HIV and Juvenile Idiopathic Arthritis Quiz

Introduction to Immunology Course

• Course title: Introduction to Immunology
• Presenter: Sarah Nixon RN MN
• Date: January 14, 2025

Topics and Objectives

• Topics: Human Immunodeficiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS), Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA), Juvenile Idiopathic Arthritis, Severe Combined Immunodeficiency (SCID), Pediatric conditions, Long Covid
• Objectives: Reflect on anatomy and physiology of the immune system and its connection to chronic illness, explain pathophysiology of listed conditions, examine relevant nursing assessments, clinical manifestations and relevant lab values for various conditions

HIV and Acquired Immune Deficiency Syndrome (AIDS)

• Global HIV/AIDS prevalence (2019): 38 million people
• HIV's effect: Infects and destroys CD4+ T-helper cells (Th cells)
• Other CD4+ cells affected: Monocytes, macrophages, astrocytes, oligodendrocytes
• HIV’s destructive nature: Th cells activate B cells and Killer T cells in response to invaders
• HIV reproduction: Requires host cells
• Retrovirus nature: HIV is a retrovirus

HIV Transmission

• Transmission methods include: blood-borne pathogens, blood/blood products, IV medication use, heterosexual and homosexual activity, and maternal-child transmission (low risk via breast milk)
• Transmission methods excluded: mosquitoes, ticks, other insects, hugging, shaking hands, sharing dishes/toilets, or social kissing that does not involve fluid exchange, or exchanging body fluids

HIV Pathophysiology

• Initial viremia: High viral load, see peak blue wave
• Latency period: 2–12 years
• Progression: Ability of HIV to destroy CD4+ Th cells exceeds body's ability to replace them, leading to lower CD4+ counts, and a compromised immune system, resulting in the development of severe health problems (AIDS), fewer than 200 CD4+ T cells/cubic millimeter constitutes AIDS

Diagnostic Tests

• Nucleic acid tests (NATs): Check blood for viral RNA to determine viral load
• Antibody and antigen tests: Test for presence of HIV antibodies and antigens. HIV produces antigen p24 before antibodies. Antibody tests can be done via venous blood, oral fluid, or finger prick.

Typical AIDS Progression

• Asymptomatic seronegative status
• Asymptomatic seropositive status
• Subclinical immunity deficiency
• Lymphadenopathy (early AIDS)
• AIDS-related complex (middle stage) with symptoms
• AIDS (in later stage)

AIDS Clinical Manifestations

• Fatigue: Unexplained weight loss (>10%), fever;
• Lymphadenopathy: Swollen lymph nodes
• Skin/mucous lesions: purplish-red nodules, and skin lesions. Can include oral thrush.
• Cough: Persistent diarrhea; oral thrush (tongue/mouth);
• Perianal lesions: Herpes simplex infection
• Cancers: Kaposi's sarcoma, other cancers related to AIDS
• Cytomegalovirus retinitis: Infections in the eyes.

Opportunistic Infections

• Fungal infections: Candidiasis, cryptococcus, coccidioidomycosis, histoplasmosis
• Bacterial infections: Mycobacterium avium complex (MAC), tuberculosis, nocardiosis, salmonella
• Viral infections: Cytomegalovirus (CMV), herpes simplex
• Other infections: Cellulitis, osteomyelitis, endocarditis, varicella zoster virus

HIV and AIDS Nursing Assessment

• Nursing assessment for HIV: Neuro, CV, Resp, GI, GU, Integ; Health History, Labs.
• Nursing assessment for AIDS: Neuro, CV, Resp, GI, GU, Integ; clinical symptoms of opportunistic infections; analysis of CD4 cell counts; labs.

Obstetric Considerations for HIV Positive Women

• Increased risk of preterm labor, premature rupture of membranes, perinatal loss, IUGR
• Post-partum risks: UTIs, vaginitis, postpartum endometritis, poor wound healing, HIV-related thrombocytopenia (increased risk for hemorrhage)

Neonatal/Pediatric AIDS

• Neonatal Transmission: Placental, blood contact at birth, breastfeeding
• Symptoms often different than adult cases.
• Increased risk for non-hodgkin lymphoma, Kaposi sarcoma.
• Common signs: Oral candidiasis, bacterial infections, failure to thrive, developmental delay, parotitis, lymphadenopathy, hepatosplenomegaly, chronic or recurrent diarrhea. Includes oral lesions, and other infections.

Systemic Lupus Erythematosus (SLE)

• Autoimmune disease
• Affects: 1 in 2000 Canadians
• Most common in women (20-40 age range)
• Increased risk for black individuals
• Etiology: chronic, inflammatory, connective tissue disease of unknown origin (multifactorial)
• Characterized by butterfly rash
• Includes skin and mucosal lesions

SLE Clinical Manifestations

• Common clinical manifestations: fatigue, fever, muscle pain, headache, skin lesions (including butterfly rash), joint pain, cardiovascular diseases, hematological abnormalities, kidney disease. Often systemic throughout the body

SLE Pathophysiology

• Autoimmune response against one's own tissues: Inflammatory process; Autoantibodies (immunoglobulins aka RF – Rheumatic factor). RF binding to antigens, formations of immune complexes, increasing RF levels in the blood, and increase in inflammatory response are part of the condition’s vicious cycle.

SLE Nursing Assessment-

• Neurological assessments: seizures, cognitive disturbances, strokes, meningitis, headaches
• Cardiovascular assessments: Dysrhythmias, HTN, hypercholesterolemia, edema, antiphospholipid syndrome, pericarditis
• Respiratory assessments: Tachypnea with cough, pleurisy
• Gastro-intestinal assesments: abdominal pain
• Genitourinary assessments: Lupus nephritis, end-stage kidney failure
• Integumentary assessments: Malar rash, alopecia, discoid erythema, urticaria, purpura, petechiae, leg ulcers
• Musculoskeletal assessments: polyarthralgia, morning joint stiffness, arthritis. Includes skin manifestations
• Lab tests: CBC, ANA, electrolytes, magnesium, TNT, coagulation, CRP

Rheumatoid Arthritis (RA)

• Chronic, systemic, inflammatory autoimmune disorder
• Affects joints symmetrically (wrists, hands, elbows, shoulders, knees, and ankles).

RA Pathophysiology

• Inflammatory process
• Autoantibodies (immunoglobulins) known as RF form immune complexes.
• Stimulation of T and B lymphocytes increases RF levels, increasing the inflammatory response.
• Affects joints symmetrically.
• Pannus formation: vascular tissue that erodes cartilage
• Leads to joint destruction.

RA Clinical Manifestations

• Onset: Usually gradual
• Course, progressive with remission and exacerbations
• Pain & Stiffness: Predominant on arising, lasting more than an hour, can occur after prolonged inactivity
• Affected joints: Appear red, hot, swollen and tender; decreasing range of motion, and weakness
• Systemic manifestations: Fatigue, weakness, anorexia, weight loss, fever, rheumatoid nodules and anemia
• Commonly involves the hands and feet

RA Deformities

• Swan neck deformity
• Boutonniere deformity
• Ulnar deviation
• Hallux valgus

RA Complications

• Joint destruction, flexion contractures, hand deformities, difficulty grasping, nodular myositis
• Cataracts, glaucoma
• Nodules on vocal cords, carpal tunnel syndrome, cardiac complications, pulmonary complications, lymphadenopathy and splenomegaly
• Includes skin rashes.

RA Nursing Assessment

• Neurological: pain, fatigue, brain fog, weakness, fever,
• Cardiovascular: anemia, thromboses, vasculitis,
• Respiratory: pleuritis, parenchymal nodules, pneumoconiosis, Caplan syndrome, diffuse pulmonary fibrosis
• Gastrointestinal: anorexia, weight loss, mesenteric infarction,
• Genitourinary: kidney damage
• Musculoskeletal: pannus, joint stiffness, joint deformities, and rashes
• Skin: Rashes, nodules
• Labs: CBC, ESR, RF, anti-CCP, ANA, CRP.
• Includes possible skin lesions.

Juvenile Idiopathic Arthritis (JIA)

• Childhood inflammatory autoimmune condition affecting joints, lymph nodes, and spleen
• Requirement for diagnosis: At least 6 weeks of arthritis
• Distinct onset styles: Oligoarthritis (3 or fewer joints); Polyarthritis (more than 3 joints); Still's disease (severe systemic onset)

JIA Differences from RA

• Common in JIA: Chronic uveitis (eye inflammation);
• Serum tests may exclude Rheumatoid Factor (RF).
• Potential for cervical spine subluxation and ankylosis
• Can have significant effects on growth and adult morbidity with long-term disease progression. Includes possible skin lesions.

JIA Clinical Manifestations

• Insidious or abrupt onset, often with morning stiffness, complaints of joint pain or abnormal joint use, history of absences from school or physical education classes.
• Spiking fevers are common
• Rash may occur
• Includes possible associated conditions like psoriasis.

Long COVID

• Post-COVID-19 condition
• Epidemiology: Prevalence in the UK (3-11.7% in 12 weeks).
• Substantial impact on social and professional life
• Etiology: Limited knowledge, with antibodies against ACE2 receptor, possible inflammation, involvement of the nervous system, and dysregulation of the immune system
• Possible symptoms including fatigue, shortness of breath, chest pain, cough, headache, and cognitive problems. Symptoms can fluctuate over time.

Long COVID Clinical Manifestations

• Neurological: cognitive and mental health disorders, pain, headaches, fatigue, anosmia (loss of smell) or ageusia (loss of taste), numbness and tingling.
• Cardiovascular: Fatigue at rest, dyspnea, chest pain
• Respiratory: Dyspnea, chest pain, cough
• Gastrointestinal: Abdominal pain, bloating, changes in bowel habits
• Immune disorders: Continuing inflammation, disrupted microbiome, autoimmunity.
• Other: skin rashes, irritation, problems with taste, skin lesions
• Includes problems with sleep, and neurological problems.

Long COVID Nursing Assessment

• Neurological: sleep disturbances, fatigue, headaches, taste/smell loss, numbness, and nerve pain.
• Cardiovascular: Fatigue, SOB, chest pain
• Respiratory: Shortness of breath, dyspnea, chest pain, cough
• Gastrointestinal: Abdominal pain, bowel issues
• Musculoskeletal: DVT risk factors, pain, swelling in the lower legs, irritation to skin.
• Skin: rashes and irritation
• Labs: CBC, Lytes, LFTs, Troponin, CRP, D-dimer
• Includes additional assessments for neurological and other issues based on symptoms.

Key Points Review

• Proper head-to-toe assessment is crucial for understanding HIV/AIDS-related illnesses (neuro, CV, Resp, GI, and GU systems), SLE, and RA and connections to other systems.
• Lab value alterations and immunity are significant for accurate assessment
• Focus on pathophysiology, clinical manifestations, and nursing skills for relevant illnesses.
• Emphasizing the importance of distinguishing between conditions with overlapping symptoms is important

Test your knowledge on the effects of HIV on the immune system and key aspects of Juvenile Idiopathic Arthritis. This quiz covers important topics such as transmission methods, symptom identification, and diagnosis requirements. Dive into the knowledge of immunology and pediatric diseases in one go!