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Summary RNSG 1341 - Exam 1 Review.
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RNSG 1341 - Exam 1 Review.
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Exam 1 Human Immunodeficiency Virus (HIV) (Pg 218, CH 14)
Causes immunosuppression Opportunistic diseases (main cause of disease, disability,
and death in HIV)
RNA virus (retrovirus): replicate in backward manner (RNADNA)
Initial infection: Viremia (large amount in blood) follow by low levels in blood can last
>10 years
Attacks CD4-T cells
Life span: 120 days if normal
Life span: 2 days if effected with HIV
800-1,200 normal, if < than 200 HIV, risk for opportunistic disease
Transmission
Contact with infected blood, semen, vaginal secretions, breast milk
Sexual intercourse (MOST common), perinatal transmission at delivery (ART
therapy)/breast feeding, sharing needles (puncture wound)
Can transmit to others within a few days of becoming infected
Influence exposure: duration/ frequency of contact; volume, virulence,
concentration of organism; host immune status
Large amounts are in blood, higher risk with lesions at site
Transmitted through all phases
Can’t: hugging, dry kiss, shaking hands, sharing eating utensil, tears, saliva,
urine, emesis, sputum, feces, sweat, resp. droplets, enteric routes
Diagnostics
HIV- testing antibodies and antigen in the blood
Takes several weeks of the infection before antibodies can be detected
(Window Period)
Standard: blood or oral specimen- day to a week for report
Rapid: before they leave office
At-Home: test kit
CD4+T cell count: decrease (norm 800-1200) and Viral load: increased
Decrease WBC, Plt, Altered LFT
Resistance test to ART: Genotype assay- detects drug-resistant viral mutations;
Phenotype assay- measures growth of HIV in various concentrations of AVT
drugs
AIDS is diagnosed when an individual with HIV develops at least one of the
following conditions: Table 10-14
1. CD4+ T cell count drops below 200 cells/µL.
2. One of the following opportunistic infections (OIs):
Fungal: candidiasis of bronchi, trachea, lungs, or esophagus;
Pneumocystis jiroveci pneumonia (PCP); disseminated or
extrapulmonary coccidioidomycosis; disseminated or
extrapulmonary histoplasmosis
Viral: cytomegalovirus (CMV) disease other than liver, spleen or
nodes; CMV retinitis (with loss of vision); herpes simplex with
chronic ulcer(s)or bronchitis, pneumonitis, or esophagitis,
progressive multifocal leukoencephalopathy (PML);
extrapulmonary cryptococcosis
, Protozoal: toxoplasmosis of the brain, chronic intestinal
isosporiasis chronic intestinal cryptosporidiosis
Bacterial: Mycobacterium tuberculosis (any site); any
disseminated or extrapulmonary mycobacteria, including
Mycobacterium avium complex (MAC) or Mycobacterium
kansasii; recurrent pneumonia; recurrent Salmonella septicemia
3. One of the following opportunistic cancers:
Invasive cervical cancer
Kaposi sarcoma (KS)
Burkitt’s lymphoma
Immunoblastic lymphoma
Primary lymphoma of the brain
4. Wasting syndrome. Wasting is defined as a loss of 10% or more of
ideal body mass.
5. AIDS dementia complex (ADC).
Clinical Manifestations
Disease progression is highly individualized, treatment alters pattern, individuals
prognosis is unpredictable
Acute: Flulike symptoms, Mononucleosis- fever, swollen lymph, sore throat,
HA/N/D, malaise, muscle/joint pain, rash with seroconversion; Neuro- aseptic
meningitis, peripheral neuropathy, facial palsy, guillain-barre syn., oral hairy
leukoplakia
Occur 2-4 weeks after initial infection, last 1-3 weeks, high viral load
Chronic: asymptomatic for about 10 years; symptomatic- acute symptoms
become worse, persistent fevers, drenching night sweats, chronic diarrhea, local
infections, lymphadenopathy, nervous system manifestations, shingles, herpes,
bacterial infection, Kaposi sarcoma, oral hairy leukoplakia
Most common: oropharyngeal candidiasis or thrush
AIDS: Acquired Immunodeficiency Syndrome
HIV-infected patient meets criteria
Become severely compromised, T-cells decrease as viral load increases
CD4-T <200
Needs host to survive
Encephalitis, meningitis, retinitis, pneumocystis pneumonia, TB, tumors,
esophagitis, chronic diarrhea, tumors
Interprofessional Care
Focus on: 1) monitoring HIV progression and immune function, 2) initiating and
monitoring ART, 3) preventing development of diseases, 4) detecting/ treating
disease, 5) manage symptoms, 6) preventing or decreasing complications of
treatment, 7) preventing further transmission of HIV
Case report
Teaching of disease, treatment, prevention of transmission, health, family
planning, diet
Drug Therapy
Goal: 1) decrease the viral load, 2) maintain or increase CD4+T cell, 3) prevent
symptoms/diseases, 4) delay progression, 5) prevent transmission, 14-13
Antiretroviral therapy (ART): delay progression, NOT a cure
Can decrease viral load by 90-99%
Drug resistance develops quickly when used as monotherapy or
inadequate doses; need three or more drug types
Lethal interactions with OTC drugs and herbs (St johns wort)
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