HIV / AIDS

IRIS

"immune reconstitution inflammatory syndrome" - Exaggerated inflammatory reaction to a disease-causing microorganism that can occur when the immune system begins to recover following ART. Occurs in two forms: "unmasking" IRIS = flare-up of an underlying, previously undiagnosed infection soon after antiretroviral therapy (ART) is started; "paradoxical" IRIS refers to the worsening of a previously treated infection after ART is started. Can be mild or life-threatening.

Vitamin A potential causes / results of deficiency

- Inadequate intake /Increased risk of progression to AIDS Necessary to correct low levels, should not exceed DRI when serum levels normal, high intakes beyond correcting low levels is harmful and increase mortality risk - more research needed

Vitamin E potential causes / results of deficiency

- Inadequate intake /increased risk of progression to AIDS, oxidative stress, impaired immune response, high intake associated with increased surrogate marker of atherosclerosis Needs more research on supplementation

Vitamin B potential causes / results of deficiency

- Malabsorption / inadequate intake /results in increased risk of progression to AIDS, dementia, peripheral neuropathy, myelopathy, diminished performance Limited evidence of supplementation beyond restoration of serum levels

Selenium potential causes / results of deficiency

- inadequate intake /increased risk of progression to AIDS, weakened immune system fx, oxidative stress MV providing DRI rec, higher doses not recommended - pending further research

Zinc potential causes / results of deficiency

- inadequate intake /increased risk for HIV related mortality, impaired healing process, weakened immune system, lower CD4 counts Supplement recommended to DRI, higher levels may lead to faster dx progression, more research needed

Vitamin D potential causes / results of deficiency

- inadequate intake / exposure to sun /immune suppression Correct low levels, needs more research

Iron potential causes / results of deficiency

- low levels during initial asymptomatic HIV infection caused by inadequate absorption, inadequate intake /anemia, progression and mortality in HIV infection, potentially increases viral load, increases susceptibility to and severity from other infections such as TB Correct low levels as needed, rec intakes at DRI, more research needed

β -carotene potential causes / results of deficiency

-Inadequate intake and Fat malabsorption /relationship with oxidative stress, potentially weakens immune function Recommend only amounts found in MV supplements, needs more research

Describe the appropriate nutritional management for dysphagia/ odynophagia and stomatitis.

-Modification in food consistency and texture. Liquid or semiliquid food can stimulate flow of saliva. If poor swallowing coordination is a problem, thickening of liquids is helpful. -Adjust food temperature -Select adequate foods -Adjust patient's position -Avoid spicy foods

State five common nutritional consequences of either medical treatment or the disease process (different from those discussed in question 9) and three associated nutritional recommendations you would provide to improve the adverse effects experienced by the HIV/AIDs patient.

-Nausea/vomiting: eat small frequent meals avoid drinking w/ meals, dry crackers or toast, reduce fat (low fat alternatives, trim fat off meat, avoid greasy foods) -Diarrhea: low fiber fruits like bananas and applesauce, plain carbohydrates like white rice, congee or noodles, avoid fatty greasy foods, reduce insoluble fibers by avoiding whole grains and consuming well-cooked/canned vegetables -loss of appetite: focus on nutrient dense foods like milkshakes, lean protein, nut butters, eat small frequent meals, eat foods you enjoy -altered taste: add spice and herbs, avoid canned foods -Weight loss: add rice, barley and legume to soups, oral supplements, focus on nutrient dense foods

List the six main classes of ART drugs

1) Nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs) 2) Non-nucleoside reverse transcriptase inhibitors (NNRTIs) 3) Protease inhibitors (PIs) 4) Fusion inhibitors 5) CCR5 (chemokine receptor 5) antagonists 6) Integrase strand transfer inhibitors (INSTIs)

According to Krause's Food and the Nutrition Care Process, what are the three main components of medical management?

1) Treat possible co-morbidities: Hyperglycemia, hyperlipidemia, hypertension, body composition changes, pancreatitis, kidney and liver, diseases, hypothyroidism, hypogonadism, osteopenia, hep C 2) Monitor: Fasting blood lipid, fasting glucose/insulin level, protein status, blood pressure, TSH/testosterone level, CD4 cell count, and viral load 3) Medication: Antiretroviral therapy, lipid lowering agents, antidiabetic agents, antihypertensive agents, appetite stimulants, hormone replacement therapy, treatment for coinfectious diseases (i.e. hepatitis), prophylaxis and treatment for opportunistic infectious diseases

What are the four primary goals of MNT for HIV/AIDS?

1) optimize nutritional status, immunity, and well being 2) maintain a healthy weight and lean body mass 3) prevent nutrient deficiencies and reduce the risk of comorbidities 4) maximize the effectiveness of medical & pharmacological treatments

What three topics should be the focus of nutrition education with HIV/AIDs patients? As the RD, provide 2 guidelines per topic you find most essential for your patient.

1. General lifestyle tips for adults - basic nutrition concepts and healthy habits, physical activity recommendations, body image and altered body weight and shape 2. Nutrition interactions - maintaining optimal body composition with emphasis on lean tissue, medication-nutrient interactions, management of barriers to nutritional wellness, side effects of treatments, symptoms requiring attention, review or oral beverage/nutrient supplements, review of herbal supplements//non prescription meds, evaluate interactions w/ alcohol or drugs 3. Life skills + socioeconomic issues - food and water safety, food access, food preparation skills

HIV Encephalopathy

= AIDS dementia

Lipodystrophy

A disorder of adipose (fatty) tissue characterized by a selective loss of body fat. Patients with lipodystrophy have a tendency to develop insulin resistance, diabetes, hypertriglyceridemia, and fatty liver. Can be induced by protease inhibitors used to treat HIB

AIDS Dementia (AIDS dementia complex (ADC), HIV encephalopathy, HIV-associated neurocognitive disorder (HAND), HIV-associated dementia (HAD)

A progressive neurological condition associated with advanced HIV infection or AIDS. HIV spreads to the brain, resulting in encephalopathy --> memory loss, slowed movements, and behavioral changes.

T-helper Lymphocyte Cells

A type of T cell that provides help to other cells in the immune response by recognizing foreign antigens and secreting substances called cytokines that activate T and B cells. T-helper cells fall into two main classes: those that activate other T cells to achieve cellular inflammatory responses; and those that drive B cells to produce antibodies in the humoral immune response. Mature Th cells express the surface protein CD4 and are referred to as CD4+ T cells. HIV virus attacks T-helper cells.

Antiretroviral Therapy (ART) Highly active antiretroviral therapy (HAART)

ART = use of anti-HIV drugs Standard treatment consists of a combination of at least 3 drugs (called HAART) that suppress HIV replication. 3 drugs are used in order to reduce the likelihood of the virus developing resistance. ART has the potential both to reduce mortality and morbidity rates among HIV-infected people, and to improve their quality of life

AIDS

Acquired immunodeficiency syndrome - the most advanced stage of HIV infection Disease of the immune system due to infection with HIV. HIV destroys the CD4 cells, leaving the body vulnerable to life-threatening infections and cancers.

Albumin/Pre-albumin

Albumin is a protein produced by the liver Carries certain minerals in blood stream and maintains osmotic pressure within vascular space - prevents edema Normal values: 4 - 6 Elevated: Usually indicates dehydration Below normal: Can indicate liver dysfunction or insufficient protein intake

Mycobacterium Avium Intracellulare (MAI)

An infection caused by 2 closely related and hard-to-distinguish bacteria, Mycobacterium avium and Mycobacterium intracellulare. These two bacteria can be found in drinking water, dirt, and household dust. Most people are not affected by the bacteria, but for immunocompromised, the bacteria can cause infection. M. intracellulare tends to cause lung disease, and M. avium tends to spread throughout the body (disseminated). Sx: fever, night sweats, weight loss, abdominal pain, fatigue, and diarrhea. In people infected with HIV, MAI infection that is outside of the lungs (extrapulmonary) or that has disseminated is an AIDS-defining condition.

AIDS Wasting Syndrome (AWS)

An involuntary loss of >10% of body weight (esp. muscle mass), plus ≥30 days of either diarrhea or weakness and fever. Unintended and progressive weight loss often accompanied by weakness, fever, nutritional deficiencies and diarrhea

Amphotericin-B Action

Anti-fungal, anti-protozoal

Pyrimethamine Action

Anti-parasitic for the treatment of toxoplasmosis- used conjointly with a sulfonamide

Epogen Action

Antianemic, recombinant human erythropoietin

Ethambutol (Myoambutol) Action

Antibacterial, (Antituberculosis)

Dapsone (DDS) Action

Antibacterial, antileprosy, anti-PCP, toxoplasmosis

Biaxin Action

Antibiotic (anti-MAC: mycobacterium avium complex)

Rifampin (Rifadin) Action

Antibiotic, TB treatment (also anti-MAC)

Bactrim (Trimethoprim-Sulfamethoxazole) Action

Antibiotic, for PCP - Pneumocystis carinii pneumonia, drug-resistant TB

Marinol Action

Antiemetic, appetite stimulant

Diflucan Action

Antifungal

Interferon Action

Antineoplastic (Kaposi's Sarcoma)

Foscarnet (Foscavir) Action

Antiretroviral - anti- cytomegalovirus (CMV) retinitis (a viral infection and inflammation of the eye's retina) in individuals with AIDS.

Combivir Action

Antiretroviral, NRTI

Stavudine (Zerit) Action

Antiretroviral, NRTI

Combivir Nutrition Implications / Adverse Effects

Antiretroviral, NRTI Nutr: Anorexia Oral/GI: N/V, dyspepsia, abdominal cramps, diarrhea

Zidovudine (Retrovir, ZDV, AZT) Action

Antiretroviral, anti HIV, Prevention of maternal-fetal HIV transmission, NRTI

Didanosine (ddl, Videx) Action

Antiretroviral, anti-HIV, NRTI

INH (Isoniazid) Action

Antituberculosis, Antimyobacterium

Carafate Action

Antiulcer, gastric mucosa protectant

Ganciclovir (Cytovene) Action

Antiviral, Anti-CMV, Nucleoside Analog

3 TC (lamivudine, Epivir) Action

Antiviral, Anti-HIV, Nucleoside Analog

Crixivan (indinavir sulfate) Action

Antiviral, anti-HIV, protease inhibitor

Marinol Nutrition Implications / adverse effects

As appetite stimulant, take BID before lunch and dinner to appetite. Avoid alcohol Nutr: appetite, weight Oral/GI: dry mouth, N/V, abdominal pain, diarrhea

Asymptomatic HIV Infection

Asymptomatic HIV infection is a phase of HIV/AIDS during which there are no symptoms of HIV infection. During this phase, the immune system in someone with HIV slowly deteriorates, but the person has no symptoms. Length of phase varies by individual

CD4 Count

CD4= type of white blood cell, destroyed by HIV The higher the count, healthier the immune system (500-1,600 c/mm is healthy) Low CD4 count (<200 c/mm), stage 3 advanced HIV CD4% is more stable over time but CD4 count is still used as most reliable measure

Kaposi's Sarcoma

Cancer that develops from the cells that line lymph or blood vessels. It usually appears as tumors on the skin or on mucosal surfaces e.g. inside the mouth, but tumors can also develop in other parts of the body, such as in the lymph nodes, lungs, or digestive tract.The abnormal cells of KS form purple, red, or brown blotches or tumors on the skin. These affected areas are called lesions. AIDS-related KS is one type. When HIV damages the immune system, people who also are infected with a certain virus (the Kaposi sarcoma associated herpesvirus or KSHV) are more likely to develop KS. KS is considered an "AIDS defining" illness--when KS occurs in someone infected with HIV, that person officially has AIDS.

Neupogen nutrition implications / adverse effects

Caution with lactation. No specific nutritional issues. Other: bone pain, fever, transient decrease in BP

Nutrition implications of HIV-induced enteropathy

Chronic diarrhea, wt loss, malabsorption, changes in behavior

Neupogen Action

Colony Stimulating Factor ( production and activity of neutrophils)

Solemudrol Action

Corticosteroid

Isosporiasis

Cystoisosporiasis (formerly known as isosporiasis) is an intestinal disease of humans caused by the coccidian parasite Cystoisospora belli. Most common in tropical/subtropical areas. Found in feces, spread by ingesting contaminated food or water. The most common symptom is watery diarrhea. Immunocompetent hosts typically have self-limited infection; chronic, debilitating diarrhea is common in untreated HIV-infected patients.

Nutrition implications of PCP

Difficulty chewing and swallowing caused by SOB

Nutrition implications of Kaposi's Sarcoma

Difficulty chewing/swallowing d/t lesions in oral cavity or esophagus

Symptomatic HIV Infection

Early symptomatic HIV infection is a stage when sx are present but AIDS has not yet developed. includes persistent generalized lymphadenopathy; oral lesions such as thrush and oral hairy leukoplakia; hematologic disturbances such as hypoproliferative anemia and thrombocytopenia; neurologic disorders such as aseptic meningitis; and dermatologic disorders e.g. shingles. Chronic HIV infection - asymptomatic period that progresses to symptomatic faster if HIV RNA levels are high. Some individuals develop symptoms or organ dysfunction during chronic infection due to direct effects of the virus rather than a defect in cell-mediated immunity. Some infected persons who are otherwise asymptomatic develop persistent generalized lymphadenopathy (PGL) during this time.

Foscarnet (Foscavir) Nutrition Implications / Adverse Effects

Ensure adequate fluid intake Anorexia, N/V, diarrhea, abdominal pain, dry mouth, stomatitis

Blood Glucose

Fasting BG test to determine blood sugar / Diabetes Some HIV meds can affect BG, potentially leading to Diabetes

Lipid Profile (LDL, HDL, TGs)

Fasting Lipid Panel (Chol & TG): Lipids are fat or fat-like substances found in the blood and body tissues. These tests measure your lipid levels, including chol and TGs Some HIV medications can affect your cholesterol levels and the way your body processes and stores fat. High lipids can make you prone to other medical problems, including heart problems. It's important to know what your lipids are before starting treatment to help guide the choice of medications and to treat high lipids to avoid other serious health problems.

Nutrition implications of Mycobacterium avium complex (MAC)

Fever, cachexia, abdominal pain, diarrhea, malabsorption

INH (Isoniazid) Nutrition Implications / Adverse Effect

Food significantly ¯ absorption. Take 1 hr. before meals. May take with food if drug causes GI distress. Avoid alcohol. Avoid high tyramine or histamine foods Nutr: Anorexia, inhibits conversion of tryptophan to niacin. May cause Pyroxidine (B6) deficiency or pellagra (niacin deficiency). Potential liver problems if alcohol is used - hepatitis may be fatal Affects vit. D metabolism Oral/GI: dry mouth, N/V, epigastric distress, constipation, diarrhea

What is HALS?

HALS= HIV-associated lipodystrophy syndrome 1/3-1/2 of HIV pt.'s have lipodystrophy (lipohypertrophy and Lipoatrophy)

Cryptosporidiosis

Highly contagious diarrheal disease caused by microscopic parasites, Cryptosporidium, that can live in the intestine of humans and animals and is passed in the stool of an infected person or animal. One of the most common waterborne diseases in humans in U.S. In healthy people, cryptosporidiosis is usually self-limited, causes mild diarrheal illness. In HIV-infected patients, cryptosporidiosis can cause severe chronic diarrhea, electrolyte disturbances, malabsorption, and profound weight loss. Infection also can occur outside GIT and cause cholangitis, pancreatitis, and hepatitis.

HIV

Human immunodeficiency virus- harms your immune system by destroying the white blood cells that fight infection. This puts you at risk for serious infections and certain cancers.

Herpes Simplex Virus (HSV)

Infection with the herpes simplex virus, can be due to either herpes simplex virus type 1 (HSV-1) or herpes simplex virus type 2 (HSV-2). HSV-1 is mainly transmitted by oral to oral contact to cause infection in or around the mouth (oral herpes). HSV-2 is almost exclusively sexually transmitted, causing infection in the genital or anal area (genital herpes). Infections are mostly asymptomatic but can cause mild symptoms or painful blisters or ulcers at the site of infection. Infection with HSV-2 in people living with HIV often has a more severe presentation and more frequent recurrences. In advanced HIV disease, HSV-2 can lead to more serious, but rare, complications- meningoencephalitis, esophagitis, hepatitis, pneumonitis, retinal necrosis, or disseminated infection.

Interferon nutrition implications / adverse effects

Insure adequate fluid intake/hydration Nutr: Anorexia, weight loss, increased thirst Oral/GI: dry mouth, taste changes, gingivitis, stomatitis, dysphagia, saliva, N/V, dyspepsia, gastritis, abdominal pain, diarrhea, flatulence, constipation. Rare- GI hemorrhage

Amphotericin-B Nutrient Interactions / Adverse Effects

Insure adequate fluid intake/hydration; K, Mg, Ca diet or K, Mg and/or Ca supplement S/Cond: not with lactation Nutr: Anorexia, weight loss Oral/GI: nausea/vomiting, stomach pain, dyspepsia, diarrhea

Nutrition implications of Cytomegalovirus

Loss of appetite, wt loss, fatigue, enterisis, colitis

Nutrition implications of HIV-induced encephalopathy (AIDs dementia)

Loss of coordination and cognitive function, inability to prepare food

Ethambutol (Myoambutol) Nutrition Implications / Adverse Effects

May take with food or milk to ¯ GI distress. S/Cond: caution w/ lactation Nutr: Anorexia Oral/GI: Abdominal pain, N/V, GI distress

Nutrition implications of Candidiasis

Oral sores in mouth, difficulty chewing/swallowing

Nutrition implications of TB

Prolonged fatigue, anorexia, nutrient malabsorption, altered metabolism, weight loss

Dapsone (DDS) Nutrition Implications / Adverse Effect

Prophylactic administration of vitamin C, folate, and iron may prevent some adverse hematologic effects S/Cond: not with lactation; not with severe anemia Nutr: Anorexia Oral/GI: N/V, abdominal pain

Crixivan (indinavir sulfate) nutrition implications / adverse effects

Take 1 hr. before or 2 hr. after a high fat meal if administered with ritonavir. Light, fat free meal does not affect drug level. Take without regard to meals if administered with ritonavir. Separate from high dose (1 g) Vit C. Adequate hydration essential to prevent kidney stones. Drink at least 1500 mL fluids daily. Caution with grapefruit/related citrus. Avoid SJW. Nutr: Concomitant high dose vitamin C ¯ drug level. Oral/GI: taste changes, N/V, regurgitation, abdominal pain, diarrhea

Zidovudine Nutrient Interactions / Adverse Effects

Take > 1 hour before meals or with low fat meal; high fat meal ¯ absorption Nutr: Anorexia Oral/GI: taste changes, mouth ulcer, N/V, dyspepsia, dysphagia, pain, constipation, flatulence

Didanosine (ddl, Videx) nutrition implications / adverse effects

Take on an empty stomach at least 30 minutes before or 2 hours after food (food ¯ absorption). Do not mix with acids such as grapefruit juice/citrus/tomatoes. Consider Na content with ¯ Na diet. Do not take antacids with Mg or aluminum within 2 hours. Take Fe 1 hr. before or 4 hr. after drug Nutr: Anorexia, weight loss Oral/GI: dry mouth, stomatitis, ¯ taste acuity, dyspepsia, N/V, abdominal pain, bloating, diarrhea, constipation, flatulence

Ganciclovir (Cytovene) nutrition implications / adverse effect

Take oral form with food to enhance bioavailability. Insure adequate fluid intake/hydration. Nutr: Anorexia, weight loss Oral/GI: dry mouth, N/V, GI hemorrhage, abdominal pain, flatulence, diarrhea

3 TC Nutrient Interactions / Adverse Effects

Take w/o regard to food. S/Cond: Caution with alcohol- increased risk of pancreatitis; not with lactation Nutr: Anorexia Oral/GI: nausea, vomiting, dyspepsia, abdominal cramps, diarrhea

Rifampin (Rifadin) nutrition implications / adverse effect

Take with 8 oz. water 1 hr. before or 2 hr. after food to absorption. May take with food if GI upset, but food decreases absorption. May mix cap contents w/ applesauce or jelly Avoid alcohol. Not with lactation. May need vitamin D supplement. Nutr: Anorexia, May Vitamin D metabolism, and decrease BMD with long-term use Oral/GI: oral candidiasis, dyspepsia, N/V, cramps, diarrhea, flatulence

Pyrimethamine nutrition implications / adverse effects

Take with food Anorexia, vomiting. Check folate status, megaloblastic anemia, atrophic glossitis

Bactrim (Trimethoprim-Sulfamethoxazole) Nutrition Implications / Adverse Effects

Take with food and ≥ 8 oz. water Insure adequate fluid intake/hydration to insure output of >1500 cc/day; may need folate supplementation. Avoid SJW S/Cond: Avoid alcohol Nutr: Anorexia, interferes with folate metabolism. Oral/GI: stomatitis, glossitis, N/V, diarrhea

Solemudrol nutrition implications / adverse effect

Take with food to decrease GI effects. Caution with grapefruit and related citrus. Limit caffeine to reduce GI effects. Avoid alcohol. Caution with DM ( glucose). Not with lactation. Diet: ¯ Na, Ca, Vit D, pro. May need K, Vits A, C, P (or supplement). Ca-Vit D suppl. recommended with long-term use. Nutr: appetite, weight. Negative nitrogen balance due to pro catabolism. Cr deficiency may risk for steroid induced DM. Oral/GI: esophagitis, N/V, dyspepsia, peptic ulcer, bloating, GI bleeding/perforation

Carafate Nutrition Implications / Adverse Effect

Take with water on empty stomach 1 hr. before meals & bedtime; bland diet may be recommended. Take Ca or Mg suppl. or antacids separately, ≥ 30 minutes. Avoid or limit alcohol Oral/GI: ¯pepsin activity by 32%, constipation, cramps

Epogen Nutrition Implications / Adverse Effects

Take without regard to food May need Fe, Vitamin B12 or folate supplement. Oral/GI: N/V, diarrhea

Biaxin Nutrition Implications / Adverse Effect

Take without regard to food. Caution with alcohol Oral/GI: abnormal taste, dyspepsia, N/V, abdominal pain, diarrhea

Diflucan Nutrition Implications / Adverse Effects

Take without regard to food. Take with food if GI distress occurs. Not with lactation. Caution with diabetics on sulfonylurea (hypoglycemia) Oral/GI: taste changes, dry mouth, dyspepsia, N/V abdominal pain, diarrhea

Stavudine (Zerit) nutrition implications / adverse effects

Take without regard to meals. Limit alcohol. Not with lactation Nutr: Anorexia, weight loss Oral/GI: stomatitis, N/V, abdominal pain, diarrhea, lipodystrophy, hyperlipidemia

What nutrition interventions will be key for individuals with HALS?

Tesamorelin, a growth hormone-releasing factor analog, was approved by the US Food and Drug Administration (FDA) for treatment of HIV-associated lipodystrophy General nutritional considerations for the treatment of lipodystrophy: (from eatrightpro) - maintain an appropriate weight range; - increase dietary fiber intake; - encourage foods rich in n-3 fatty acids; - adhere to the National Cholesterol Education Program dietary recommendations; - encourage smoking cessation; and - encourage physical activity and resistance training

List 5 factors that have been associated with poor adherence that you may look for in your patient.

Treatment is lifelong and non-adherence may lead to drug resistance. Before beginning ART, patients understanding of HIV disease and prescribed treatment is critical - factors associated with poor adherence include: 1) low levels of literacy 2) age-related challenges (e.g., vision loss, cognitive impairment), 3) psychosocial issues (e.g., depression, homelessness, low social support, stressful life events, dementia, or psychosis) 4) Active substance use 5) Difficulty taking medicine (e.g., trouble swallowing,pills, daily schedule issues),

Nutrition implications of Cryptosporidiosis

Watery diarrhea, abdominal cramping, malnutrition and wt loss, electrolyte imbalance

Non-Hodgkin's Lymphoma (NHL)

a cancer that starts in white blood cells (lymphocytes) most common subtypes include diffuse large B-cell lymphoma and follicular lymphoma.

Cytomegalovirus

a common virus that infects people of all ages. Most people infected with CMV show no signs or symptoms b/c immune system keeps virus from showing symptoms. In some cases, infection in healthy people may cause mild illness - fever, sore throat, fatigue, swollen glands. Can cause serious health problems for immunocompromised people - serious symptoms affecting the eyes, lungs, liver, esophagus, stomach, and intestines

Acute HIV Infection (aka primary HIV infection/acute retroviral syndrome)

a condition that develops within 2-4 weeks after someone is infected w/ HIV. It is the primary stage of infection and lasts until the body has created antibodies against HIV. During this first stage of infection, the virus is duplicating at a rapid rate

Tuberculosis (TB)

a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body. TB spreads through the air via droplets. TB = an opportunistic infection. HIV patients have higher risk of TB and latent TB is more likely to advance to TB disease in people with HIV

Toxoplasmosis

a disease that results from infection with the Toxoplasma gondii parasite, one of the world's most common parasites. Infection usually occurs by eating undercooked contaminated meat, exposure from infected cat feces, or mother-to-child transmission during pregnancy. Toxoplasmosis may cause flu-like symptoms in some people, but most people never develop signs and symptoms. For infants born to infected mothers and for people with weakened immune systems, toxoplasmosis may cause serious complications - headache, confusion, poor coordination, lung problems resembling TB/PCP, blurred vision caused by severe retina inflammation.

Candidiasis

a fungal infection caused by yeasts that belong to the genus Candida. Candidiasis that develops in the mouth or throat is called "thrush"/ oropharyngeal candidiasis. Invasive candidiasis occurs when Candida species enter the bloodstream and spread throughout the body.

Progressive Multifocal Leukoencephalopathy (PML)

a neurological disorder characterized by destruction of cells that produce myelin. It is caused by a virus called JC virus (JCV). The virus is widespread, found in up to 85% of the general adult population. It remains inactive in healthy individuals and causes disease only when the immune system has been severely weakened, such as in people with HIV/AIDS

Anemia of Chronic Disease

a type of anemia that commonly occurs with chronic, or long term, illnesses or infections. Causes include RBC not functioning normally so they can't absorb/use iron efficiently; body can't respond normally to EPO

5 categories to consider in assessment of HIV/AIDs pt.

a) Medical - stage of HIV disease, comorbidities, opportunistic infections, metabolic complications, biochemical measurements b.) Physical- change in body shape, weight or growth concerns, oral/GI symptoms, cognitive function, anthropometrics c.) Social- living environment, familial support, mental health d.) Economical- barriers to nutrition, food access e.) Nutritional- typical intake, alcohol/drug use

Viral Load

aka HIV RNA test tracks HIV particles in blood sample Goal of HIV tx to keep viral load so low that it cannot be detected in viral load test

Osteomyelitis

infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs

Opportunistic Infections (OIs)

infections that occur more frequently and are more severe in individuals with weakened immune systems, including people with HIV

Liver Function Tests (LFTs)

liver is responsible for metabolism of macronutrients and producing biochemicals needed in digestion Alanine aminotransferase (ALT) Aspartate aminotransferase (AST) Alkaline phosphatase (ALP) Bilirubin tests can identify liver damage, hepatitis, hepatotoxicity (some HIV drugs can result in hepatotoxicity early in treatment) 1/3 of Americans with HIV also have HBV or HCV so blood tests can check for Hep A, B, C

Complete Blood Count (CBC)

measure of the concentration of red blood cells, white blood cells, and platelets in a sample of your blood - most commonly ordered blood test can reveal infections, anemia (abnormality in your red blood cells), and other medical issues

HIV Pneumocystis jirovecii Pneumonia

ubiquitous fungus that causes pneumocystis pneumonia (PCP) in immunocompromised. (Healthy people can carry fungus w/o symptoms). In HIV-infected patients, the most common manifestations of PCP are subacute onset of progressive dyspnea, fever, non-productive cough, and chest discomfort that worsens within days to weeks. The incidence of PCP has declined substantially with widespread use of PCP prophylaxis (TMP/SMX) and ART. Most cases now occur in patients who are unaware of their HIV infection or are not receiving ongoing care for HIV, and in those w/ CD4 counts <100 cells/mm.