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