Acquired Immune Deficiency Syndrome (AIDS)

*Look at neuromusculoskeletal Diseases slide 25

*Look at neuromusculoskeletal Diseases slide 25

*Look at slide 32

*Look at slide 32

HAART

-Simplifying the drug regimens to improve adherence -Developing alternatives for those whom the current medication have failed -Preventing viral rebound -Managing the wide range of pharmacological side effects

musculoskeletal pain syndromes

Characterized by a disproportionate loss of metabolically active tissue, specifically body cell mass Secondary to low food intake, altered metabolism, and poor nutrient absorption

Varies in the time that passes between acute HIV infection, appearance of symptoms, diagnosis of AIDS, and death

Clinical Manifestations of HIV/AIDS

False (Deaths can be due to to any cause, not just AIDS related)

True/False: Deaths due to HIV are only AIDS related.

True (not strenuous or exhausted exercise)

True/False: Exercise is ok in symptomatic and advanced stages

1.) stop HIV from replicating 2.) increase the number of CD4+ cells 3.) delay HIV disease progression

what are the goals of intervention of HIV?

Protease

what assembles new HIV virion particles? Replication of the virus can cause cell death

200-500 cells/mm^3

what is the CD4 count during the symptomatic stage?

200 or less

what is the CD4 count of advanced disease?

developmental delay

what is the first sign of HIV in pediatrics?

HIV/AIDS

A disease caused by the retrovirus human immunodeficiency virus, Characterized by progressive destruction of cell-mediated immunity and changes to humeral immunity First recognized in 1981

CD4 cells and macrophages

After HIV enters the body, what serve as receptors for the retrovirus allowing direct passage of the infection into other target cells?

serum

After a few months, very little HIV found in the blood, only HIV antibodies found in the what?

HIV virion

After attaching to and fusing with a cell, what injects the core proteins and two strands of viral RNA into the cell?

$360,000

For every HIV infection that is prevented, how much is saved in the cost of providing lifetime HIV treatment?

lipodystrophy or lipodystropic syndrome

Defective fat metabolism, dyslipidemia, and insulin resistance Concomitant fat deposits in the abdomen, breasts, and back of the neck ("buffalo hump") (Jaw, heart, body cavities, gallbladder, skin, and soft tissues) Loss of fat in arms, legs, or face

CD4+ T cells, immune cells, neurogial cells

Destruction of what causes impairment in function of surviving helper T cells?

Advanced disease

Development of opportunistic infections, wasting, or dementia, infection of the brain can occur, Kaposi's Sarcoma

lentivirus

HIV is classified as a what which is a subclass of retroviruses that contain RNA?

transgender individuals

Heavily affected On average, among male-to-female women, 28% positive of HIV/AIDS

40,000

In US, new infections have remained stable overall in recent years at about how many per year?

exchange of blood or body fluids containing the virus or virus-infected cells

How is HIV/AIDS transmitted?

women (unique gynecologic syndromes)

Is HIV pain greater in men or women?

Look at slide 38-40

Look at slide 38-40

cardiac disease

Major cause of mortality in those who respond well to antiretroviral therapy Myocardial infarction, cardiomyopathy, pericardial effusion, and pericarditis occur as a result of HIV or treatment

Exercise

May provide pain relief, improve appetite, reduce muscle atrophy, regular bowel activity, and function Important way to increase CD4 cells, possibly delaying symptoms while increasing muscle strength and size in early asymptomatic stages

1980's

Number of cases of HIV/AIDS and deaths increased rapidly in what year followed by a substantial decline in the 1990s?

Symptomatic Phase

Once cells are depleted in the lymph nodes, the virus enters the blood to infect any remaining lymphocytes, Clinically apparent disease occurs, Immune system compromised, Places individual at risk for opportunistic infection, Nonspecific symptoms include diarrhea, weight loss, fatigue, night sweats, fevers

integrase

Once viral genome is transcribed, what allows it to be integrated into the host's DNA and duplicated?

gay or bisexual men of all races and ethnicities

Who are at greatest risk for developing HIV/AIDS? Account for 54% of all people living with HIV infection in 2011

HIV-associated myopathy

Progressive weakness in the proximal limb muscles Symmetrical Often involves the muscles of the face and hands

Injection drug users

Represented 8% of all new infections in 2010 Represent 15% of those living with HIV in 2011

opportunistic infections, secondary neoplasms, and neurologic manifestations

Results in progressive and eventually profound immune suppression that leads to what three things?

immunodeficiency, autoimmunity, and neurologic dysfunction

Results of HIV infection results in one or more what?

AIDS related lymphomas (Burkitt's lymphoma, non-Hodgkin's lymphoma, Hodgkin's lymphoma)

Second most common cancer associated with HIV Occurs at any CD4+ level, but increases with decrease in CD4+ count

3-6 weeks after infection (can take up to 6 months to occur)

Seroconversion (positive antibody test for HIV) usually takes place when?

Asymptomatic (early stage)

Virus migrates from the serum into the tissues to infect CD4 cells in the lymph tissue, Continues to kill CD4 cells in the lymph tissue, Laboratory evidence of seroconversion, clinically healthy and capable of normal ADLs

1. directly related to HIV infection 2. caused by HIV diagnostic procedures and treatment 3. unrelated to AIDS or treatment (diabetic neuropathy)

What are the 3 types of pain associated with HIV?

Peripheral neuropathy Associated with Kaposi's sarcoma and other dermatologic conditions Headache Abdominal pain Chest pain Arthralgias and myalgias

What are the most common pain symptoms of HIV?

1.) Use protective barriers when anticipating contact with blood or body fluids 2.) Immediately wash hands, skin, and mucous membranes thoroughly if contaminated by blood or body fluids 3.) Careful handling and disposing of sharp instruments during and after use 4.) Ventilation devices for resuscitation

What are the standard precautions for healthcare workers when treating patients who are HIV/AIDS positive?

sexual, parenteral (intravenous drug users, blood transfusions), mother to infant

What are the three major routes of transmission of HIV/AIDS?

immune system, CNS

What are the two major targets of HIV infection?

percutaneous injury (.3%), mucous membrane contamination with blood (.09%), and non intact skin contamination (<.09%)

What are the ways healthcare workers can contract HIV/AIDS at work?

Reverse transcriptase

What copies all the genetic information of the virus from the HIV RNA strand to make viral DNA?

500 cells/mm^3

What is the CD4 count during the asymptomatic stage?

profound immune deficiency (primarily affecting cell-mediated immunity)

What is the Hallmark of AIDS?

1.) Infection of cells 2.) Integration of the provirus into the host cell genome 3.) Activation of the viral replication 4.) Production and release of infectious virus

What is the life cycle of HIV?

African Americans

What is the most affected racial/ethnic population with HIV/AIDS? Accounted for 44% of new infections in 2014 Account for 41% of people living with HIV in 2011

HIV-1 antibody enzyme immunoassay test

What is the most common test for HIV?

1.2 million (this includes approximately 168,000 who are unaware of HIV status)

What is the number of people living with AIDS in the U.S.?

no cure but manageable

What is the treatment for HIV?

500

When CD4 drop below what number is HAART (highly active antiviral therapy) initiated Involves combination of antiretroviral drugs from different classes

DNA template

When the RNA virus initiates replication, it must convert the RNA genetic information into a what to replicate?

Hispanics/Latinos

Who accounted for 21% of all new infection in 2010 and 20% of those living with HIV in 2011?