Questions and Answers
What are the key components of high-quality HIV/AIDS palliative care?
What does the abbreviation ART stand for in the context of HIV/AIDS treatment?
Antiretroviral Therapy
HIV and AIDS are synonymous terms.
False
What is the primary goal of AIDS care?
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What criteria are considered for the admission of AIDS patients to hospice?
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Patients with AIDS have a relatively predictable disease progression similar to cancer.
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Early diagnosis of HIV and initiation of treatment leads to the prevention of ____________.
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What is the role of integrase in the HIV replication process?
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Which symptom is commonly experienced within 5 to 30 days of primary HIV infection?
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Advanced disease in HIV/AIDS can result in incontinence.
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When the CD4 count drops below 200 cells/mm3, HIV-infected individuals are at risk of __________ infections.
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Match the following conditions with their association to advancing HIV infection:
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What laboratory tests are recommended annually for HIV-infected persons?
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Complete blood count, chemistry profile, and urine analysis are important for staging HIV disease.
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What is the goal of Antiretroviral Therapy (ART)?
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LTBI diagnosis can be achieved with the use of tuberculin skin test (TST) or by interferon gamma ____ assay.
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Match the Antiretroviral Drug Class with its function:
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According to the content, what were some of the symptoms experienced by more than half of the sample population?
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Patients with an AIDS diagnosis had significantly lower symptom burden scores compared to those currently receiving ART.
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What is recommended by Alexander (2011) if antiretrovirals cause burdensome symptoms or the patient no longer wants to use the drug?
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The Edmonton Symptom Assessment Scale (ESAS) assists in the assessment of _ common symptoms.
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Match the following symptoms with their prevalence in the AIDS population:
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What are some stressors faced by individuals living with HIV/AIDS?
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A good diet can help delay HIV progression and improve the immune system.
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Metabolic alterations in patients with HIV may be due to HIV infection or secondary infections, as well as abnormalities in carbohydrate, fat, and _______ metabolism.
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What is one important health promotion activity recommended for patients with HIV/AIDS?
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What are some adjuvant therapies recommended for patients with AIDS-related pain?
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What were the 10 most commonly used complementary therapies and activities by participants in the study mentioned?
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Nonpharmacological interventions, such as bed rest, exercise, and acupuncture, are considered valuable in managing pain and symptoms in patients with HIV?
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_______ immunity, phagocytic function, and antibody response are impaired by deficiencies in diet.
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Match the following reported benefits with their corresponding activity:
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Study Notes
HIV/AIDS: An Overview
- HIV/AIDS is a global health epidemic, with 36.7 million people living with HIV globally, and 2.1 million people acquiring HIV in 2015.
- In countries with advanced healthcare, HIV/AIDS is managed as a chronic illness, while in resource-poor countries, individuals without access to care continue to die from AIDS.
Key Components of High-Quality HIV/AIDS Palliative Care
- Competent, skilled practitioners
- Confidential, nondiscriminatory, and culturally sensitive care
- Flexible and responsive care
- Collaborative and coordinated care
- Fair access to care
Disease Trajectory
- HIV and AIDS are not synonymous terms, but rather refer to the natural history or progression of the infection.
- The disease trajectory ranges from asymptomatic infection to life-threatening illness.
- Without treatment, the continuum of illness is associated with progressive immune-system dysfunction and persistent viral replication.
Pathogenesis of HIV
- The HIV virus survives by reproducing itself in a host cell, replacing the genetic machinery of that cell, and eventually destroying the cell.
- The life cycle of HIV consists of attachment, uncoating, reverse transcription, integration, transcription, and assembly and release of mature virus particles.
Prevention and Treatment
- Pre-exposure prophylaxis (PreEP) has become an important part of HIV prevention, with a daily regimen of tenofovir disoproxil fumarate (TDF) recommended for high-risk individuals.
- Combination antiretroviral therapy (ART) is available to treat HIV infection.
- Screening for HIV infection has been implemented, and biological and behavioral cofactors have been identified related to infection and disease progression.
Incidence and Prevalence
- In the past decade, the trajectory of HIV/AIDS has changed significantly, with a decline in new HIV infections and AIDS-related deaths.
- In 2015, there were 1.1 million AIDS-related deaths, compared to 1.7 million in 2011.
- In the United States, an estimated 1.2 million people are living with HIV infection, but 1 out of 8 of them do not know that they are infected.
Palliative Care and HIV/AIDS
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Palliative care (PC) is the comprehensive management of the physical, psychological, social, spiritual, and existential needs of patients with incurable progressive illness.
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PC has become an important component of AIDS care from diagnosis to death, involving ongoing prevention, health promotion, and health maintenance to promote the patient's quality of life throughout the illness trajectory.### HIV/AIDS and Palliative Care
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HIV/AIDS patients experience concurrent or consecutive opportunistic infections and various malignancies, which are severe and cause numerous symptoms.
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According to a large Veterans Aging Cohort Study, HIV-infected patients had a higher risk for non-AIDS-related diseases and cardiovascular, renal, and non-AIDS-defining cancers than uninfected patients.
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However, the onset of those diseases occurred at similar ages in both groups.
Palliative Care Principles
- Palliative care (PC) includes comprehensive care with respect for patient goals, preferences, and choices, and acknowledgment of caregivers' concerns.
- PC is fundamental in addressing the complex needs of patients and families with HIV/AIDS and requires the coordinated care of an interprofessional PC team.
Mortality and HIV/AIDS
- In 2014, only half of the deaths were related directly to HIV, indicating a shift in the causes of death among HIV-infected patients.
- Increasing age, comorbid conditions, and markers of functional status are more predictive of mortality than traditional HIV-prognostic variables.
HIV/AIDS Care and Prognosis
- Early diagnosis of HIV and initiation of treatment leads to the prevention of complications and improves quality of life (QOL) and length of life.
- The criteria for assessing patients with HIV/AIDS include the history of present illness, past medical history, medication history, and lifestyle habits.
- Physical examination should include a general assessment of vital signs, height, and weight, as well as a complete head-to-toe assessment.
Laboratory Data
- Laboratory tests performed during initial patient visits can be used to stage HIV disease and to select antiretroviral therapy (ART).
- The following laboratory tests are important in assisting the healthcare practitioner in making therapeutic decisions:
- HIV antibody testing
- CD4 T-cell count
- Plasma HIV-RNA (viral load)
- Complete blood count, chemistry profile, transaminase levels, blood urea nitrogen (BUN), and creatinine
- Serologies for hepatitis A, B, and C viruses
Antiretroviral Therapy
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The decision regarding laboratory testing is based on the stage of HIV disease, the medical processes warranting initial assessment or follow-up, and consideration of the patient benefit-to-burden ratio.
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Genotypic resistance testing at entry into care is recommended, regardless of whether ART will be initiated immediately.
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The goal of ART is to inhibit the replication of HIV-1 to the host cell by blocking one of several targets.### Management of HIV/AIDS
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The goal of Antiretroviral Therapy (ART) is to slow disease progression, limit opportunistic infections, and promote quality of life (QOL).
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ART is recommended for all HIV patients regardless of CD4 cell count.
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The benefits of early therapy include earlier suppression of viral replication, preservation of immune system function, and decrease in HIV transmission risk.
Considerations for Changing Antiretroviral Regimens
- Criteria for changing regimens include virologic or incomplete failure, virologic rebound, immunologic failure, and occurrence or recurrence of HIV-related events.
- A change in regimen can also be guided by drug-resistance tests and consultation with an HIV specialist.
Antiretroviral Therapies
- Antiretroviral drugs are classified by the phase of the retrovirus life cycle that they inhibit.
- Types of antiretroviral drugs include:
- Nucleoside reverse transcriptase inhibitors (NRTIs)
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- Protease inhibitors (PIs)
- Integrase inhibitors
- Entry inhibitors (fusion inhibitors and CCR5 antagonists)
Palliative Care in HIV/AIDS
- Symptom management is crucial in HIV/AIDS care.
- Patients with HIV/AIDS require symptom management not only for chronic debilitating opportunistic infections and malignancies but also for treatment side effects.
- The most prevalent symptoms in the AIDS population are fatigue, pain, nausea, and constipation.
Symptom Assessment and Management
- The Edmonton Symptom Assessment Scale (ESAS) is a validated and reliable instrument to assess symptoms.
- Patients who score greater than seven have a self-defined symptom burden, meaning their symptoms significantly impact physical, emotional, and social functioning.
- The five principles of successful symptom management are:
- Taking symptoms seriously
- Assessment
- Diagnosis
- Treatment
- Ongoing evaluation
Pain Management
- The principles of pain management in HIV/AIDS care are the same as for cancer patients.
- The three-step guidelines for pain management as outlined by WHO should be used for patients with HIV disease.
- Anti-inflammatory drugs such as NSAIDs or acetaminophen are recommended for mild-to-moderate pain.
- Opioids of increasing potency are recommended for moderate-to-severe pain that is persistent.
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Description
This quiz assesses knowledge on the key components of high-quality HIV/AIDS palliative care, HIV/AIDS treatment options, and admission criteria to hospice care. It covers the primary goal of AIDS care and disease progression.
