated with AIDS

bacterial infections

• tuberculosis

• mycobacterium avium

fungal infections

• coccidioidomycosis

• candidiasis

• cryptococcosis

• histoplasmosis

protozoan infections

• pneumocystis jirovecii pneumonia

• cryptosporidiosis

• toxoplasmosis

viral infections

• herpes simplex virus

• cytomegalovirus CMV

• progressive multifocal leukoencephalopathy

• herpes zoster

neoplasms

• kaposi sarcoma

• malignant lymphomas

• cervical cancer

tuberculosis

a disease caused by Mycobacterium tuberculosis, an aerobic acid-fast bacillus spread through inhalation of droplet nuclei that are aerosolized by coughing, sneezing, or talking

tuberculosis signs and symptoms

fever

weight loss

night sweats

cough

fatigue

followed by

dyspnea

chills

hemoptysis

chest pain

tuberculosis treatment

isoniazid

rifampin

pyrazinamide

ethambutol

followed by

rifampin and isoniazid for 9 months

mycobacterium avium

primary infection acquired by oral ingestion or inhalation

can infect bone marrow, liver, spleen, GI tract, lymph nodes, lungs, skin, brain, adrenal glands, and kidneys

chronic and may be localized and disseminated

mycobacterium avium symptoms

fever

fatigue

weight loss

anorexia

night sweats

abdominal pain

chronic diarrhea

mycobacterium avium physical and lab assessment findings

emaciation

generalized lymphadenopathy

diffuse tenderness

jaundice

hepatosplenomegaly

lab-

anemia

leukopenia

thrombocytopenia

mycobacterium avium treatment

clarithromycin or azithromycin and ethambutol

with

amikacin

ciprofloxacin

rifabutin

rifampin

coccidoidomycosis

caused by fungus coccidioides immitis

grows in arid regions in southwest us mexico central america and south america

coccidoidomycosis symptoms

flu-like illness

• malaise

• fever

• backache

• headache

• cough

• arthralgia

periarticular swelling in knees and ankles

meningitis

bony lesions

pulmonary or genitourinary involvement

coccidioidomycosis treatment

fluconazole

itraconazole or

amphotericin B

candidiasis

by fungus candida albicans on teeth gingivae and skin and in oropharynx vagina and large intestine

majority of infections are endogenous

possible human-human transmission indlucing congenital transmission

candidiasis symptoms

thrush

• creamy curdlike white patches found on any oral mucosal surface

nail infection

vaginitis

candidiasis treatment

nystatin suspension and clotrimazole troches for thrush

nystatin syspension or pastilles, clotrimazole troches, fluconazole, or itraconazole for esophagitis

topical clotrimazole miconazole or ketoconazole for cutaneous candidiasis

topical imidazole or oral fluconazole ketoconazole or both for candidiasis of nails

topical clotrimazole miconazole or oral fluconazole for vaginitis

cryptococcosis

by fungus cryptococcus neoformans

found in nature - bird droppings

can be inhaled

responsible for pulmonary, cns and disseminated infection

cryptococcosis symptoms

pulmonary cryptococcosis

• fever

• cough

• dyspnea

• pleuritic chest pain

CNS cryptococcosis

• fever

• malaise

• headaches

• stiff neck

• nausea

• vomiting

• altered mentation

disseminated cryptocossosis

• lymphadenopathy

  • multifocal cutaneous lesions

other symptoms cryptococcosis

macules

papules

skin lesions

oral lesions

placental infection

myocarditis

prostatic infection

optic neuropathy

rectal abscess

lymph node infection

cryptococcosis treatment

primary therapy for initial infection

• amphotericin B through IV

• amphotericin B and flucytosine together

• fluconazole and itraconazole

after initial treatment

• fuconazole therapy

histoplasmosis

by fungus histoplasma capsulatum

airborne

can reach bronchioles and alveoli

histoplasmosis symptoms

fever

weight loss

hepatomegaly

splenomegaly

pancytopenia

diarrhea

cerebritis

chorioretinitis

meningitis

oral and cutaneous lesions

GI mucosal lesions causing bleeding

histoplasmosis treatment

amphotericin B

itraconazole

pneumocystis jirovecii pneumonia

by P. jirovecii

in human lungs

transmitted airborne

most common life-threatening infection in ppl with AIDS

pneumocystis jirovecii pneumonia symptoms

fever

fatigue

weight loss

dyspnea

cough

pneumocystis jirovecii pneumonia treatment

co-trimoxazole

IV pentamidine isethionate

dapsone with trimethoprim

clindamycin

primaquine

atovaquone

corticosteroids

prophylaxis-

co-trimoxazole

atovaquone

dapsone

cryptosporidiosis

intestinal infection by protozoan cryptosporidium

person-person contact, water, food, airborne

most common site- small intestine

cryptosporidiosis symptoms

abdominal cramping

flatulence

weight loss

anorexia

malaise

fever

nausea

vomiting

myalgia

profuse watery diarrhea

cryptosporidiosis treatment

palliative

fluid replacement

total parenteral nutrition TPN

correction of electrolyte imbalances

analgesic antidiarrheal and antiperistaltic agents

paromomycin

octreotides

toxoplasmosis

by toxoplasma gondii

undercooked meats and vegetables with oocysts

cat feces

causes meningoencephalitis w cell necrosis

progresses to lungs heart and skeletal muscle

toxoplasmosis symptoms

localized neurologic deficits

fever

headache

altered mental status

seizures

toxoplasmosis treatment

sulfadiazine

clindamycin with pyrimethamine

folinic acid

herpes simplex virus

chronic infection by herpes virus

reactivation of an earlier herpes infection

herpes simplex virus symptoms

red blister-like lesions in oral anal and genital areas

also found on esophageal and tracheobronchial mucosa

pain

bleeding

discharge

herpes simplex virus treatment

acyclovir

famciclovir

valacyclovir

cytomegalovirus CMV

viral infection of herpes virus

lungs, adrenal glands, eyes, CNS, GI tract, male GU tract, blood

cytomegalovirus symptoms

unexplained fever

malaise

GI ulcers

diarrhea

weight loss

swollen lymph nodes

hepatomegaly

splenomegaly

blurred vision

floaters

dyspnea

dry nonproductive cough

vision changes to blindness

CMV treatment

ganciclovir

intraocular ganciclovir implants

progressive multifocal leukoencephalopathy PML

progressive demyelinating disorder by hyperactivation of a papovavirus

leads to brain degeneration

PML symptoms

progressive dementia

memory loss

headache

confusion

weakness

seizures

PML treatment

attempted therapies include-

prednisone

acyclovir

herpes zoster

aka acute posterior ganglionitis, shingles, zona, and zoster

acute infection caused by reactivation of chickenpox virus

herpes zoster symptoms

small clusters of painful reddened papules that follow route of inflamed nerves

may be disseminated involving two or more dermatomes

herpes zoster treatment

oral acyclovir capsules

IV acyclovir for disseminated varicella zoster lesions

capsaicin may relieve pain

famciclovir

valacyclovir

kaposi sarcoma

lesions involving all skin surfaces

kaposi sarcoma symptoms

cutaneous and subcutaneous

painless nonpruritic tumor nodules pigmented and violaceous, nonblanching and palpable

patchy lesions

kaposi sarcoma treatment

focused on palliation and prevention of spread

systemic chemotherapy or radiation therapy

intralesional therapy with vinblastine

laser therapy and cryotherapy for small isolated lesions

interferon alfa-2a

malignant lymphomas

immune system cancer

lymph tissue cells grow abnormally and spread to other organs

malignant lymphomas symptoms

fever

night sweats

weight loss

commonly confined to one body system

malignant lymphomas treatment

individualized therapy

methotrexate

bleomycin

doxorubicin

cyclophosphamide

vincristine

dexamethasone

radiation therapy

cervical cancer

females are at increased risk for cervical neoplasm associated with human papillomavirus infections

cervical cancer symptoms of early invasive disease

abnormal vaginal bleeding

persistent vaginal discharge

postcoital pain and bleeding

cervical cancer symptoms of advanced disease

pelvic pain

vaginal leakage of urine and feces from a fistula

anorexia

weight loss

fatigue

cervical cancer treatment

tailored to disease stage

preinvasive lesions

• total excisional biopsy

• cryosurgery

• laser destruction

• conization

• possibly hysterectomy

invasive squamous cell carcinoma

• radical hysterectomy

• radiation therapy

several types of drugs are used to

tread HIV and prolong life

antiretrovirals

drugs used to control reproduction of virus and slow progression of HIV-related disease

ART antiretroviral therapy combines medications from 6 major drug classes

nonnucleoside reverse transcriptase inhibitors NNRTI

nucleoside reverse transcriptase inhibitors NRTI

protease inhibitors PI

fusion inhibitors FI

integrase strand inhibitors

CCR antagonist

preexposure prophylaxis

regimen of antiretroviral agents in one pill or injection

postexposure prophylaxis

regimen of antiretroviral agents in one pill or injection to people who have known exposure to infection

anti-infectives and antineoplastics

treat opportunistic infections