-
HIV
- retrovirus transmitted by direct contact with body fluids
- attaches to CD4 cells (T-helper)
- sexual contact
- needle sharing
- transfusions
-
body fluids
- high risk
- --blood
- --CSF
- --semen
- moderate risk
- --vaginal
- --breast milk
- low risk
- --urine
- --tears
- --saliva
- no risk
- --stool
- --sweat
-
early HIV - infection
- exposure
- replication of viral DNA
- blood test negative for first few weeks (up to 6 months)
- still contagious
-
seroconversion
- antibodies produced
- Ab detectable
- CD4 cells infected
-
stages of HIV
- 1. transmission
- 2. ARS - acute retroviral syndrome - flu like symptoms - days to weeks after infection
- 3. seroconversion
- **HIV disease - asymptomatic - CD4 > 500
- **AIDS defined - CD4 < 200 or HIV+ with opportunistic infection
- **Advanced AIDS - CD4 < 50
-
AIDS dementia
- most common cause of mental status change
- early: memory loss, confusion, lethargy
- late: dementia, ataxia, tremor, incontinence, paraplegia
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AIDS neuro manifestations
- PNS: sensory neuropathy (pain, numbness), Guillian-Barre
- CNS: opportunistic infections (toxoplasmosis [Zithromax], Non-Hodgkin's, cryptococcal meningitis, CMV)
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opportunistic infections
- CD4 < 500 - immunodeficient
- CD4 < 200 - opportunistic infections/cancers likely
-
pneumocystis pneumonia
- PCP/PJP
- 75-80% of AIDS patients
- 55% survive first episode
- 25% survive second episode
- **treated with pentamidine (prophylactic after first episode)
-
tuberculosis
- 4% of AIDS patients
- PPD - > 5mm = positive because HIV+ patients can't mount immune response
- dx with bronchoscopy (cannot sputum culture because lack of sputum)
-
candidiasis
- oral thrush
- treated with nystatin
-
mycobacterium avium complex (MAC)
- 25% of AIDS patients
- from fresh food (bac in soil)
- causes "wasting syndrome"
- CD4 < 50
-
other infections
- herpes simplex/zoster
- CMV - blindness, GI tract, lungs
- salmonella
-
Kaposi's sarcoma
- AIDS defined
- 18 month prognosis
- painless lesions, rapid growth
- GI tract (bleeds)
- dx with biopsy
-
other cancers
- Non-Hodgkin's lymphoma
- lymphoma of the brain
- cervical cancer (pap every 6 months)
-
diagnostic tests
- ELISA - repeat (same sample) if positive
- Western blot - confirmation (same sample)
- viral load - increases as HIV progresses
- CBC - anemia, leukopenia, thrombocytopenia
- CD4 count - monitor progress (s/b > 500)
- PPD
- MRI - brain lesions
- cultures/serologies for infections
- pap smears every 6 months
-
Rapid HIV test
- 20 minute
- follow up with ELISA x2, Western Blot
-
goals for care
- early identification
- health maintenance
- prevent infections
- treat complications
- emotional support
-
treatment
- goals: decrease viral load and prevent opportunistic infections
- H&P
- CBC/chemistry
- Viral load/CD4
- treatment starts at CD4 <350
- **client must be assessed for readiness for medication adherance (>95%)
-
HAART
- highly active antiretroviral therapy
- multiple drug therapy
- 3 or more antiretrovirals
- stop HIV from replicating at multiple stages
- discontinuation can be dangerous
-
NRTIs
- reverse transcriptase inhibitors
- AZT
- Retrovir
-
NNRTIs
- reverse transcriptase inhibitors
- Viramune
- Sustiva
-
other meds
- Protease inhibitors
- Fusion inhibitors (last choice)
-
complications of HAART
- lactic acidemia
- lipodystrophy (truncal obesity)
- dyslipidemia
- insulin resistance
- cardiovascular disease
- bone demineralization
- peripheral neuropathy
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