Chapter 85 - HIV and AIDS

AIDS dementia complex

(ADC) also known as HIV-associated neurocognitive disorders, includes behavioral changes and diminished mental functioning.

HIV-associated nephropathy

(HIVAN) HIV-associated kidney disease, is an inflammation of the renal filters that affects the kidney's ability to remove fluids and waste products.

Acquired Immunodeficiency Syndrome

AIDS. the most advanced and final stage of HIV. Not all persons with HIV will advance to this stage of the disease. *last stage of HIV*.

"the cocktail"

ART, HAART

cytomegalovirus

CMV. a herpes virus transmitted in body fluids such as saliva, blood, urine, semen, and break milk. if it develops, it causes damage to the eyes, digestive tract, lungs, and other organs.

HIV-2

Endemic to West Africa. less virulent form of HIV that infects fewer individuals. takes longer to progress to symptomatic HIV/AIDS and has a lower mortality rate than HIV-1 infection.

saliva, sweat or tears

HIV is NOT transmitted in what body fluids?

25 to 44 years of age

HIV remains a leading cause of death for individuals between what ages?

Human Immunodeficiency Virus

HIV. An infectious human retrovirus (invades healthy normal white blood cell). invades the body due to the fact that the immune system is unable to function. *treatable but NOT curable*. The virus *invades, multiplies, and proliferates through the body, becoming increasingly destructive because the protective mechanisms of immunity are ruined.

Medication therapies

Have resulted in a significant decrease in the frequency of OIs and the numbers of death in persons infected with HIV

A reverse transcriptase enzyme allows HIV to invade a normal cell, insert its RNA into the cell, and uses that cell's life-sustaining biomechanisms to convert RNA to DNA. HIV cells are then created and are able to reproduce new HIV cells. WBC are destroyed.

How does HIV convert the virus's RNA to DNA?

Because most agents are designed to attack only one phase of the virus's lifecycle

How does HIV processes make pharmaceutical destruction of the virus difficult?

(Chimpanzee virus known as *simian immunodeficiency virus [SIV]*) When hunters became exposed to infected blood from a subspecies of chimpanzees native to west equatorial Africa. Additional studies show that HIV was transmitted from apes to humans in the late 1800s.

How was HIV introduced to human populations?

symptoms suggesting AIDS

Kaposi sarcoma, TB, AIDS dementia complex or HAND, HIVAN, wasting syndrome, lymphomas, lipoatrophy, lipodystrophy.

mycobacterium avium-intracellulare

MAC. bacterial disease with fever, malaise, night sweats, anorexia, diarrhea, weight loss, and lung and blood infections.

opportunistic infections

OI's. infections that take advantage of an ailing immune system. commonly found in later stages of HIV or part of diagnosed AIDS. *account for a large proportion of deaths related to HIV.

Lymphocytes

One of the 5 types of WBCs *T cells, B cells and CD4 cells*

pneumocystis jiroveci (carinii) pneumonia

PJP. formerly PCP. one-celled organism causing infection of the lungs, with cough, fever, chest pain, and sputum production.

pre-exposure prophylaxis and post-exposure prophylaxis

PrEP and PEP. the prevention of HIV in noninfected individuals

tuberculosis

TB. a bacterial infection causing the growth of nodules (tubercles) in the tissues especially the lungs. *the most common OI and a leading cause of death of individuals with AIDS*.

1983

What year did an international team of scientists discover the virus that leads to AIDS?

Kaposi sarcoma

a cancerous tumor of the blood vessel walls. appearing as *red, brown, pink, or purple spots* on or under the skin, inside the mouth, nose, or eyelids, and internal organs such as the gastrointestinal tract and lungs.

crytococcal meningitis

a fungus found in the soil causing inflammation of the membranes and fluid surrounding the central nervous sytems. (i.g. the brain and spinal cord [mininges]).

antibodies

act specifically against the antigen as part of the immune response.

cryptosporidiosis

an intestinal parasite commonly found in animals that is passed through contaminated food or water. it grows in the intestines and bile ducts leading to the severe, chronic diarrhea of AIDS.

diagnostic testing for HIV

antibody tests antigen/antibody tests, and nucleic acid (RNA) test.

HIV transmission. because blood banks test donors for HIV. *transplant recipients*

before 1985, what was blood transfusion associated with? why does it rarely occur now?

contaminated body fluids

blood, semen, preseminal fluid, rectal fluids, vaginal fluids, and breast milk.

persons with HIV

can be asymptomatic for many years, and individuals who have not been tested may not know they are infected.

window period

can range from 2 to 8 weeks or about 25 days on average. in some cases, months may be needed before an accurate HIV-positive result is obtained.

No.

can results be given over the telephone?

western blot test

confirms the HIV diagnosis.

antibody tests

detect antibodies that are made as an *indirect response* to HIV.

antigen and RNA tests

detects HIV *directly*.

help clients and families cope with the illness

emotional support, combined with technical skills

lipodystrophy

excessive fat buildup on back of neck and shoulders, breasts, or abdominal areas.

is considered a crime

failure to provide notification of positive HIV-positive status

symptoms suggesting primary HIV or AIDS

fatigue, recurring fever, leachate, lymphadenopathy, diarrhea, general malaise, anorexia, dry cough, rash, elevated viral load, oral thrush, herpes zoster infection or shingles, pneumonia, memory loss, soaking night sweats, white spots or unusual lesions on tongue or in mouth, skin rash or bumps.

Chronic latent infection

follows the acute phase. the virus becomes less active. the individual appears to be healthy, often for many years following the initial infection. the viral load may be "clinically undetectable" but HIV is active and infectious. if untreated, HIV depletes the individual's immune system over a number of years, allowing the development of both minor and major infections and cancers, eventually leading to death.

histoplasmosis

fungal infection caused by inhaling spores of a fungus often found in bird and bat droppings.

methods of contracting HIV

having vaginal sex with an infected person, sharing infected needles, being in contact with the feces of an infected person, or cleaning up the vomit of an infected person. *HIV is NOT transmitted via the air or through casual contact such as shaking hands*.

explain how to take each does; provide suggestions for pill boxes and calendars; assist in the management of side effects; aid in obtained refills on time; and teach so that the client and family understand interactions that might occur with food and other drugs

how can the nurse help in planning with the client how to take medication?

it reproduces and mutates rapidly, which results in a multiplicity of HIV genetic variations in a single person. several variations can occur within one client at any particular time.

how does HIV differ from most viruses?

through contact with infected body fluids, which can be found inside the mouth, rectum, vagina, and the opening of the penis. these areas have mucous membrane linings that have the potential to be abraded, cut, or damaged which will result in leakage of blood.

how is HIV transmitted?

with strong suppression of the virus via multiple drug therapies

how may the immune system be able to repair?

untreated person

in this person, the average from acquisition of HIV until a diagnosis of AIDS is made is about 10 years.

retrovirus

invades a healthy, normal white blood cell (T cells and B cells). uses it's own ribonucleic acid (RNA) to change the healthy cell's existing deoxyribonucleic acid (DNA) into cells that replicate; that is, the virus overtakes the biosynthesis of existing cells to duplicate and spread HIV within the body.

majority of cases of HIV

involve unprotected vaginal, oral, and anal sexual contact.

lipoatrophy

loss of fat in face, arms, legs, and buttocks.

antiretroviral therapy

medications that are specifically designed to combat the retrovirus. they have exerted a profound effect on the progression of HIV disease to AIDS.

Primary acute infection

occurs typically 2 to 4 weeks after initial exposure to the virus. this client may complain of flu-like symptoms such as sore throat, mild fever, aches, mouth ulcers, rashes, and night sweats. some individuals have no symptoms. virus goes to the lymph nodes where most viruses are destroyed however HIV has begun to invade the cells within the lymph nodes and starts making copies of itself, which are released to the general circulation, and travel to the bloodstream to release more invaders. *viral load is specifically high*.

toxoplasmosis

parasitic infection spread by cat's stool, which can spread to other animals and humans. it involves the brain, lungs, and other organs, causing fever, chills, visual disturbances, confusion, hemiparesis, and seizures.

lymphadenopathy

persistent enlargement of lymph nodes

3 main stages of HIV

primary infection (acute HIV), chronic latent infection (clinical latency or inactivity), and AIDS.

general malaise

profound or unexplained fatigue

antigens

proteins that stimulate the immune system to make a specific antibody.

CDC

provides recommendations for HIV testing by labs recognized as official testing sites in the United States.

Common HIV-related signs and symptoms in women

recurrent vaginal candidiasis, menstrual abnormalities including amenorrhea or bleeding between periods, abnormal pap test, or cervical cancer.

third party notification

requires that healthcare personnel report the HIV status to an individual who has a significant risk for exposure to HIV by someone who is known to be HIV infected.

ELISA or EIA

the first test usually ordered to test for HIV. enzyme linked immunoassay. *can have false positive*.

prevention of OIs when possible and the early treatment of such infection when they occur

the ideal approach to the management of AIDS involves

helper T4 lymphocytes (CD4 cells)

the main cells affected by HIV. HIV *destroys*, allowing the immune system to increasingly deplete.

HIV-1

the viral form of HIV that causes the majority of infections in the United States and worldwide.

PEP

used within 72 hours or 3 days after a single, high-risk event. used for healthcare workers who have had a single event of exposure to blood or body fluids that are infected or whose infection status is unknown. The goal is to stop HIV from making copies of itself and spreading throughout the body.

early detection and treatment of HIV/AIDS as part of maternal prenatal care.

what can prevent HIV infection in newborns?

candidiasis

yeast-like fungus causing thick, which coating on the mucous membranes of the mouth (thrush), tongue, esophagus, or vagina.

HIV has begun to invade the cells within the lymph nodes and starts making copies of itself, which are released to the general circulation and travel to the bloodstream to release more invaders

If the lymph nodes destroys most viruses? Why can't it destroy HIV?

1982

What year was AIDS added to the list of conditions that are formerly tracked by the CDC?

In individuals with syphilis, lupus or Lyme disease may have

When may a false positive occur?

wasting syndrome

a loss of at least 10% of body weight, accompanied by diarrhea, chronic weakness, and fever. can be reduced by aggressive treatment protocols.

algorithm

a sequence of tests used in combination to improve the accuracy of the lab diagnosis of HIV.

rapid test

a test done in a home or clinic, the next test will be done in a lab.

effective prophylactic measures

are available after a worker has an accidental exposure to infected blood but must be started as soon as possible after exposure or in less than 3 days.

partner-notification laws

are available in many states and some cities do require the HIV-positive individual to tell specific people of their HIV status. require that positive HIV test must be reported by the individual or the healthcare provider to any sexual partner(s) or any person(s) with whom the HIV-positive person has shared needles.

Standard precautions

are the healthcare worker's primary protective measures against infections carried by bodily fluids. are to be used for *every client*.

Transmission-based precautions

are to be used when the client has a known infection (i.g. hepatitis or measles).

they are less sucepitalbe to OI's

as a consequence, what happens to clients who often have an increase in the T cells?

lymphoma

cancer of the WBCs originating in the lymph nodes seen as painless swelling of the lymph nodes of the neck, armpit, or groin.

duty to warn

is designed to show good faith efforts to notify a partner of an individual who has HIV/AIDS.

PrEP

is used for prevention of infection with HIV. intended for individuals who are at high risk of getting HIV, for example, a sexually active partner of an individual who is HIV positive. *used consistently*. a pill is used every day, and to be used with other prevention options (e.g. condoms).

antiretroviral agents

it is essential to take these as directed, and persons with HIV often require assistance with the adherence.

t cells

lymphocytes that mature in the thymus

b cells

lymphocytes that originate in the bone marrow.

t cells and b cells

normally, these cells function to fight infection and to produce antibodies for specific immune responses.

viral load

viral count. the amount of the virus in the body.

herpes simplex

viral infection causing a variety of problems including colitis, pneumonitis, and retinitis.

early detection of HIV, OIs, and AIDS

what allows for more options in treatment of infections and preventative healthcare?

the testing was done too early, that is, before the body has produced enough antibodies to the virus to be detected.

what does a false negative HIV result mean?

the development of confusion, forgetfulness, depression, anxiety, and difficulty walking

what does neurologic complications lead to?

a future test may be scheduled after antibodies have had a chance to develop.

what happens if the initial test is negative?

the first OIs may appear

what happens when an HIV-positive person's T cell count falls between 200 and 400/mm? *initial infections of the skin and mucous membranes, such as oral thrush, shingles, and severe athlete's foot, may develop*.

the diagnosis of AIDS is confirmed

what happens when the HIV-infected person's CD4 count falls below 200 and/or the client has developed unusual infections.

providing the client with comfort

what is the focus when a person is in the terminal stages of AIDS?

HIV testing

what must nurses strongly advocate for all pregnant women?

for future comparison and to determine the presence of suspected complications

why should a baseline be established?