List patho of HIV
What are its target cells?
What is the process called as it enters the host?
How many cells per day does HIV destroy?
Replicates inside a living cell, using their RNA and inserting into the host DNA (retrovirus)
Target hosts are CD4 T-cells (type of lymphocyte)
Fusion: entry pathway of virus into host cell
Destroys: 1 billion CD4 cells per day
- While they can be replaced, it will exhaust eventually, causing impaired immune function
List values of CD4 T cells/ul:
From healthy to severe
Healthy: >500 CD4 T cells/ul
Abnormal-unhealthy: <500
Severe: <200
Stage 1 HIV class
1. This term occurs within the first few weeks of an initial infection where HIV antibodies develop and become detectable.
2. This term is when there are large amounts of the virus in the blood
3. s/s with first 2-4 weeks?
4. Other characteristics? (2)
1. Seroconversion
2. Verimia
3. Flu/mono like symptom
4. Very contagious and person often unaware of infection
Stage 2 HIV class
List characteristic of when an acute HIV infection can be classified as chronic
List some symptoms that can show
A person can be asymptomatic up to 10+ years, as the viral load is active at low levels
As CD4 levels decrease and viral load increases, they will finally become symptomatic
- fever, night sweats, diarrhea, severe fatigue, and outbreaks (candida, shingles, herpes)
What is the CDC diagnostic criteria for AIDS?
Person has to be HIV positive and presents with at least one of the following:
1. CD4 T cell count <200 cells/ul (normal = 800-1200)
2. Has one of many opportunistic infections/cancers
- this refers to people who are more prone to infections/cancers d/t a severely compromised immune system from HIV for this example
Even though cytomegalovirus is very common and remains dormant, when can it cause serious health issues?
How is it treated
It can cause serious health issues to persons with weakened immune systems or immature ones in newborns.
encephalitis, PNA, retinitis, gastroenteritis
tx: Foscarnet
List clinical progression characteristics
Beginning
Few years
SEveral years
10 years
Beginning: asymptomatic
Few years: mild weight loss, mouth ulcers, itching, skin dz
SEveral years: important weight loss, trush, TB, fever
Why is ART recommended for ALL HIV positive people?
What is the dosing strength based on?
It prevents dz progression, and transmission of infections
Strength based on: CD4, transmission risk
An AIDS patient is asking why he needs to have regular opthalmologic exams for his retinitis if he is already taking Foscarnet for his CMV. What is the appropriate response?
Foscarnet is not a cure for CMV, as progression of CMV retinitis may continue in immunocompromised patients during and after therapy.
T or F: HIV can be spread through breast milk
True
What is the common PPE required for HIV patients?
Patients with HIV will be in standard precautions.
Gowns, masks, glasses, etc. indicated if there is chance of exposure from blood spatter, sprays, droplets, etc.
List 3 HIV testing methods
Dx testing for HIV antibodies and antigens can be done in blood or saliva:
1. What is the limitation of the rapid antibody testing?
2. How soon can results be ready?
3. Name two of the tests
4. after the first test result is done, what will you tell the patient to do next?
1. this test cannot detect HIV within a window period of 2 months between infection and when there is a "detectable" amount of antibodies
2. Results ready in about 20 minutes
3. Names: OraQuick HIV Test and Home Acces HIV-1 Test System
4. After a positive test, needs confirmatory testing with a blood draw
- After a negative test, needs a follow-up of risk assessment to determine if repeat test is needed.
1. What can the 4th generation HIV test do that the rapid antibody testing cannot?
2. How does it do this?
3. If a negative result occurs, how soon should they come back for another retest?
1. It can detect HIV within the 2-month window period where there is an undetectable amount of HIV antibodies.
2. It tests for both HIV antibodies AND antigens
3. 4-6 weeks and have pt. report for any risky behaviors
1. The Nucleic Acid Test (NAT) for HIV is the most expensive out of the Rapid and 4th generation test. However, what is its benefit over those two tests?
2. What type of patient is it indicated for?
3. How long can it take to detect HIV?
1. It can detect for HIV the earliest by measuring viral load.
2. Used for high-risk exposure or early sx of HIV
3. It may take 7-23 days to detect HIV, so it's best practice to combine test with 4th generation (combination) with NAT.
What are these acronyms:
ART
ARV
HAART
PrEP
Which one is used for adults at high risk of sexually acquired HIV? What two drugs are used to do this?
ART: anti retroviral therapy
ARV: anti retro virals
HAART: highly active anti retroviral therapy
PrEP: Preexposure prophylaxis
- combo drugs: Tenofovir and Emtricitabine (Truvada)
Describe how these Tx of HIV/AIDS disrupts the virus
Entry Inhibitors
NRTI
NNRTI
Integrase Inhibitors
Protease inhibitors
Entry Inhibitors: prevent binding to host cells at receptor point
NRTI: (Nucleoside reverse transcriptase inhibitors) inserts a piece of DNA into HIV DNA chain, blocking its development
NNRTI: (Non-nucleoside reverse transcriptase inhibitors) Blocks conversion of HIV RNA to DNA
Intigrase Inhibitors (II): blocks integration of viral DNA into host
Protease Inhibitors (PI): blocks HIV replication
This HIV tx class changed HIV from a terminal disease to a "chronic disease"
What are the ART drugs that are commonly being used post 2010 that went from 10 pills in 96, to 2, today?
ART: antiretroviral therapy
Truvada and Sustiva
What must you teach patients about ART?
Meds to be taken on time, at the same time, everyday
this is because low blood concentrations, if not taken consistently, allow HIV to mutate
List the goal of drug therapy for HIV
Prevent opportunistic Infections
Delay disease progression
Prevent HIV transmission
Drug resistance testing:
What value viral load (copies/ml) will genotype testing be most successful?
How will the results from this be used?
>1000 copies/ml
It is used as an initial form of resistance testing (over Phenotype) and is also used to select an effective ART
Drug Resistance Testing:
How is Phenotype testing done and how long is the process?
Who is this test recommended for?
A strain is grown with escalating amounts of ART drugs and the process takes 2-3 weeks (costly)
It is recommended for patients with complicated multidrug resistance patterns.
List strategies to improve drug adherence to HIV tx
choose one daily dosing (if possible)
Provide tools: reminder alarms, text msg reminders, pill boxes, etc.
