N440 - HIVAIDS

Immunity: HIV/AIDS I. HIV – human immunodeficiency virus a. Can lead to AIDS b. No cure but can be controlled c. Affects specific cells of the immune system d. Antiretroviral therapy e. Need testing for a positive diagnosis II. AIDS – acquired immunodeficiency syndrome a. Final state of HIV b. Immune system = badly damaged c. CD4 cell count falls below 200 d. Develops one or more opportunistic infections e. Poor prognosis III. South Dakota HIV/AIDS prevention program: a. GOALS include: i. ↓ number of people who become infected with HIV ii. ↑ access to care and improving health outcomes for people living with HIV iii. Reduce HIV-related health disparities IV. Financial Implications: a. $2,00-$5,000/mo average for AIDS patients b. Medicaid/title 19 covers most c. Ryan White fund – helps pay for meds d. Drug company grants e. Loss of job, go on permanent disability i. Hug cost to society V. Pathophysiology of HIV: a. Virus i. Intracellular parasite -> use infected cells’ resources to reproduce b. Can infect a cell and take over its functions to force the cell to make more copies of the virus c. REPEAT cycle VI. Effects of HIV infection: a. Not everyone with HIV has AIDS b. Number of CD4 + T-cells and whether any opportunistic infections have occurred i. Healthy adult = 800-1,000 CD4 + T-cells c. Acute infection w/in 4 weeks of first being infected i. Fever, night sweats, chills, headache, muscle aches, rash, sore throat

d. As time passes – more CD4 + T cells are infected and taken out of immune system service i. Lymphocytopenia ii. ↑ production of incomplete and nonfunctional antibodies iii. Abnormally functioning macrophages e. Opportunistic infections i. Reduced immunity -> harmless organisms to overgrow and cause infection VII. HIV classifications – 5 stages of HIV disease a. Stage 0 i. 1 st + HIV test result w/in 6 months after – test result b. Stage 1 i. CD4+ T-cell count <500 ii. No AIDS-defining illness c. Stage 2 i. CD4+ T-cell between 200-499 ii. No AIDS-defining illness d. Stage 3 i. CD4+ T-cell count <200 e. Stage unknown i. Any pt. w/ a +HIV infection but no information regarding CD4+ T-cell counts VIII. HIV progression a. Time frame form the beginning of HIV infection to development of AIDS ranges from months to years b. Viral load i. Amount of virus present in the blood and other body fluids ii. ↑ the blood level of HIV, ↑ risk for sexual and perinatal transmission iii. Current therapy has caused the viral load of some patients to drop below the detectable levels IX. Persons at risk for HIV a. Intravenous drug users b. Persons with STDs – open sores c. Unprotected anal, oral, or vaginal sex i. Teach ALL adults and young adults the importance consistently using safe sex practices d. People with high-risk partners or multiple partners e. Transfusion recipients i. 1:676,000 X. According to the CDC the following should be tested: a. People with STD b. Injection drug users c. People who consider themselves at risk

c. For a select population that is at high risk for acquiring HIV infection d. Pt. not protected until 4 days of consistent dosing i. Two consecutive doses significantly reduced protection XIV. Post-exposure prophylaxis a. Post exposure prophylaxis generally falls into one of three exposure categories i. Those who have had an occupational exposure, non-occupational exposure, suffered sexual assault b. Once exposure has been discovered i. 3-drug cART within 2 hours of the exposure has the best possible outcome in preventing HIV 1. Take for 28 days or wait for negative results XV. Perinatal transmission a. HIV transmission can occur across the placenta during pregnancy i. Exposure to blood or vaginal secretions during birth ii. Exposure after birth through breast milk b. Inform women of child bearing age with HIV about the risks for perinatal transmissions c. Pregnant women WITH HIV infection - medication i. Not using – 25% transmission ii. Using – 8% transmission d. Encouragement to continue therapy or to start therapy as soon as possible if HIV + e. Repeated exposure to the virus during pregnancy can increase the risk of transmission to the fetus f. Zidovudine (Retrovir) – recommended for the prevention of maternal to fetal HIV transmission i. Administered orally – 14 weeks after gestation ii. IV – during labor iii. Syrup form – NB for 6 weeks after birth g. Babies born to HIV + mothers may test + because antibodies received from the mother may persist for 18 months h. Increased exposure risk: i. Tearing ii. Internal monitoring iii. Birth canal iv. Avoid episiotomy v. Decrease amount of Pitocin XVI. Signs and symptoms of HIV infection a. May be asymptomatic for 7-10 years b. Flu-like or mononucleosis – like illness i. Fever ii. Malaise iii. Rash iv. Lymphadenopathy

v. Meningitis vi. Night sweats vii. Diarrhea viii. Wgt. Loss ix. Oral thrush x. Vaginal yeast infections xi. Myalgia xii. Pharyngitis XVII. Stages a. Acute retroviral syndrome (ARS) or primary HIV infection i. Often described as worst flu they’ve ever had ii. Difficult to diagnose iii. Symptoms: flu-like (body’s natural response) iv. Rapid replication b. Asymptomatic infection (latency) i. Virus is living or developing in a person (without producing symptoms) ii. Reproduce at low levels – still replicating but not as quickly iii. 7-10 years can still transmit c. AIDS i. Immune system is badly damaged ii. Vulnerable to opportunistic infections iii. CD4 <200 or 1/more opportunistic infections XVIII. Ways to control transmission a. GOAL: often is more realistic to decrease risk than to alleviate risk b. Education: i. Safe sex ii. No sharing needles iii. Prophylaxis iv. Abstinence c. Prevention (shock therapy for teens) having HIV positive teens talk d. For HIV +people – teach them about the prevention of getting and passing different strains of HIV e. Pre-exposure prophylaxis (PrEP) XIX. HIV diagnosis a. Medical hx and thorough physical b. Monitored on a regular basis; frequency varies c. Antibody screening – most common d. Antibody and antigen tests

XXIII. Complications: a. Malignancies i. HIV/AIDS are at increased risk for some cancers and includes 1. Kaposi’s sarcoma, lymphomas, invasive cervical cancer, lung cancer, GI cancer, and anal cancer a. Kaposi’s sarcoma – most common, develops small/purplish/brown/raised lesions, not painful or itchy XXIV. AIDS clinical manifestations a. AIDS dementia complex i. CNS involvement b. AIDS wasting syndrome i. Alt. metabolism from cancer or infection ii. Diarrhea, malabsorption, anorexia, and oral//esophageal lesions c. Skin changes i. Dry, itchy, irritated skin d. Kidney problems XXV. HAART therapy a. Doesn’t kill the virus, just inhibits b. Meds: “triple therapy” i. Nucleoside reverse transcriptase inhibitors 1. Block the reverse transcriptase, thus inhibiting viral replication ii. Non-nucleoside reverse transcriptase inhibitors 1. Used later in disease since body resists them quickly iii. Protease inhibitors 1. Block the protease enzyme which is needed for HIV replication iv. Tx usually includes 3 or more of these given together c. Drug therapy reduces viral load, improves CD4+T-cells and slowed disease progression d. Patient education i. Take at same time every day ii. Take meds with you if you are leaving home iii. Refill 1 week before you run out XXVI. Medical and nursing treatment a. Misc. investigational drugs b. Education – prevention and medication c. Tx of opportunistic infection d. Radiation/chemo for HIV related malignancies e. Counseling/therapeutic communication f. Avoid being judgmental g. Acupuncture/herbs – know what he/she is doing

XXVII. Nutrition a. Lots of non-caffeinated fluid b. High calorie, high protein c. Supplements and vitamins d. Avoid… i. Raw eggs, undercooked meat, unpasteurized milk or juice, fresh fruits and veggies (neutropenia diet) e. ENCOURAGE WATER XXVIII. Legal and ethical implications a. REPORTING i. CDC – all states require MDs report AIDS cases, and all states require the reporting of HIV ii. Employer – ADA helps but it is not a guarantee against discrimination iii. Partner – required by law (most states) b. Anonymous testing c. Tx pt with HIV d. Confidentiality