Chapter 85, HIV and AIDS
when individual is known to be infected with HIV, two primary lab test performed to determine status of immune system & strength of virus ...
CD4 (T cell) counts used to measurre immune function; normal values between 500-1500 cells per/cubic mm (MM3) ; values less than 500/mm3 are considered abnormal
diagnostic testing if HIV is suspected includes ... (specific HIV meds (coreceptor tropism assay)
CD4count; viral load, CBC, blood chemistries(liver/kidney function tests); urinalysis; test 4 STIs; test 4 hepatitis, TB or toxoplasmosis; Test 4 sensitivities (HLA-B*5701 test) or drug resistance to specific HIV meds (coreceptor tropism assay
in 1982, AIDS was added to list of conditions that are formally tracked by
Centers for Disease Control and Prevention (CDC); virus has existed in US since at least mid- to late-70s; in 1983, international team of scientists discovered the virus that leads to AIDS
rapid HIV antibody screening test can determine ...
HIV exposure using blood, oral fluid, or urine in about 20 min
if EIA or rapid HIV antibody test is positive ...
a second test, the Western blot assay, is done for confirmation of antibodies; can take up to 2 weeks for confirmation of pos result; home test=sending blood sample via lancet stick to lab for confidential testing
HIV drugs are collectively referred to as
antiretrovirals (ARVs); highly active antiretroviral therapy (HAART or ART), or just "The Cocktail"
both tests are performed regularly to
ascertain need for antiretroviral therapy and adequacy of response to these meds; an uninfected person has an undetectable viral load
HIV infection in women may be overlooked because they may be
attributed to other disorders, such as genital ulcer disease, STIS, human papillomavirus (HPV) infections, pelvic inflammatory disease (PID); may experience characteristic s/s but gynecologic problems initial manif
mycobacterium avium-intracellulare (MAC)
bacterial disease w/fever, malaise, night sweats, anorexia, diarrhea, weight loss, lung and blood infections
Polymerase chain reaction test (PCR test) ....
can identify HIV w/n 2-3 weeks as well as identify genetic material of the HIV; PCR important for use on babies born to HIV-positive mothers; will differentiate infected babies w/mom's
more common OIs include
candidias; crptococcus; cytomegalovirus (CMV); herpes simples; histoplasmosis; mycobacterium avium-intracellulare (MAC); pneumocystis carinii pneumonia (PCP; toxoplasmosis
HIV is an infectious human retrovirus that invades a healthy, normal cell ... uses its own ribonucleic acid (RNA) to ...
change healthy cells' existing deoxyribonucleic acid (DNA) into cells that replicate ... virus overtakes biosynthesis of existing cells to duplicate and spread HIV w/n the body; commonly invades T cells and B cells
variety of other fungal, viral, bacterial infections may occur causing
constitutional disease (weight loss, diarrhea, fever) and neurologic disorders (dementia, muscle, nerve)
if untreated, HIV
depletes the immune system over a # f years, allowing development of both minor/major OIs and cancers; life expectancy after diagnosis is about 10 years
one of most common screening HIV tests is the
enzyme immunoassay (EIA); detects antibodies to HIV proteins; saliva, urine, or blood can be used; EIA is less specific and less expensive; can result in false-positive; results can take up to 2 wks
further NC and data collection
establish baseline for future comparison and determine presence of suspected complications; usually contain specific legal concerns, such as consents to obtain HIV infection status
undetectable reading considered to be an ..
excellent response to therapy, although inability to detect virus in blood does not indicate person is no longer infected; uncontrolled w/meds may have readings as high as 1 million copies or more of viral cells read as viral load
T cells and B cells normally function to
fight infection and to produce antibodies for specific immune responses
a disorder affecting work of immune system is
human immunodeficiency virus (HIV); often leads to acquired immunodeficiency syndrome (AIDS)
with strong suppression of virus via multiple drug therapies,
immune system may be able to rebuild; often an increase in T cells; less susceptible to OIs; some OIs can be treated and/or prevented w/meds
Mortality rate has declined in US due to treatment
in developing countries w/o adequate healthcare, education program or meds, and in impoverished pops in US, mortality rate continues to be high
more than half of all new cases of HIV involve
individuals between 25-44 years of age; >50 are among fastest-growing groups of persons living w/HIV; hetero-sexual transmission of HIV has incr across ethnic groups/ age groups; males/males w/un protect sex largest growth
HIV is transmitted through
infected body fluids; passed thru unprotected sex (vaginal, oral, anal), sharing of needles, accidental exposure of healthcare worker to infected blood, from pregnant woman to fetus, and breastfeeding
HIV+ people w/T-cell count below 200 may be considered to have diagnosis of AIDS
infections and cancers can develop; persons w/HIV and certain OIs or cancers are considered to have AIDS; AIDS occurs during later states of HIV infection
treatment of AIDS
involves prevention of OIs when possible (prophylaxis) and early treatment of infections when they occur; when T cell counts are low, prophylaxis is commonly given to prevent PCP or MAC
NC and HIV testing ...
legal implications; informed consent; Pre- post-test counseling required regardless of test results; results cannot be given over phone; client confidentiality essential; lab must be approved by state for testing
more s/s of HIV
lipoatrophy (loss of fat in face, arms, legs, buttocks); lipodystrophy (excessive fat buildup on back of neck and shoulders, breasts, or abdominal areas)
the HIV-RNA or viral load ...
measured to determine how virulent the virus is
standard antibody tests cannot detect the difference between ....
mother's blood and baby's blood (because newborns carry their mother's HIV antibodies for several months)
less than 1% of HIV infections of healthcare workers result from work-related exposure; most are from
needlestick injuries; postexposure prophylaxis (PEP) should begin immed
data collection
observe/monitor pt diagnosed with HIV; determine if regimens and requirements for taking anti-HIV meds are being followed; observe for depression, anxiety, other symptoms
pneumocystis carinii pneumonia (PCP)
one-celled organism causing infection of lungs, with cough, fever, chest pain, and sputumproduction
cytomegalovirus (CMV)
one-celled parasitic infection of GI tract causing diarrhea, fever, weight loss
direct consequence of invasion is person's vulnerability to
opportunistic infections (OIs) caused by microorganisms that do not generally cause disease in a person w/normal immune system; OIs and cancer account for large propor- tion of deaths related to HIV
OIs ... may appear when T-cells fall between 200-400/mm3; initial infections of skin/mucous membranes ...
oral thrush, shingles, severe athlete's foot; as immunity diminishes, more life-threatening infections likely
toxoplasmosis
parasitic infection involving brain, lungs, and other organs, causing fever, chills, visual disturbances, confusion, hemiparesis, and seizures
nursing implications
persons w/HIV often require assistance w/med adherence; plays key role in client/family teaching about all aspects of disease and care
HIV treatment can complicate aging process ...
potentially hazardous drug interaction may occur in pts taking meds or illness often affecting older pop
immune system
protects body from adverse effects of invasion by microorganisms/foreign substances; regulates removal of damaged cells/disposes of abnormal cells w/n body
S/S of HIV infection ... (can be asymptomatic for many years) herpes zoster infection or shingles; red/brown/pink/purple spots on or under skin, inside mouth, nose, eyelids; memory loss
rapid wt loss, persistent enlargement of lymph nodes (lymphadenopathy) recurring fever, night sweats; diarrhea; gen'l malaise; anorexia; dry cough; oral thrush; white spots on tongue, in mouth/throat; pneumonia
other common HIV-related s/s in women include
recurrent vaginal candidiasis; menstrual abnormalities (amenorrhea) or bleeding between periods; abnormal pap tests; cervical cancer
side effects of drugs can be severe ...
severe GI upset w/NVD; lipoatrophy, lipodystrophy, bone marrow suppression; peripheral neuropathy; illnesses can become life-threatening (DM, incr cholesterol/triglyceride levels); tolerance may be 4 short due 2 toxicity of med
antiretroviral therapy (a significant decrease in frequency of OIs and deaths)
strong combinations of medications to specifically combat the retrovirus; have had a profound effect on the progression of HIV disease; amount of circulating virus drops/& a restoration of immune function per Tcell count
the main cell affected by HIV is
the helper T4 lymphocytes, better known as CD4 cells
if treated w/highly active sets of meds,
time frame varies from years to decades
follow standard precautions in caring for all clients
to minimize risk of contracting HIV and other infections
treatment of HIV
use meds specifically designed to combat retroviral replication cycle of HIV; include 5 classifications; therapy consists of a combination of these 5 classes
each class is designed to attach a different developmental cycle of virus ...
use of different drugs simultaneously more effective in controlling amount of virus in the individual; often results in a lowering of the viral load
herpes simplex
viral infection causing colitis, pneumonitis , retinitis
histoplasmosis
viral infection causing small, painful blisters on skin of lips, nose or genitalia
antigen tests can us used to diagnose HIV infection ...
within 1 to 3 wks after infection; blood specimen required
candidiasis
yeast-like fungug that overgrows, cuasing infection of mouth (thrush), respiratory tract, skin
cryptococcus
yeast-like fungus causing infections of lung, brain, and blood
