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What are some body fluids that can transmit HIV/AIDS?
blood, semen, vaginal secretions and primary transmitters, and breast milk
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Pathopysiology of HIV/AIDS (how does the virus infect the cells) 1st steps to taking over
- virus is a parasite that must take over another cell to multiply
- virus has special "docking proteins" known as gp41 and gp 120 that help it locate a host
- inside the virus are genetic material (single strand RNA) and reverse transcriptase
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Pathophysiology 2nd steps of the HIV/AIDS virus taking over
- virus bumps into many cells, but the CD4 cells has receptors on its surface (it fits CD4 cell like a lock and key perfectly)
- the viral docking proteins gp41 and gp120 bind to the protein receptors on the CD4 cell
- HIV is a retrovirus- it contains only one strand of RNA. to take over the CD4 cells DNA, the virus uses reverse transcriptase to convert the viral RNA to DNA.
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How does the virus take over the CD4 cell
Since HIV is a retrovirus (contains only one strand of RNA). to take over the CD4 cells DNA, the virus uses reverse transcriptase to convert the viral RNA to DNA
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what allows the virus to take over the CD4 cells RNA and change it to DNA
the enzyme reverse transcriptase
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pathophysiology of HIV/AIDS (Hiv uses another enzyme to insert its DNA into the host cells DNA what is that enzyme
integrase
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after the enzyme "integrase" insert it's DNA into the host cells DNA what happens
New HIV particles are made in the infected CD4 cell and these particles need to be cut into pieces to work. (this is done by an enzyme called Protease.
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after the pieces are cut by the enzyme protease what happens to the pieces
finally these pieces are joined together to make a new virus which fuse with the CD4 cell membrane and bud off the CD4 cell to look for another CD4 cell to infect
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Pathophysiology of HIV/AIDS broken down in simple steps (part 1)
- HIV enters the system
- HIV attaches or fuses to CD4 cell wall
- HIV enters cell
- HIV RNA converts to DNA with help of reverse transcriptase
- HIV DNA penetrates CD4 cell nucleus
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pathophysioloy of HIV/AIDS broken down in simple steps (part 2)
- DNA replicates HIV using protease (protease cuts into pieces, then pieces come together to form viral RNA)
- Accumulation of viral RNA
- New HIV assembled and Buds out of cell
- CD4 cell dies.
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How many phases of HIV are there and what are they
- Acute Retroviral Infection
- Asymtomatic HIV disease (latent phase)
- Symptomatic HIV disease (Progresses to AIDS)
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How many weeks does it take before we know the person has been infected
1-3 weeks after infected or up to 4-5 months after infected (so individualized, depends on how healthy the immune system is and how much you are exposed
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What are the symptoms of Acute Retroviral Infection
- Fever
- Chills
- Night Sweats
- Sore Throat
- Fatigue
- Nausea, vomiting, headache, muscle aches, rash, lymphadenopathy (swollen lymph nodes)
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In Acute Retroviral Infection what happens to the symptoms
most symptoms go away, lymph glands usually remain with multiple small swollen glands.
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In which phase is the viral load high and most transmission of the virus occurs
Acute Retroviral Infection
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most contagious during what stage
Acute Retroviral Infection, and also most contagious when they do not know they have the disease
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Period of latency is which phase
Asymptomatic HIV disease phase
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period of latency is how long
several months to 10 years or more
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person without symptoms or mild symptoms like fatigue, headache lymphadenopathy which phase
Asymptomatic phase
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CD4 (T helper ) cells destroyed and # declines which phase
Asymptomatic phase
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viral load lower than acute infection "set point" which phase
Asymptomatic phase
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When moves to the 3rd phase what will we see
immune sysytem so compromised that AIDS develops
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When the CD4 count drops lower than 200 what will we see
- it is the Symptomatic phase we will see AIDS
- also opportunistic Infections
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Which organs of the body can AIDS affect
every organ in the body
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where will we see the viral load rise rapidly again
Symtomatic phase
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Opportunistic infection and CD4 below 200 what is it
AIDS
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Category A (No symptoms)
- HIV positive, asymtomatic or persistent generalized lymphenopathy or
- Acute (primary) HIV infection with accompanying illness or history of acute infection as the only manifestation
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what is HIV
- an acquired infection in which HIV invades CD4 (T4 helper) cells, destroys the cell and uses the cell to help make copies of itself
- the result is severe immune deficiency
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is HIV curable
HIV IS STILL AN INCURABLE AND FATAL DISEASE
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What kind of illness is HIV
chronic illness
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bacterial endocarditis, meningitits, pneumonia or sepsis which category of infection is this
category B
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vulvovaginal candidiasis that persists for more than 1 month or poorly responds to treatment which classification system
category B
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Oropharyngeal candidiasis (Thrush) which classification system
Category B
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Which classification system has Severe cervical dysplasia or carcinoma
Constitutional symptoms like fever, diarrhea lasting longer than one month
Oral hairy Leukopenia (hairy tongue)
category B
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What classification system shows Herpes Zoster (shingles) involving at least 2 distinct episodes or more than one dermatone
Idiopathic Thrompocytopenic Purpura
Listeriosis
Pulmonary Mycobacterium tuburculosis infection
Narcardiosis, pelvic inflammatory disease, peripheral neuropathy
category B (with category B think Infections.
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To know that a classification of HIV CDC is a Category B what is a clue
Think Infection
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Bronchial, Tracheal, Pulmonary, or Esophageal Candidiasis are what classification of HIV CDC
Invasive Cervical Cancer
Disseminated or extrapulmonary coccidioidomycosis
Chronic Intestinal Cryptosporidiosis (drinking city water)
Cytomegalovirus disease other than taht of liver, spleen, or lymph nodes
Cytomegalovirus with vision loss
Category C (invades deep in body)
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HIV CDC classification system what will we see (Category C)
- HIV related encephalopathy
- Herpes Simplex (chronic: bronchitis, pneumonitis, or esophagitis)
- Disseminated or extrapulmonary histoplsmosis
- Chronic intestinal isosporiastis
- Kaposi's sarcoma
- Lymphoma (Berkitt's immunoblastic or primary brain)
- Disseminated or extrapulmonary Mycobacterium avium complex or M Kansasii
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HIV CDC classification system for category C what are some diseases we will see
- extrapulmonary Mycobacterium tuberculosis
- pneumocystis carii pneumonia
- recurrent infectious pneumonia
- progressive multifocal leukoecephalopathy (lesions on the brain)
- salmonella septicemia (cat litter uncooked pork or beef)
- Toxoplamosis (brain)
- wasting syndrome
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The person with HIV can transmit the virus to others at what stages
At all stages of the disease
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AIDS= CD4 Of what and/or what else
- AIDS= CD4 count <200 and/or an opportunistic infection
- progression of HIV
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What are some Diagnostic testing done for HIV
- Elisa (enzyme-linked immunosorbent assay) blood test (HIV antibody test)
- Western Blot confirmatory testing (looking for the gp41 and gp120 proteins)
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Which test is done first to test if person is HIV positive
Elisa Test (test looking for the HIV antibodies)
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Once a person tests positive for the Elisa test what is done next
then the Western Blot confirmatiory test is given it detects the HIV antigens
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what is the period of time after infection when testing will test negative for antibodies because body has not produced enough antibodies to be detected by blood test
The "Window Phase"
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how long can it take in the window phase for the test to turn positive
6 months
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during the window phase can the patient still infect others?
yes (during the window phase the person can have sex today but body has not produced the antibodies for it to be detected)
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during which phase is there a small chance that blood that has been screened can have HIV because the antibodies are not detected yet.
during the window phase
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if we have a false negative elisa test what will be done
the Western Blot test
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what blood tests are monitored in HIV patients
- CD4 (T helper)cells and CD8 (T suppressor) cells
- Viral Load (Quantitative RNA Assays)
- CBC (chronic panic level, low wbc <2
- Metabolic panel-liver enzymes, acidosis (monitor the liver)
- Initial testing should include screens for Hepatitis A, B, and C (high likelihood if exposed to HIV, could have been exposed to Hep A, B, and C
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the blood tests CD4 (t helper) and CD8 (T suppressor) cells measure what
measures how severely damaged immune system is (the lower the number the worse the damage)
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What does the Viral Load (Qunantitative RNA Assays) test measure
measures how much HIV is in the blood or serum (the higher the number the more serum present)
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When the Viral load is high what is the risk of passing the HIV virus to another person
risk is Greater
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Which hepatitis is bloodborne
B and C
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what are some things you cannot be infected with the HIV virus
saliva, mosquitos, toilets, utensils, drinking after someone
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What are some treatments of HIV
NRTI, nucleoside reverse transcriptase inhibitors ( stops HIV RNA from converting to DNA it needs reverse transcriptase to do this
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what are the first HIV drug and the drug of choice for HIV treatment
AZT
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what does the AZT drug do?
works on transcriptase enzyme we block that step and the virus cannot change it's RNA to DNA
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What is the CBC chronic panic level
low wbc <2
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what are some physical disadvantages of taking HIV meds
- they lose the fat pockets in their face sunk in cheeks stuck out bones Lipodystrophy (fat redistrubution)
- Buffalo hump- deposits of fat from taking HIV meds
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another treatment for HIV is NNRTI's what does this stand for and what does it do
nonnucleoside reverse transcriptase inhibitors (stops HIV RNA from converting to DNA)
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If virus mutates and is resistant to one NNRTI it is then what?
it is then resistant to all NNRTI's
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The majic drug used to treat HIV is called what
protease inhibitors
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protease inhibitors are another treatment for HIV what does protease inhibitors do
- stops the viral DNA from final step of replication
- drops the viral load to levels so low they are undetectable in the blood
- allows immune system to rebuild (increases CD4 T helper cells)
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what is the history behind protease inhibitors
in 1995 it changed HIV from rapidly fatal disease to chronic manageable disease
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when on protease inhibitors where did research find that the HIV virus hides
in the bone marrow
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which HIV treatment stops the virus from attaching to CD4 cell and fusing with the cell membrane (virus cannot get into the cell)
- fusion inhibitors (Fuzeon or T-20) subcut injection 2Times a day
- new medication in this category are in a pill form and soon to be released oral (celesteril)
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what is a major disadvantage of taking fusion inhibitors sub cut
development of lumps and bumps in the skin making it hard to find places to give the medicine
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what is the biggest side effect of protease inhibitors
GI upset
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what are some medications for HIV patients
- HAART (Highly Active Antiretroviral Therapy)
- Medication "cocktail" (mixture of at least 3 different medicines)
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combination of drugs from different classes, initially used 2 NRTI's and one NNRTI or 2 NRTI's and one protease inhibitor what is this called
medication cocktail
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How many drugs should be used for HIV patients
Never use just one or two drugs, must use at least 3 drugs (trying to hit the virus at all phases) and there are 3 phases of HIV
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what does the metabolic panel blood test monitor
liver enzymes, acidosis
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the initial testing for HIV should include what
screens for Hepatitis A, B, and C (high likelihood if exposed to HIV, could have been exposed to Hepatitis also)
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What is one of the biggest issues of people taking HIV meds
compliance is the biggest issue
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If a person misses one dose of their HIV meds what can happen
even one missed dose a month can lead to virus mutation that will make a new mutated virus that the medicine will not work on
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what are some more issues with taking HIV meds
- compliance
- pill burden or # of pills to take each day
- side effects of the meds
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what are some side effects of taking HIV meds
- 1. nausea, vomiting, diarrhea
- 2. peripheral neuropathy
- 3. lactic acidosis, pancreatitis, liver damage
- 4. lipodystrophy (fat redistrubution)
- 5. elevate cholesterol levels, insulin intolerance
- 6. many restrictions with how to take pills
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what are some treatments for the patient taking the HIV meds (Diet)
- 1. high calorie diet, high protein
- 2. work to get nutrients in with side effects of meds
- 3. low cholesterol diet
- 4. wasting syndrome
- 5. obesity, lipodystrophy, diabetes
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what are some treatments for the patient taking HIV meds and activity
no restrictions except working around patient's fatigue, med side effects
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how do people feel about HIV (what are some fears they have)
HIV is still a feared disease patients feel stigmatized, rejected and abandoned.
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patients need help coping how with HIV
emotionally
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How expensive can some HIV therapy be
can total $3000.00 per month
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HIV doctors (traditionally infectious)
disease doctors but managing HIV diseases is very time consuming
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case managers to keep track of patients, work on med compliance and make needed referrals for social, emotional and financial help what kind of referral is this
HIV clinic
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what are some resources in our area for people with HIV
- 1. Ryan White agency
- 2. Comprehensive Care Center
- 3. Trumbull County Area AIDS task force
- 4. Ursuline Sisters AIDS ministry
- 5. ODAP (ohio drug assistance program)
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assistance with medical bills, testing, medications, food, gas, other emergency needs ODAP (ohio drug assistance program which agency helps with these things
Ryan White Agency
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History taking on all patients should include what
accurate sexual history, assess for risk factors for HIV (unprotected sex) NON JUDGEMENTAL
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with HIV patients assess for which symptoms especially
especially fatigue and problems taking meds or problems maintaining weight
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what other infections should be assessed for in HIV patients
opportunistic infections
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what are some interventions for HIV
- 1. prevent infections
- 2. promote nutrition
- 3. control fatigue
- 4. support individual coping
- 5. promote strict compliance with medications
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what are some family teaching for HIV
Reinforce need for compliance with meds and close follow up with physician
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what else should be taught to patients with HIV and their family
HIV is not spread by casual contact
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in teaching the family how HIV is transmitted, what should be taught?
- 1. HIV is not transmitted from sharing bathrooms, sharing eating utensils
- 2. family members need to protect themselves from blood contact
- 3. sexual partners need to use barrier protection (condoms)
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what are some Opportunistic infections
- 1. bacterial- MAC (Infection that kill people with AIDS)
- 2. Fungal- Candidiasis, cryptococcosis, histoplasmosis
- 3. Protozoal Infections- Cryptosporidium pnemocystis carinii, Toxoplasmosis
- 4. Viral Infections- Cytomegalovirus, herpes simplex
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patient's immune system is so compromised they cannot fight off or defend against these infections which are all around us
opportunistic infections
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