NSG 470: HIV & AIDS

All of the following statements are true regarding HIV Encephalopathy, except: a) You can see cognitive, motor, and behavioral symptoms in patients with this disease. b) Mild symptoms may include memory deficits, headaches, and confusion. c) Symptoms seen in later stages may involve global cognitive impairment, psychomotor slowing, hyperreflexia, psychosis, and hallucinations. d) HIV Encephalopathy tends to occur in the later stages of an AIDS infection. e) This complication affects the PNS by infection of peripheral muscle and nerves by the HIV virus.

(e) - HIV Encephalopathy affects the CNS by direct HIV infection of the brain and CSF.

What are the main symptoms of acute HIV infection (Stage 0)?

*Generalized viral illness - Fever - Weight loss - Pharyngitis - Thrush - Mouth & esophageal sores - Skin rash - Myalgia - Enlargement of the liver and spleen - Malaise, headache, and neuropathy - N/V - Lymphadenopathy

Health care professionals are encouraged to use standard precautions when caring for patients with HIV/AIDS. What type of PPE should be worn in the following situations: 1. Touching blood, body fluids, secretions, excretions, and contaminated items, and for touching mucous membranes and nonintact skin. 2. Procedures and patient care activities when contact of clothing/exposed skin with blood or body fluids, secretions, and excretions is anticipated. 3. Procedures and patient care activities likely to generate splashes or sprays of blood, body fluids, and secretions, especially suctioning or endotracheal intubation.

1. Gloves 2. Gown 3. Mask / eye protection / face shield

Western blot assay

A more sensitive blood test that identifies antibodies to HIV Used to confirm the results of a positive EIA or ELISA test

Certain events establish the conversion of HIV infection to AIDS, including:

- A markedly decreased T4 cell count from a normal level of 800 to 1200/mm³ (the CD4 T-cell count drops below 200 cells) - The development of certain cancers and opportunistic infections, such as Pneumocystis carinii pneumonia, candidiasis, cytomegalovirus, or herpes simplex.

In terms of the Nursing Process, what might be included as part of our nursing diagnoses of patients with HIV/AIDS?

- Impaired skin integrity - Diarrhea - Risk for infection - Activity intolerance - Disturbed thought processes - Ineffective airway clearance - Pain - Imbalanced nutrition - Social isolation - Anticipatory grieving - Deficient knowledge

AIDS Criteria

- Longstanding HIV, OR a shorter course of HIV but with other chronic illnesses, exposure through transfusion, or poor/noncompliant Rx - Worsening evidence of immune suppression: CD4+ T-cell count <200 or < 14% (normal count is 500-1600) - Opportunistic infections, pathogenic infections, tumors

Fusion Inhibitors: Mechanism of Action

Act extracellularly to prevent the fusion of HIV to the CD4 cell (or other target cell) Work on Step 1 of the HIV life cycle

Potential side effects of AIDS medications

Hepatotoxicity Nephrotoxicity Osteopenia Increased risk of cardiovascular disease Increased risk of MI Metabolic alterations (dyslipidemia, insulin resistance) Facial wasting (d/t loss of fat)

In patients with AIDS Wasting Syndrome, what area of the brain is affected, causing anorexia?

Hypothalamus

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): Mechanism of Action

Inhibit DNA replication Work on Step 3 of the HIV life cycle

Life Cycle of an HIV Virus

1. Binding - HIV binds to host CD4 2. Fusion & Uncoating - HIV RNA empties into the CD4 cell 3. Reverse Transcription - HIV changes from RNA to DNA (results in double-stranded DNA) → At this point, patients are only considered to be "exposed" to HIV, not infected 4. Integration - new viral DNA enters the nucleus of the CD4 T-cell, where it blends with the DNA of that T-cell and becomes permanently engrained = life-long infection → At this point, patients are now "infected" with HIV 5. Transcription - when the T-cell is activated, the DNA forms mRNA 6. Translation - mRNA makes new viral proteins, enzymes, and other components of the HIV virus 7. Cleavage - new virus production 8. Budding - new mRNA exits the cell and starts the process over

Ribonucleotide Reductase Inhibitors: Mechanism of Action

Interfere with HIV synthesis Act in the S-phase of the cell-cycle, where the DNA replicates, and so they are cell-cycle specific Ex. Hydroxyurea

An immunologist is presenting to a group of nursing students about the different treatments and therapies for patients with AIDS. She knows that the students require further instruction when which of the following statements is made? a) "Triple therapy HAART is a drug "cocktail" that suppresses HIV viral replication in the blood while attempting to prevent the virus from developing resistance." b) "HAART therapy decreases HIV associated morbidities and is shown to restore and preserve immunologic function in patients with AIDS." c) "Before providing HAART therapy, the patient's IgG level and CD4 cell count should first be determined." d) "This therapy actually prevents the transmission of HIV infection." e) "HAART is a treatment involving at least three active anti-retroviral medications (ARV's)."

(c) - this therapy is given regardless of CD4 count; IgG levels are unrelated.

A nurse educator is teaching a group of students about the transmission of HIV. Which of the following statements would indicate that the teaching was successful? a) "I should avoid any direct contact with persons who have HIV, including kissing, hugging, and sharing food, as this might expose me to the HIV virus." b) "In caring for a person with HIV, I should make sure to wear protective equipment, such as a mask and goggles, to avoid ingesting HIV viral particles that may spread when the person coughs or sneezes." c) "A person with HIV should always use condoms during sexual intercourse, as the virus can spread through semen and vaginal fluids." d) "If a woman with HIV decides to get pregnant, she must undergo a caesarian section (C-section) to avoid spreading the virus to her child."

(c) is true - HIV can spread through semen & vaginal fluid, contact with infected blood, and from mother to baby. (a) is false - you cannot get the HIV virus from kissing, hugging, or sharing food. (b) is false - HIV does not spread through coughing or sneezing. (d) is false - HIV can be spread from mother to baby in utero, during delivery, or via breast milk.

HAART (Highly Active Antiretroviral Therapy) is often called the drug "cocktail" or triple-therapy. HAART therapy affords us a potent way of suppressing viral replication in the blood while attempting to prevent the virus from rapidly developing resistance. Which of the following statements are true regarding HAART? Select all that apply. a) It is given to patients with a CD4 count greater than 250. b) It has no effect on HIV associated morbidities. c) It restores and preserves immunologic function. d) It increases plasma HIV viral load. e) Patients utilizing HAART therapy can still transmit HIV to others.

(c) is true; all other options are false. (a) - HAART therapy is given regardless of CD4 count (b) - this therapy decreases HIV associated morbidities (d) - it suppresses plasma HIV load (e) - HAART prevents HIV transmission

All of the following nursing interventions can be utilized to ensure adequate nutrition in patients with HIV/AIDS, except: a) Monitoring weight, I & O, dietary intake, and factors that may interfere with nutrition. b) Consulting with a dietician. c) Providing dietary supplements. d) Use of prescribed antiemetics to control nausea. e) Avoiding the use of enteral feedings or parenteral nutrition.

(e) - if needed, enteral feedings and parenteral nutrition can be utilized to meet the body's nutritional requirements.

In terms of the Nursing Process, what goals could be included as part of the planning for patients with HIV/AIDS? (Remember, the goals of care are created based on our nursing diagnoses specific to each patient)

- Achievement and maintenance of skin integrity - Resumption of usual bowel patterns - Absence of infection - Improved activity tolerance - Improved thought processes - Improved airway clearance - Increased comfort, improved nutritional status - Increased socialization - Expression of grief - Increased knowledge regarding disease prevention and self-care - Absence of complications

What does it mean when a patient tests negative for HIV?

- Antibodies to HIV are not present in the blood at this time, which can mean that the patient has not been infected with HIV or, if infected, the body has not yet produced antibodies (stage 0). - The patient should continue taking precautions. The test result does not mean that the patient is immune to the virus, nor does it mean the patient is not infected; it just means that the body may not have produced antibodies yet. - If a viral test is used, as opposed to an antibody test, a negative result is more consistent with the conclusion that the patient is uninfected.

What does it mean when a patient tests positive for HIV?

- Antibodies to HIV are present in the blood (the patient has been infected with the virus, and the body has produced antibodies). - HIV is active in the body, and the patient can transmit the virus to others. - Despite HIV infection, the patient does not necessarily have AIDS. - The patient is not immune to HIV (the antibodies do not indicate immunity).

AIDS Disease Management

- Maintain skin integrity: KS may need radiation therapy - Thought processes: depression, neurological changes (i.e. encephalopathy), prioritize patient safety, re-orientation, psychotropic meds, may need Rx for ↑ ICP - Social isolation and discrimination: HIV cultures are still stigmatized socially and economically - Support group involvement: HIV/AIDS patients need social interactions and a positive support system - End-of-life care

What potential collaborative problems might occur in patients with HIV/AIDS?

- Opportunistic infections - Impaired breathing, respiratory failure - Wasting Syndrome - Fluid and electrolyte imbalances - Adverse reactions to their medications

In terms of the Nursing Process, what should be included as part of our assessment of patients with HIV/AIDS?

- Physical & psychosocial status - Identification of potential risk factors i.e. IV drug abuse, risky sexual practices - Immune system function (CD4 cell count) - Nutritional status - Skin integrity - Respiratory status - Neurologic status - Fluid & electrolyte balance - Knowledge level regarding their disease process

What prevention measures should be utilized to avoid HIV infection?

- Standard precautions - Safer sex practices and safer behaviors - Abstain from sharing sexual fluids - Reduce the number of sexual partners to one (or as few as possible) - Always use latex condoms (if allergic to latex, use non-latex condoms) - Do not share drug injection equipment - Blood screening and treatment of blood products - PreP (Pre-exposure Prophylaxis): consists of one pill per day, given to "at risk" patients for HIV prophylaxis i.e. those with multiple sexual partners, drug users, etc.

Highly Active Antiretroviral Therapy (HAART) is defined as treatment with at least three active anti-retroviral medications (ARV's), including:

2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTI's) PLUS 1 non-nucleoside reverse transcriptase inhibitor (NNRTI), or a protease inhibitor (PI), or another NRTI called Abacavir (Ziagen)

PreP (Pre-Exposure Prophylaxis) involves taking one pill containing two HIV medications (tenofovir disoproxil fumarate 300 mg & emtricitabine 200 mg [Truvada]) daily in order to avoid the risk of sexual HIV acquisition in adults and adolescents age 12 and older. HIV status should be checked every _____ months to be sure that the person has not become infected.

3

PEP (Post-exposure Prophylaxis) includes taking antiretroviral medicines as soon as possible, but no more than _____ hours after possible HIV exposure; two to three drugs are usually prescribed which must be taken for _____ days.

72 28

To detect/diagnose a PIDD (primary immune deficiency disease), what should be analyzed first?

A complete blood cell count (CBC) with differential: abnormal levels including anemia, thrombocytopenia, and leukopenia; platelet counts will be less than 150,000

Which of the following interventions can be utilized in the management of pain in HIV/AIDS patients? Select all that apply. a) Antidepressants and anticonvulsants can be used to address neuropathies, as well as the physical manifestations that accompany depression. b) Non-pharmacologic comfort measures such as rest, hydration, nutrition, and massage. c) Opioids (as necessary) and NSAIDs, such as Meloxicam and Naproxen, to relieve pain and reduce inflammation. d) IM injections to produce maximum analgesic effect.

All of these interventions can be used for pain management, except (d) - IM (intramuscular) injections should be avoided whenever possible because patients with AIDS, especially in advanced stages, experience a loss of muscle mass. As a result, an IM injection is more painful and doesn't absorb as effectively, producing less of an analgesic effect.

Alternative therapies for AIDS

Echinacea (it's actually believed that this herbal supplement may actually worsen the immune system) Vitamins Shark cartilage: most famously used for cancer; also used for osteoarthritis, plaque psoriasis, age-related vision loss, wound healing, damage to the retina of the eye due to diabetes, and inflammation of the intestine

AIDS patients who have developed adverse GI manifestations as a result of their disease should be treated with what therapies?

Good oral care Small, frequent meals that are low in fat Supplemental vitamins & minerals Anti-diarrheals May require tube feeds or TPN (esp. those experiencing AIDS Wasting Syndrome)

This AIDS related complication tends to occur in the later stages of an AIDS infection and affects the CNS by direct HIV infection of the brain and CSF. The diagnosis is confirmed with an extensive neuro exam, including a CT exam, which will show cerebral atrophy and ventricular enlargement.

HIV Encephalopathy

Nucleoside Reverse Transcriptase Inhibitors (NRTIs): Mechanism of Action

Inhibit DNA synthesis & replication (block reverse transcriptase) Work on Step 3 of the HIV life cycle

This AIDS-related complication effects the epithelial layer, blood and lymphatic vessels. It is characterized by small, purple (or brown) lesions on the skin that may be flat or raised, surrounded by ecchymosis and edema. These lesions aren't painful, unless they become ulcerated. They can range from localized lesions to multiple organ systems in the body.

Kaposi's sarcoma

________ is the most common HIV-related malignancy and involves the endothelial layer of blood and lymphatic vessels.

Kaposi's sarcoma

________ stage HIV is characterized by non-dividing HIV cells, producing few to no viral particles. However, the virus can become activated again through additional stress, infection, or other stimulus that causes HIV replication to begin again. When reactivation occurs, the infection will become even worse, infecting new CD4 cells throughout the body.

Latent

This AIDS-related complication often progresses rapidly into malignancy and is treated with combination chemotherapy and stem-cell transplant. It commonly effects the brain and is generally classified as Non-Hodgkin's, although it can be Hodgkin's.

Lymphomas

What is the standard regimen for prophylactic treatment of latent TB infection?

Isoniazid + Pyridoxine, for 9 months Note: The 12-dose regimen is not recommended for people with HIV/AIDS who are taking antiretroviral therapy (ART)

AIDS patients (or anyone) with latent TB can experience a "flare up" at any point, meaning that they develop active TB. In order to prevent the development of an active TB infection, patients are treated prophylactically with combination therapy ________ and ________ for 9 months.

Isoniazid, Pyridoxine

HIV is a retrovirus that targets all of the following cells, except: a) B-lymphocytes b) T-lymphocytes c) Monocytes d) Dendritic cells e) Brain microglia

(a) - HIV targets cells with CD4 receptors; this does not apply to B-lymphocytes.

Which of the following statements regarding Candidiasis is false? a) Candidiasis is an infection that occurs most commonly on the buccal surface, hard & soft palate, oropharyngeal mucosa, and tongue. b) This GI fungal infection is characterized by painful white lesions. c) Candidiasis is extremely common in AIDS patients. d) It can also occur in the vagina.

(b) - Candidiasis is characterized by painless white lesions.

Hypogammaglobulinemia vs Agammaglobulinemia vs Panhypoglobulinemia

- Hypogammaglobulinemia is a lack of one or more of the five immunoglobulins. - Agammaglobulinemia is a disorder marked by an almost complete lack of immunoglobulins or antibodies. - Panhypoglobulinemia is a general lack of immunoglobulins in the blood.

Medical Management of PIDDs

A pattern of unusually frequent, opportunistic, or severe infections generates the possibility of a PIDD and initial testing or referral to an immunologist. Hematopoietic Stem Cell Transplantation (HSCT): a curative modality; the stem cells may be from embryos or adults. Toxicity and reduced efficacy are frequent limitations. Gene Therapy: the use of cells as vehicles for the delivery of genes or gene products. Adverse effects and toxicities are common with GT.

________, the most common secondary disorder, is perhaps the best-known secondary immunodeficiency disorder. It results from infection with the human immunodeficiency virus (HIV).

AIDS

An RN is caring for a patient suffering from end-stage AIDS disease who is following up from her appointment 1 month ago, where she sought treatment for complaints of severe diarrhea and fatigue. Upon re-examination, you note that she's lost more than 10% of her body weight since you last saw her. Additionally, she reports that she is still experiencing frequent episodes of diarrhea and is becoming progressively weaker and fatigued. As the RN, you suspect that this patient is suffering from what AIDS-related complication?

AIDS Wasting Syndrome

Prevention of HIV infection is achieved through which of the following interventions? Select all that apply. a) Behavioral interventions...have been effective in reducing the risk of acquiring or transmitting HIV by ensuring that people have the information, motivation, and skills necessary to reduce their risk. b) HIV testing...because most people change behaviors to protect their partners if they know they are infected with HIV. c) Linkage to treatment and care...which enables individuals with HIV to live longer, healthier lives and reduce their risk of transmitting HIV. d) Other than abstinence, consistent and correct use of condoms is the only effective method to decrease the risk of sexual transmission of HIV infection.

ALL of these interventions can help to prevent people from acquiring HIV

Viral set point

Amount of virus in the body after an initial immune response subsides It is the "equilibrium" between HIV levels and the body's immune response

Diagnosis of Kaposi's sarcoma (KS)

Biopsy of suspected lesion(s)

When diagnosing an AIDS patient with HIV Encephalopathy, what findings would you look for on a CT scan?

Cerebral atrophy and ventricular enlargement

How is MAC (Mycobacterium avium complex) treated?

Clarithromycin (Biaxin), or Azithromycin + Ethambutol

A nurse is assessing a client with Kaposi's sarcoma. What initial sign does the nurse know to look for during assessment?

Deep purple cutaneous lesions; localized cutaneous lesions may be the first manifestation of this HIV-related malignancy, which appears in 90% of clients as immune function deteriorates. Other symptoms develop over time as the lesions increase in size and spread to other locations.

OraQuick test

Detects for the presence of HIV antibodies (not the virus) in a patient's saliva Commonly used in the ED and L&D Can be used as an at-home HIV test

Signs & Symptoms of HIV/AIDS Encephalopathy

Earlier: - Memory deficits - Headaches - Confusion Later: - Global cognitive impairment - Psychomotor slowing - Hyperreflexia - Psychosis - Hallucinations - Seizures - Coma or death

A client suspected of having human immunodeficiency virus (HIV) has blood drawn for a screening test. What is the first test generally run to see if a client is, indeed, HIV positive?

Enzyme-linked immunosorbent assay (ELISA)

HAART is therapeutically beneficial for many reasons; however, it does have its drawbacks. What are the downsides to this triple-therapy approach?

Expensive Multiple pills and/or injections per day Many side effects

True or False: When latex male condoms are used consistently and correctly during vaginal or anal intercourse, they are highly effective in preventing the sexual transmission of HIV. Non-latex condoms made of natural materials, such as lambskin, are available for people with latex allergy and are also effective in protecting against HIV infection.

False - Nonlatex condoms made of natural materials are available for people with latex allergy, but will not protect against HIV infection.

AIDS patients who have developed Acute Respiratory Distress Syndrome (ARDs) should be treated with what therapies?

PEEP (positive end expiratory pressure) Increasing O2 Bronchodilators

Protease Inhibitors (PIs): Mechanism of Action

PI's bind to protease (an enzyme), preventing the assembly of new (mature) HIV viruses Work on Step 6 of the HIV life cycle

A client with common variable immunodeficiency (CVID) comes to the ED reporting tingling and numbness in the hands and feet, muscle weakness, fatigue, and chronic diarrhea. An assessment reveals abdominal tenderness, weight loss, and loss of reflexes. A gastric biopsy shows lymphoid hyperplasia of the small intestine and spleen as well as gastric atrophy. Based on these findings, what common secondary problem has this client developed?

Pernicious anemia

HIV is a retrovirus that contains its genetic material in the form of RNA. It targets cells with CD4 receptors, which include:

T-lymphocytes Monocytes Dendritic cells Brain microglia

HIV-1

The most prevalent and pathogenic type of HIV virus

The characteristic sign of PCP, as indicated by an X-Ray, is a "ground glass" appearance of the lungs. What does this indicate?

This is indicative of partial filling of air spaces in the lungs with exudate & interstitial thickening of the alveoli

True or False: HAART suppresses HIV viral replication in the blood, is given to patients regardless of their CD4 cell counts, and prevents the transmission of HIV.

True

True or False: Live vaccines are contraindicated in patients with antibody deficiency disorders because the patient is incapable of generating antibodies and the live substance in the vaccine can cause disease.

True

True or False: The higher the amount of HIV virus that an infected patient has, the higher the probability that a simple exposure to somebody else will result in transmission of infection.

True

OraSure test

Uses saliva to perform an EIA antibody test 20 minutes 99.6% accuracy

The characteristic clinical symptom of active TB is ________ for any length of time, and if treatment is delayed, the infection can progress rapidly and become fatal.

cough

DAF refers to lysis of erythrocytes due to lack of ________ (DAF) on erythrocytes.

decay-accelerating factor

The most common infection in people with AIDS is pneumocystis pneumonia caused by pneumocystis ________. It is the most common opportunistic infection associated with AIDS.

jiroveci

When a patient is initially infected with HIV (Stage 0), there is very high viral replication that occurs within the body. Eventually, the patient is going to produce antibody molecules in an effort to contain the HIV. When testing a patient for HIV during Stage 0, they will test ________ for HIV, and ________ for antibodies.

positive, negative (HIV+, Antibody-)

________ is a disorder in which both B and T cells are missing.

severe combined immunodeficiency disease (SCID)

This stage of HIV occurs when your body develops detectable neutralizing antibodies and an HIV infection is firmly established. Viral RNA has become permanently engrained in the DNA of the affected CD4 cells. Patients commonly report feeling well and experience very few symptoms during this period, which can last up to 10 years.

Stage 1

In this stage of HIV, CD4 T-cell levels range between 200-499.

Stage 2

In this stage of HIV, CD4 T-cell levels fall below 200, and the patient is now considered to have AIDS.

Stage 3

This stage of HIV is the period from infection with HIV to the development of antibodies. It is characterized by very high viral replication, dissemination of HIV throughout the body, and destruction of CD4 T-cells. The host response to this infection involves other immune cells, mainly CD8 lymphocytes, attempting to kill these infected, virus-producing cells.

Stage 0

EIA

Enzyme Immunoassay: a test that screens for the presence of HIV antibodies in the blood (same as ELISA)

ELISA

Enzyme-Linked Immunosorbent Assay: a test that screens for the presence of HIV antibodies in the blood (same as EIA)

True or False: Tuberculosis (TB) will only develop in AIDS patients who have a CD4 T-cell count less than 100.

False - TB can develop in anyone at any time, not just those with HIV or AIDS, and can occur at any CD4 count.

PreP vs PEP

PreP: Pre-exposure prophylaxis PEP: Post-exposure prophylaxis

HIV is a retrovirus that carries its genetic material in the form of ________. HIV consists of a viral core containing the genetic material, surrounded by an envelope consisting of protruding glycoproteins.

RNA (rather than DNA)

How is HIV transmitted?

Sex without a condom (semen, vaginal fluid) Passed from mother to baby (via breast milk, in utero, or during delivery) Sharing needles (blood) Contaminated blood transfusions & organ transplants

A nurse is caring for an AIDS patient who asks about common complications that are associated with this immune disorder. As part of your teaching, you address his risk for developing Pneumocystis Pneumonia (PCP) and how he can best prepare himself for this complication. Which of the following statements by the patient indicates the need for further instruction? a) "80% of patients with HIV will develop PCP if they aren't treated prophylactically with the antibiotic TMP-SMX." b) "I should monitor for signs and symptoms of PCP, including shortness of breath, tachypnea, cough, fever, and chest pain." c) "If I develop symptoms consistent with PCP and don't seek immediate treatment, it can lead to respiratory failure with 2-3 days." d) "The characteristic sign of Pneumocystis Pneumonia is a "ground glass" appearance (X-Ray) and is diagnosed by a sputum sample or tracheal lavage."

(a) - 80% of patients with AIDS (not HIV) will develop PCP if they aren't treated prophylactically with the antibiotic TMP-SMX (trimethoprim-sulfamethoxazole); this usually involves 21 days of TMP-SMX and steroids, if indicated.

Which of the following statements regarding primary immune deficiency diseases (PIDDs) is false? a) The majority of PIDDs are diagnosed before the age of 8, with females being more at risk than males. b) Diagnosis of PIDDs later in life is frequently confounded by frequent use of antibiotics that mask symptoms. c) There are more than 200 different forms of PIDDs affecting people in the US and more than 270 different genes are associated with these primary deficiencies. d) PIDDs are rare genetic diseases that prevent the body from developing normal immune responses, resulting in a complex group of disorders with a wide array of clinical presentations. e) Major signs and symptoms include multiple infections despite aggressive treatment, infections with unusual or opportunistic organisms, failure to thrive or poor growth, and a positive family history.

(a) - The majority of PIDDs are diagnosed in infancy, with a male-to-female ratio of 5 to 1.

Which of the following statements are true regarding the prevalence of HIV? Select all that apply. a) Over 1.2 million people age 13+ are living with HIV in US b) This disease is generally considered a disease that thrives in suburban areas c) The prevalence of HIV has decreased due to improved treatments d) Gay and bisexual men account for the highest prevalence of HIV

(a) and (d) are true (b) is false - HIV is mainly an urban disease, populations over 500,000 people living in an area. (c) is false - the prevalence of HIV has increased due to reduced mortality (better treatments = prolonged lifespan = increased # of people living with the disease)

All of the following are characteristics of Kaposi's sarcoma, except: a) An AIDS complication that involves the epithelial layer, blood and lymphatic vessels. b) Lesions are very painful, purple or brown in color, and can be either flat or raised. c) These lesions are surrounded by ecchymosis and edema. d) Diagnosis of KS involves a biopsy of the suspected lesion(s). e) KS lesions range from localized areas to multiple organ systems.

(b) - Lesions are typically painless (unless ulcerated), purple or brown in color, and can be either flat or raised.

A nurse is providing education to a group of students about the immune system and testing for infections. She should include all of the following points regarding HIV/AIDS testing, except: a) HIV/AIDS screening is recommended for all people ages 18-64. b) Once the body has become infected with HIV, antibodies against the virus are produced within 1-2 weeks after infection. c) An Antibody test can be used to test for the presence of HIV antibodies, not the actual HIV virus. d) Two other tests that can be done are the Antigen/Antibody test, and the Nuclear Acid (RNA) test, both of which are direct tests for the HIV virus.

(b) - once the body has become infected with HIV, antibodies are produced within 3-12 weeks after infection.

All of the following nursing interventions can be utilized to promote normal bowel patterns in patients with HIV/AIDS, except: a) Avoiding foods that irritate the bowel, such as raw fruits and vegetables, carbonated beverages, spicy foods, and those of extreme temperatures. b) Eating large, frequent meals high in fat. c) Administering PRN medications, such as stool softeners or laxatives. d) Assessing and promoting self-care strategies to control diarrhea.

(b) - patients should eat small, frequent meals low in fat to promote bowel regularity.

All of the following nursing interventions can be utilized to maintain skin integrity in patients with HIV/AIDS, except: a) Encouraging patients to maintain a balance between rest and activity. b) Repositioning at least every 4 hours and as needed. c) Use of pressure reduction devices. d) Using gentle, nondrying soaps or cleansers. e) Avoiding scratching, as well as the use of adhesive tape.

(b) - repositioning should occur at least every 2 hours and as needed.

Ataxia-Telangiectasis

Ataxia: refers to uncoordinated muscle movement and is a clinical manifestation of combined B-cell and T-cell deficiencies. Telangiectasia: refers to vascular lesions caused by dilated blood vessels. Autosomal recessive disorder Defect in cell checkpoint kinase: cells continue through cell cycle without pausing to inspect DNA Individuals with this have 50X the risk of developing cancer Characterized by loss of muscle coordination and vascular lesions

CCR5 Antagonists: Mechanism of Action

Block the entry of HIV into the CD4 (host) cell Work on Step 1 of the HIV life cycle

Integrase Strand Transfer Inhibitors (INSTIs): Mechanism of Action

Block the integration of the double-stranded viral HIV DNA into the host cell (CD4) DNA Work on Step 4 of the HIV life cycle

In addition to medication-based AIDS therapy, there are also other ways to enhance the body's immune system, including:

Bone marrow transplant Interleukin 2 (IL-2) IV therapy Lymphocyte transfusions

The transmission of HIV occurs through body fluids containing HIV or infected ________ lymphocytes. This includes blood, seminal fluid, vaginal secretions, amniotic fluid, and breast milk.

CD4

________ is a disorder that encompasses various defects ranging from IgA deficiency (in which only the plasma cells that produce IgA are absent) to severe hypogammaglobulinemia (in which there is a general lack of immunoglobulins in the blood). More than 50% of clients with this condition develop pernicious anemia.

CVID (common variable immunodeficiency)

This complication occurs in almost all patients with AIDS and commonly precedes other life-threatening infections. It is a fungal infection characterized by painless, white lesions on the buccal surface, hard/soft palate, oropharyngeal mucosa, and tongue. Less frequently, it occurs in the vagina. Treatment includes either Mycelex troches, Nystatin, or Ketoconazole.

Candidiasis

AIDS Wasting Syndrome

Profound, involuntary weight loss > 10% of your body weight, especially muscle mass. S/S: chronic diarrhea > 30 days, fever, extreme weakness and fatigue, anorexia, cachexia (severe malnutrition), loss of fat stores & muscle mass, and organ system failure.

MAC (MYcobacterium Avium Complex)

Respiratory complication associated with AIDS Rapid acting bacilli High mortality rate, esp. with T-cell counts less than 100 Common opportunistic infection Found in the lungs, GIT, lymph nodes, and bone marrow Usually tested from the bone marrow S/S: fever, night sweats, fatigue, weight loss, abd. pain Tx: ClarithroMYcin, or AzithroMYcin + Ethambutol

This stage of HIV is characterized by the latent reservoir of HIV viruses within resting memory of CD4 T-cells. Because antibodies have yet to be produced, the patient will test positive for HIV, but negative for the HIV antibodies. The clinical S&S of this stage are consistent with generalized viral illnesses and may last 1-2 weeks. Patients are highly contagious during this time period d/t high viral replication.

Stage 0