1.0 HIV and AIDS

Immunodeficiencies

Deficiencies in the proper expression of the immune system response. 

• Primary

• Secondary

Immunodeficiencies: Two Types

Primary

• Deficiencies resulting from the improper development of the immunosuppressive cells and tissues  

• Mainly genetic disorders seen in children

Di-Georges Syndrome (Thymic Hypoplasia)

T-Cell Deficiency:

• Absence of thymus in the neonate

Secondary

• Any condition that can interfere with the normal growth or expression of the immune response system

Human Immunodeficiency Virus

Weakening of the body’s immune system from opportunistic infections due to an infection that attacks the body’s immune system, specifically the CD4 cells.

• Semen

• Vaginal Fluid

• Blood

• Breastmilk

4 Body Fluids that Transmits HIV

• 80% Sex

• 10% Needles

• <10% Breastmilk

Modes of Transmission

• HIV Attaches to the CD4 cell

• HIV proteins and enzymes are released into the cell

• Reverse transcription produces double strand HIV

• Integrase enables HIV to link into the cells DNA

• Protease cuts and reassembles new HIV

• Each cell produces hundreds of new virions

HIV Lifecycle

AUDITT CB

• Attachment

• Uncoating

• DNA Synthesis

• Integration

• Transcription

• Translation

• Cleavage

• Budding

HIV Lifecycle: ——

Attachment

HIV: Lifecycle

• Glycoproteins (GP120 and GP41) of HIV bind with the host’s uninfected CD4+ receptor and chemokine coreceptors (CCR5) resulting in fusion of HIV with CD4+ T Cell membrane

Uncoating

HIV: Lifecycle

• HIV’s viral core = two single strands of viral RNA + three viral enzymes: reverse transcriptase, integrase, and protease are emptied into the CD4+ T Cell membrane

DNA Synthesis

HIV: Lifecycle

• Through reverse transcriptase, HIV changes its genetic material from RNA to DNA resulting in double stranded DNA that carries instruction for viral replication

Integration

HIV: Lifecycle

• Through action of integrase, the new viral DNA enters the nucleus of the CD4+ T cell is blended with the DNA of the CD4+ T cell resulting in permanent, lifelong infection

Transcription

HIV: Lifecycle

• CD4+ T cell is activated and the double-stranded DNA forms single-stranded messenger RNA (mRNA) and builds new viruses

Translation

HIV: Lifecycle

• New chains of new proteins and enzymes (polyproteins) created by mRNA contain the components needed in the construction of new viruses

Cleavage

HIV: Lifecycle

• The polyprotein chain is cut by the HIV enzyme resulting into individual proteins that make up the new virus

Budding

HIV: Lifecycle

• The viral RNA and new proteins migrate to the membrane of the infected CD4+ T cell, exit from the cell and restart the process.

• HIV found in semen, vaginal fluids, breastmilk and blood

• TRANSMISSION unprotected sex, blood transfusion, sharing of blood, maternal-infant

• ENTERS THE BODY enters the bloodstream

• ATTACK CD4+ T CELLS cancer, viruses, parasites

• IMMUNOSUPPRESION

PATHOPHYSIOLOGY

Stage 1

• Asymptomatic

• Persistent generalized signs and symptoms (fever, bulging of lymph notes)

Stage 2

• Mild disease

• Antibodies are detectable in the blood

Stage 3

• Advanced disease

• Opportunistic infection can appear

Acquired Immunodeficiency Syndrome

Severe infections and development of cancer

Symptomatic HIV Infection

>= 200-499/uL

CIP FD

Candidiasis

Idiopathic Thrombocytopenic Purpura

Peripheral Neuropathy

Fever

Diarrhea

_________

• CD4+ T cells = _______

• HIV infection or a defect in cellular immunity

• Symptoms (but not limited to): 

  • ________, _________, ________, _________(38.5°C), or ________exceeding 1 month in duration

AIDS

<200/uL

Wasting syndrome

Kaposi’s Sarcoma

Toxoplasmosis of the Brain

Mycobacterium Tuberculosis

___________

• CD4+ T cells = _______

• Symptoms (but not limited to): 

  • __________, ___________, Pneumocystis jiroveci pneumonia (PCP), __________ , __________

Respiratory System

Pneumocystis Pneumonia

Mycobacterium Tuberculosis

CLINICAL MANIFESTATIONS OF HIV

• Manifestations: Shortness of breath, dyspnea, cough, chest pain, and fever

• Associated Diseases:

  • -

  • -

Gastrointestinal

Wasting Syndrome

Oral Candidiasis

CLINICAL MANIFESTATIONS OF HIV

• Loss of appetite, nausea, vomiting, oral and esophageal candidiasis, and chronic diarrhea causing profound weight loss

• Associated Diseases:

  • -

  • -

Oncologic

Kaposi’s Sarcoma

B-cell Lymphoma

CLINICAL MANIFESTATIONS OF HIV

• Manifestations: Flat or raised, brownish pink to deep purple skin discolorations, lymphedema, pain

• Associated Diseases:

  • -

  • -

Neurologic

Peripheral Neuropathy

HIV Encephalopathy

Cryptococcus neoformans

CLINICAL MANIFESTATIONS OF HIV

• Motor dysfunction and behavioral change

• Associated Diseases:

  • -

  • -

  • -

  • -

Integumentary

Herpes zoster/simplex

Eczema/Psoriasis

CLINICAL MANIFESTATIONS OF HIV

• Rashes, skin discolorations

• Associated Diseases:

  • -

  • -

Gynecologic

Ulcerative Sexually Transmitted Disease

CLINICAL MANIFESTATIONS OF HIV

• Persistent, recurrent vaginal candidiasis

• Associated Diseases:

CIA/ELISA

WESTERN BLOT

VIRAL LOAD

CD4/CD8 TEST

ORA QUICK

Diagnostic Tests:

ELISA

Diagnostic Test:

• Antibodies are detected, resulting in positive results, and marking the end of the window period

Western Blot

Diagnostic Test:

• detects antibodies to HIV; used to confirm EIA

Viral Load

Diagnostic Test:

• Measures HIV RNA in the plasma

CD4/CD8 TEST

Diagnostic Test:

• These are markers found on lymphocytes. HIV kills CD4+cells, which results in  significantly impaired immune system

ORA QUICK

Diagnostic Test:

• In-home HIV Self Test. Works by looking body’ responses (antibodies) to fighting HIV. + result is preliminary and ff

up confirmatory test is needed

PrEP Pre-exposure Prophylaxis 30 tab

HAART Highly Active Antiretroviral Therapy

TREATMENT

HAART Highly Active Antiretroviral Therapy

1. For reduction in replication of HIV and reductions in morbidity and mortality also a rise in CD4+ T Cell count

2. Reduce the viral load

Abstinence

Be Faithful

Consistent and Correct Condom Use

Do not Use Drugs and Alcohol

Education

Pre and Post Exposure Prophylaxis

HIV PREVENTION

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IMPLEMENTATION AMONG HEALTH CAREGIVERS

• Practice strict handwashing

• Wear gloves when coming in contact with body secretions

• Avoid recapping of needles

• Use of 1:10 Bleach/Water Solution

• Laundry (use bleach)

• Do not share razors, toothbrush. These are contaminated with body secretions

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IMPLEMENTATION AMONG CLIENTS

• Client education and counseling.

• Advice client to practice safe sex as follows:

  • Abstinence

  • Mutual, monogamous sexual relationship

  • Avoid multiple partners

  • Use of soluble lubricants and condoms

AZT (Retrovir/Zidovudine)

Malaise, Nausea, Headache, Fever, Insomnia

Bone Marrow Suppression

Avoid Pregnancy, Don’t donate blood, organ, sperm

• Slows progress of opportunistic infections and dementia

• Side effects:

• Toxic Effect:

• Precaution: