HIV & INFECTION CHAPTER

Pneumocystis carinii pneumonia (PCP)

***Most common*** opportunistic lung infection caused by an organism, initially thought to be a protozoan but now believed to be a fungus based on its structure.

PCP manifestations of PCP

**most common OI resulting in AIDS** diagnosis. generally less acute non productive cough. fever, chills, dyspnea, Treatment: TMP -SMZ(trimehoprim/sulfamethoxazole) Tuberculosis & myobacterium avium complex (MAC)

Treatment decisions for an individual patient are based on what 3 factors:

1) HIV RNA (viral load) 2) CD4 T cell count 3) clinical condition of the patient.

primary infection

4-7 week period of rapid viral replication immediately following infection; also known as acute HIV infection

After the accumulation of HIV in the blood and the dropping off the CD4 cell counts, what do individuals display in the acute phase:

About 3 weeks into the acute phase individuals may display symptoms reminiscent of mononucleosis, such as fever, enlarged lymph nodes, rash, muscle aches, and headaches.

Count of CD4 cells in the body of HIV: Asyptomatic, Symptomatic and AIDS

Asymptomatic: >500 ( Category A) Symptomatic: 200-499 ( Category B) AIDS: <200

second most common malignancy in people with AIDS

B cell lymphomas-> BLOOD CANCER

GI manifestation

C. diff (diarrhea) oral candidiasis- may progress to esophagus and stomach (treatment with nystatin & fluconazole) Wasting Syndrome 10% weight loss and chronic diarrhea or chronic weakness and fever; protein energy malnutrition; anoxeria; lack of nutrition

Fourth Step of HIV life cycle:

Double stranded DNA is spliced into the cellular DNA by the action of another HIV enzyme integrase.

Explain the physiology of the clinical manifestation of HIV asymptomatic ( Category A)

During this stage, patient feels well and CD4 T cells remain high enough to respond to other pathogens. viral replication reaches a lower but relatively steady rate that is reflected in the maintenance of viral levels at a kind of "set point"

First step in the HIV life cycle

HIV GP120 and GP41 attach to the uninfected CD4 cell surface receptor and fuse with the cell membrane

Third step of HIV life cycle:

HIV enzyme reverse transcriptase copies the viral genetic material from RNA into double stranded DNA.

Sixth Step in HIV life cycle:

HIV protease cleaves the new proteins (polyproteins)

During the primary infection phase of HIV, what can you see high levels of and what is being killed?

High levels of viral replication and the killing of CD4 T cells. This results in high levels of HIV in the blood.

What is HIV encephalopathy characterized by:

It is characterized by progessive decline cognitive , behavioral and motor decline, forgetful, difficulty concentration, delayed verbal responses, psychosis, hallucinations; seizures; and death

Interventions for Pain

Medications as prescribed skin and perianal care

What criteria(s) must be met in symptomatic clinical manifestation of HIV (Category B)

Must meet one of the following: 1) the condition is due to HIV infection or a defect in cellular immunity 2) the condition must be considered to have a clinical course or require management that is complicated by HIV infection.

Why do people often miss doses and why is it hard to be on an HIV med for so long?

People often miss doses because of medication side effects. It is hard to be on a HIV regimen for so long because of the toxicity, cost, and complexity.

Explain the period of the primary infection stage of HIV: Also known as Acute HIV infection or Acute HIV

Period of intense replication and widespread dissemination of HIV throughout the body. LACKS HIV-SPECIFIC ANTIBODIES

Respiratory Manifestations of HIV

Shortness of breath dyspnea cough chest pain fever

In what form does the HIV virus carry their genetic material?

The form that HIV carries their genetic material is RNA (ribonucleic acid). The RNA is surrounded by an envelope consisting of glycoproteins that protrude.

What group of viruses does HIV belong to?

The group of viruses HIV belongs to is known as retroviruses.

What must happen for HIV to enter the targeted cell?

The membrane of the viral envelope must be fused with the plasma membrane of the cell, a process mediated by the envelope glycoproteins of HIV. ATTACHMENT

Second Step of HIV life cycle:

The viral core contents are emptied into the host cell, a process known as uncoating.

What is the balance between the amount of HIV in the body and the immune response referred to as?

The viral set point and results in the steady state of infection.

What did HIV encephalopathy used to be called?

Used to be called AIDS with Dementia

Fifth Step of HIV life cycle:

Using integrated DNA or provirus as a blueprint, the cell makes new viral proteins and viral RNA.

EIA (enzyme immunoassay)

a blood test that determines the presence of antibodies to HIV in the blood or saliva; also referred to as enzyme-linked immunosorbent assay. Positive results must be validated, usually with the Western blot test.

Western blot assay

a blood test that identifies antibodies to HIV and is used to confirm the results of an EIA (ELISA) test

Cryptococcus neoformans/ Mennigitis

a fungal infection

Progressive Multifocal Leukoencephalopathy

a rare infection that damages the material (myelin) that covers and protects nerves in the white matter of the brain.

Polymerase chain reaction (PCR)

a sensitive laboratory technique that can detect and quantify HIV in a person's blood or lymph nodes.

cytomegalovirus

a species-specific herpes virus that may cause retinitis in people with AIDS

Retrovirus

a virus that carries genetic material in RNA instead of DNA and contains reverse transcriptase.

Viral set point

amount of virus present in the blood after the initial burst of viremia and the immune response that follows

Bowel Intervention

assess bowl pattern and factors avoid foods that are bowel irritants(raw fruits; veggies; spicy foods; carbonated beverages) small frequent meals administer meds as prescribed assess and promote self care strategies

Thoughts interventions

assess mental and neurologic status use clear simple language establish daily routine orientation technique strategies to improve functional ability instruct and involve family in communication and care

What do anti HIV drugs attempt to inhibit

attempt to block viral replication by inhibiting either reverse transcriptase or the HIV protease.

The rate of viral load decline toward undetectable levels are affected by what factors:

baseline T cell count initial viral load potency of medication adherence to medication regimen prior exposure to antiretroviral agents and the presence of any OI's.

Why does the window period occur in the primary infection period?

because a person is infected with HIV but test negative on the HIV antibody blood test.

p24 anitgen

blood test that measures viral core protein; accuracy of test is limited because the p24 antibody binds with the antigen and makes it undetectable.

CCR5

cell surface molecule that is needed along with the CD4 molecule to fuse with the membranes of the host's immune system cells

B-cell lymphoma

common malignancy in patients with HIV/AIDS

HIV encephalothapy

degenerative neurologic condition characterized by a group of clinical presentations including loss of coordination, mood swings, loss of inhibitions, and widespread cognitive dysfunctions; formerly referred to as AIDS dementia complex. (ADC)

peripheral neuropathy

disorder characterized by sensory loss, pain, muscle weakness, and wasting of muscles in the hands or legs and feet

reverse transcriptase

enzyme that transforms single-stranded RNA into the double-stranded DNA

Skin interventions

frequent routine skin assessment maintain balance b/w rest & activity reposition every 2 hours pressure reduction devices avoid scratching avoid adhesive tape

Opportunistic infection (OI)

illness caused by various organisms, some of which usually do not cause disease in persons with normal immune systems

Nursing Process Diagnosis of AIDS

impaired skin integrity diarrhea risk for infection activity intolerance disturbed though processes ineffective airway clearence pain imbalanced nutrition social isolation anticipatory grieving deficient knowledge

Wasting syndrome

involuntary weight loss of 10% baseline body weight with chronic diarrhea or chronic weakness and documented fever

Macrophage

large immune cell that devours invading pathogens and other intruders. Can harbor large quantities of HIV without being killed, acting as a reservoir of virus

Monocyte

large white blood cell that ingests microbes or other cells and foreign particles. When a monocyte enters tissues, it develops into a macrophage.

anergy

loss or weakening of the body's immunity to an irritating agent or antigen

Kaposi's sarcoma

malignancy that involves the epithelial layer of blood and lymphatic vessels. (MOST COMMON AIDS RELATED MALIGNANCY--> CUTANEOUS LESIONS THAT MAY INVOLVE MULTIPLE ORGANS FOR DISCOMFORT)

What are the goals of treatment for a person with HIV infection:

maximal and durable suppression of viral load; restoration/preservation of immunologic functions; improved quality of life; and reduction of HIV related morbidity and mortality.

Viral load test

measures the quantity of HIV RNA in the blood

Protease inhibitor

medication that inhibits the function of protease, an enzyme needed for HIV replication.

Nutrition intervention

monitor weight monitor I&O oral hygiene dietary supplements

Final step of HIV life cycle:

new viral particles bud from the cell and start the process over.

Antiretroviral Agents Treatment

nuceloside reverse transcriptase inhibitors non-nucleoside reverse transcriptase inhibitors protease inhibitors integrate inhibitors use of combination therapy.

Myobacterium avium complex (MAC)

opportunistic infection caused myobacterial organisms that commonly causes a respiratory illness but can infect other body systems.

progessive multifocal leukoencephalopathy (PML)

opportunistic infection that infects brain tissue and causes damage to the brain and spinal cord.

Potential complications of AIDS

opportunistic infections impaired breathing or respiratory failure wasting syndrome fluid and electrolyte imbalance adverse reaction to medications

Managing potential problems and collaborative care

opportunistic infections respiratory failure medication side effects educate about self-care community and support system emotional and ethical concerns

Assessment of AIDS

physical and psychosocial status identify potential risk factors (drug abuse; sexual practices) immune system function nutritional status skin integrity respiratory/neurologic status fluid & electrolyte balance knowledge level

Interventions for airway clearence

position semi-fowlers or high fowlers pulmonary therapy, coughing and deep breathing, postural drainage, percussion

Isolation Assessment

promote atmosphere for acceptance and understanding assess social interactions allow patient to express feelings address psychosocial issues provide information related to the spread of infection

alpha-interferon

protein substance that the body produces in response to infection

What are the symptoms associated with primary infection?

ranges from none to severe flu-like symptoms. [ malaise, fatigue, N/V, rash]

Activity intervention

relaxation measures collaboration with other members of health care energy conservation techniques

HIV-1

retrovirus isolated and recognized as the etiologic agent of AIDS

Describe the modes of transmission for the HIV infection

sexual contact (trauma to the rectal and vaginal areas) transfusion of contaminated blood or blood products use of contaminated needles placental transmission from an infected mother to a fetus through cervical or blood contact at delivery breast milk from an infected woman

When should viral load levels be measured?

should be measured immediately prior to and again at 2 to 8 weeks after initiation of antiretroviral therapy.

Seventh Step in HIV life cycle:

the new proteins join the viral RNA into new viral particles

Window period

time from infection with HIV until seroconversion detected on HIV antibody test.

Provirus

viral genetic material in the form of DNA that has been integrated into the host genome. When it is dormant in human cells, HIV is in a proviral form.

HIV-2

virus closely related to HIV-1 that has also been found to cause AIDS

Human papillomavirus (HPV)

virus that causes venereal warts

candidiasis

yeast infection of skin or mucous membrane