Chapter 18: HIV-related cancers

What does the prognosis of patients with Kaposi's sarcoma depend on?

-Shorter in patients with B symptoms -Shorter in patients with GI tract lesions -Worse in patients with prior opportunistic infections -Dependent on the location of the presenting KS lesion -Survival increases with antiretroviral therapy

What are strategies that need to be taught about HIV transmission?

-for cleanup of ekes is or other body fluid spills, wear gloves and use a solution one part housed-hold bleach to 10 parts water - condoms are not recommended - abstinence during chemo is not necessary - protected intercourse is important - avoid sharing personal care items such as razors and toothbrushes

Screening techniques for HIV-positive patients?

-periodic oral or dental exam to detect early oropharyngeal masses that can signal HPV-related squamous cell head and neck cancer -pap testing every 6-12 months for early detection -high risk: =CT of chest rather than chest radiography (detect lung cancer) =digital anal exam (detect squamous cell cancer)

What is the average life expectancy for someone with HIV?

11 to 14 years

What percentage of patients are unaware of an HIV diagnosis?

20%

Which of the following is the most frequently diagnosed AIDS-defining malignancy?

B-cell lymphoma

What body fluids should the nurse take standard precautions for?

Blood Cerebrospinal fluid Semen Vaginal secretions Synovial and amniotic fluid Pericardial fluid Pleural fluid Peritoneal fluid NOT urine, feces, vomitus, perspiration, nasal secretions, tears, sputum, saliva

What are factors associated with shorter survival in patients with HIV-related lymphoma?

CD4 cell count below 100 cells/mm3, stage 3 or 4 disease, age older than 35 years, history of injection drug use, and elevated lactate dehydrogenase

What would the nurse be able to evaluate when looking at lab data?

Chemo agents can decrease the CD4 count CD4/T4 counts decrease a sense of highly active antiretroviral therapy B2 mircroglobulin (a serum marker for immune activation) and core antigen p24 (a major structural core protein of the progression) indicate progressive infection, so serum levels will increase

Good risk Kaposi Sarcoma

Confined to skin or lymph nodes or minimal oral disease CD4 disease greater than 200 No oral thrush or B symptoms Karnofsky performance status greater than 70

Signs or symptoms related to a primary effusion lymphoma include what?

Cough and dyspnea. Human herpes virus type 8 is associated with effusion lymphoma, not Epstein-Barr virus.

If a patient is diagnosed with HIV and positive for NHL, what should the treatment be?

Delay cART therapy and start chemo using MBACOD

ART and chemo agents that interact to cause neuropathy toxicity

Didanosine and stavudine

ART and chemo agents that interact to cause hepatotoxicity

Didanosine, miraviroc, ralegravir, stavudine, tipranavir, zidovudine

What tests should be done to confirm HIV positivity?

ELISA (enzyme-linked immunosorbent assay). If positive, repeat it. A second positive test result should be followed by a wester blot Additional testing that is not diagnostic- Epstein-Barr virus, CD4 count, viral load test

Poor risk Kaposi Sarcoma

Edema or ulceration of tumor Extensive oral, GI non-node visceral tumors CD4 count less than 200 History of oral thrush or B symptoms (fever, night sweats, unintentional weight loss) Poor performance status HIV-related illness

Which is more virulent, HIV-1 or HIV-2?

HIV-1

What infectious and lifestyle factors negatively affect HIV disease progression?

Inadequate nutrition General poor health Smoking Presence of many viruses

ART and chemo agents that interact to cause diarrhea toxicity

Lopinavir, darunavir, fosamprenavir, saquinavir, tipranavir

Signs or symptoms related to GI tract lesions

Malabsorption and diarrhea

What is an anti-retro viral inducer when administered with cyclophosphamide?

Nevirapine and efavirenz (page 193)

What is the average time from the development of HIV infection to a diagnosis of AIDS?

Relatively short, only 2 to 3 years

Which treatments may be used to manage a patient diagnosed with primary central nervous system lymphoma (PCNSL) presenting with multiple lesions?

Rituximab High-dose methotrexate High-dose cytarabine

Explain the histopathology of HIV-related lymphoma

Small cell lymphomas are more likely to involve the bone marrow and meninges. Large cell lymphomas are more likely to be found in the GI tract. The majority of HIV-related lymphomas are intermediate or high-grade B-cell type. Small cell lymphomas are typically found in the bone marrow. Lesions are painful and may be mistaken for KS.

What non-oncologic medications have adverse interactions with anti-retro viral agents?

Some include anticonvulsants, benzodiazepines, and dexamethasone. Diuretics and antiemetics are not included.

Walter Reed staging for HIV infection

Stage 1- negative HIV antibody status; CD4 count >400. Skin test WNL Stage 2- POSITIVE HIV antibody status; CD4 count >400. skin test WNL Stage 3- POSITIVE HIV antibody status; CD4 count <400. Skin test WNL Stage 4- POSITIVE HIV antibody status; CD4 count <400. Skin test PARTIAL ANERGY Stage 5- POSITIVE HIV antibody status; CD4 count <400. Skin test COMPLETE ANERGY. ORAL THRUSH. Stage 6- POSITIVE HIV antibody status; CD4 count <400. Skin test partial or complete ANERGY. POSSIBLE THRUSH. HAS OPPORTUNISTIC INFECTION

HIV staging

Stage I= CD4 T-lymphocyte count is 500 cells/mcL or greater Stage II= 200 and 249 cells/mcL Stage III= less than 200 cells/mcL

ART and chemo agents that interact to cause peripheral neuropathy

Stavudine and vinblastine

ART and chemo agents that interact to cause nephrotoxicity

Tenofivir and zidovudine with platinols

What is the population most prevalent for those who have malignancies associated with viral infection?

White and male They are also more likely to present with distant metastasis.

ART and chemo agents that interact to cause myelosuppression

Zidovudine