Management of patients with immune deficiency disorders

how is HIV-1 transmitted

body fluids that contain infected cells

• blood

• seminal fluid

• vaginal secretions

• mother to child: amniotic fluid, breast milk

antiretroviral medications must be administered within how long of exposure

72 hours

how is postexposure prophylaxis treated

start within 72 hrs

2-3 drugs prescribed for 28 days

Antiretroviral medications  as postexposure prophylaxis for health care workers are started within  how many hours of exposure?

72 hours

HIV is a

retrovirus

what are the two markers used to determine staging of HIV progression

CD4+ T-cell count

Plasma HIV RNA (viral load)

CD4+ count should be measured

in all patients at entry into care

use target amplification methods to quantify HIV RNA or DNA levels in the plasma

viral load tests

what is a better predictor of the risk of HIV disease progression

viral load

the lower the viral load =

longer time for AIDS diagnosis and longer survival time

what are the 5 stages of HIV

0

1

2

3

unknown

Early HIV infection; inferred from laboratory testing

stage 0

Period from infection with HIV to the development of HIV-specific antibodies

Dramatic drops in CD4⁺ T-cell counts normally 500 to 1500 cells/mm³ of blood

stage 1: primary/acute

during what stage is the amount of virus in the body after the initial immune response subsides results in a viral set point which reflects an equilibrium between HIV levels and the immune response

stage 1

untreated, the viral set point can last for

years

the higher the viral set point =

the poorer the prognosis

Stages 1, 2, 3 are based on

CD4+ T lymphocyte count

◦Occurs when T-lymphocyte cells are between 200 and 499 cells/mm³

stage 2

◦CD4⁺count drops below 200 cells/mm³ of blood

◦Considered to have AIDS for surveillance purposes (Opportunistic Illnesses )

stage 3

◦No information on CD4+ T-lymphocyte count or percentage

unknown stage

Later stages have variety of symptoms related to

immunosuppression

asymptomatic or exhibits fatigue or skin rash during what stage

1st stage

what are the respiratory manifestations of HIV

SOB

dyspnea

cough

chest pain

pneumocystis pneumonia

mycobacterium avium comples

TB

what are the GI manifestations of HIV

Loss of appetite

N/V/D

oral thrush

wasting syndrome

what are the oncologic manifestations of HIV

kaposi sarcoma

AIDS related lymphomas

what are the neurologic manifestations of HIV

cognition/ motor function /visual memory/ visuospatial function

peripheral neuropathy

HIV encephalopathy

◦Fungal infection, Cryptococcus neoformans

◦Progressive multifocal leukoencephalopathy

◦Depression and apathy

what are the skin manifestations of HIV

◦Herpes zoster

◦Seborrheic dermatitis

what are the  Gynecologic manifestations of HIV

◦Genital ulcers

◦Persistent, recurrent vaginal candidiasis

◦Pelvic inflammatory disease

◦Menstrual abnormalities

Achieving viral suppression requires the use of

combination antiretroviral therapy (ART) that generally include 3 active drugs from 2 or more drug classes

An adequate CD4+ response is

an increase in CD4+ count in the range of 50 to 150 mm3 per year, generally with an accelerated response in the first 3 months

when should viral load be measured

baseline and regular basis after starting ART

what is the most important indicator of response to ART

viral load

what can cause sub-optimal treatment/ inadequate virus suppression

monotherapy

poor compliance

late treatment initiation

genetic mutation

what is a major side effect of HIV meds

bone marrow depression