Burgess Nursing Care of Patients with HIV and AIDS

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Questions and Answers

What is the primary function of CD4 T lymphocytes in relation to HIV infection?

Directly killing infected cells

Coordinating all immune functions (correct)

Producing antibodies against bacteria

Activating cytotoxic T cells only

Which phase of the HIV life cycle involves converting RNA to HIV DNA?

Assembly

Budding

Integration

Reverse Transcription (correct)

What year was highly active antiretroviral therapy (HAART) first introduced?

1987

1981

1996 (correct)

2000

How does integrase inhibitor medication function in the treatment of HIV?

It stops the incorporation of HIV DNA into the host cell DNA Signup and view all the answers

What strain of HIV is most prevalent globally?

HIV-1 Signup and view all the answers

Which of the following describes the latent state of HIV?

The virus lies dormant in viral reservoirs Signup and view all the answers

What is the primary mechanism of action for CCR5 antagonists in HIV treatment?

Blocking HIV attachment to host cell receptors Signup and view all the answers

As of the end of 2018, how many new cases of HIV were reported that year?

39,968 Signup and view all the answers

What is the primary goal of Antiretroviral Therapy (ART) in HIV treatment?

To achieve an undetectable viral load Signup and view all the answers

Which of the following factors increases the risk of opportunistic infections in HIV patients?

Weakened immune system due to low CD4 counts Signup and view all the answers

What does the term 'clinical latency stage' refer to in the context of HIV infection?

The relatively symptom-free phase while the virus replicates Signup and view all the answers

Which testing method can confirm the presence of HIV following a positive enzyme immunoassay (EIA)?

Western blot assay Signup and view all the answers

Which of the following routes is NOT responsible for the transmission of HIV?

Sharing of household items Signup and view all the answers

What is the consequence of medication non-adherence in HIV treatment?

Increased risk of transmission of resistant strains Signup and view all the answers

Which statement accurately describes the relationship between HIV and AIDS?

HIV-positive individuals diagnosed early may not develop AIDS Signup and view all the answers

Which of the following symptoms is associated with Stage 1, Acute retroviral syndrome?

Fatigue and fever Signup and view all the answers

What is the recommended preventive measure against parenteral transmission of HIV?

Avoiding injectable drugs Signup and view all the answers

What is indicated by a CD4 count below 200 cells/mm3?

The patient is likely to develop AIDS Signup and view all the answers

What does PrEP stand for, and what is its purpose?

Pre-exposure prophylaxis; to prevent HIV in high-risk individuals Signup and view all the answers

What is the primary cause of HIV-associated Neurocognitive Disorder?

Direct viral invasion of the CNS Signup and view all the answers

Which of the following is a key objective for routine testing of HIV in general populations?

To understand and manage HIV status Signup and view all the answers

Which HIV strain is predominantly responsible for the global epidemic?

HIV-1 Signup and view all the answers

Which stage of the HIV life cycle involves incorporation of HIV DNA into host cell DNA?

Integration Signup and view all the answers

What is the primary mechanism through which nucleoside reverse transcriptase inhibitors (NRTIs) act?

Inhibiting RNA conversion to HIV DNA Signup and view all the answers

Which of the following correctly describes the purpose of protease in the HIV life cycle?

To cleave HIV proteins into functional forms Signup and view all the answers

What is the main consequence of the destruction of CD4 T lymphocytes by HIV?

Progressive destruction of the immune response Signup and view all the answers

Which statement accurately reflects the state of HIV being dormant in viral reservoirs?

HIV can lie dormant for many years without treatment Signup and view all the answers

What factor distinguishes highly active antiretroviral therapy (HAART) from earlier treatments?

Combination of at least two ARV medications Signup and view all the answers

What is a possible outcome of lifelong antiviral treatment for HIV patients?

Control of HIV progression and reduction of viral load Signup and view all the answers

What happens when CD4 counts drop below 200 cells/mm3 in an HIV-infected individual?

Opportunistic infections or certain cancers develop. Signup and view all the answers

Which method of HIV transmission is the least likely to occur?

By sharing utensils. Signup and view all the answers

What is the average duration from initial HIV infection to the symptomatic stage?

8-12 years. Signup and view all the answers

What is the role of antiretroviral therapy (ART) in HIV treatment?

It prevents the reproduction of HIV. Signup and view all the answers

What percentage effectiveness does pre-exposure prophylaxis (PrEP) provide in preventing HIV transmission?

99%. Signup and view all the answers

Which of the following complications is specifically characterized by significant involuntary weight loss?

AIDS Wasting Syndrome. Signup and view all the answers

What laboratory test confirms the diagnosis of HIV following a positive enzyme immunoassay?

Western blot assay. Signup and view all the answers

Which statement accurately reflects the relationship between HIV infection and AIDS?

HIV is the precursor to developing AIDS but not all progress to AIDS. Signup and view all the answers

What is a common early symptom in the acute retroviral syndrome stage of HIV infection?

Sore throat. Signup and view all the answers

What distinguishes opportunistic infections in the context of HIV?

They exploit a weakened immune system. Signup and view all the answers

How can health care workers reduce the risk of occupational HIV transmission?

Through the use of safety devices on needles. Signup and view all the answers

Which viral load result indicates a successful response to ART?

Undetectable for greater than 6 months. Signup and view all the answers

What is the best way for individuals at high risk of HIV to ensure they remain HIV-negative?

Taking PrEP and practicing safe sex. Signup and view all the answers

Study Notes

Nursing Care of Patients with HIV and AIDS

Focuses on the care of individuals with HIV and AIDS, including their history, pathophysiology, treatment, and prevention.

History of HIV

Epidemic first reported in June 1981.
First antiretroviral drug (ARV) introduced in 1987.
Highly active antiretroviral therapy (HAART) introduced in 1996, also known as antiretroviral therapy (ART).
Combination of at least two ARVs with different mechanisms of action.
At the end of 2018, there were 1.2 million infected individuals and 39,968 new cases reported.

HIV

Human immunodeficiency virus.
Two strains: HIV-1 (most common, global) and HIV-2 (found in specific areas of West Africa).
Retrovirus with RNA makeup, attracts to CD4 receptors on lymphocytes and macrophages, destroying them.
CD4 T lymphocytes crucial for immune function.
Destruction of CD4 T lymphocytes leads to a weakened immune response.

7 Steps of the HIV Life Cycle

Binding: HIV attaches to the CD4 receptor of the host cell.
Fusion: HIV envelope fuses with the host cell membrane.
Reverse Transcription: HIV releases reverse transcriptase to convert RNA into DNA in the host cell.
Integration: HIV integrase incorporates the viral DNA into the host's DNA.
Replication: HIV uses host cell machinery to replicate long chains of HIV proteins.
Assembly: HIV RNA and proteins assemble into new viral particles.
Budding: Immature non-infectious HIV buds from the host cell, and protease releases chains into shorter functional forms, creating mature infectious HIV.

Pathophysiology (continued)

HIV can persist in a latent (inactive) state for years.
Can lie dormant in small cells called viral reservoirs.
Currently, no cure exists, however lifelong antiviral treatment controls the virus.
Ongoing research for a cure and possible vaccine development.

Antiretroviral Medications

Stop HIV at different stages of its life cycle.
Binding: Cellular chemokine receptor type 5 (CCR5) antagonists block HIV attachment.
Fusion: Fusion inhibitor drugs.
Reverse Transcription: Nonnucleoside reverse transcriptase inhibitors (NNRTIs) and nucleoside reverse transcriptase inhibitors (NRTIs).
Integration: Integrase inhibitors.
Budding: Protease inhibitors.

Progression of HIV Infection

Initial infection involves a symptom-free period (clinical latency stage).
CD4 counts decrease.
Symptomatic stage varies in onset (average 8-12 years).
Early symptoms point to a weakened immune system.
Diagnosis of AIDS occurs when CD4 counts drop below 200, leading to opportunistic infections or cancers.

AIDS

Acquired immunodeficiency syndrome.
Final stage of HIV infection.
Can develop at any point during HIV infection.
Most people with early diagnosis and treatment do not progress to AIDS.
HIV positive does not equal AIDS.

Transmission

Person-to-person transmission through specific bodily fluids.
Fluids include blood, semen, pre-seminal fluid, vaginal secretions, rectal fluids, and breast milk.
Transmissible within 2-4 weeks of initial infection.
Transmission occurs via bodily fluids through tears in mucous membranes, nonintact skin, needle injection, and sexual contact.
Transmission is not via air, water, food, or insects (household transmission is rare).
Does not survive long outside of the human body.

Prevention

Education on transmission modes.
Pre-exposure prophylaxis (PrEP) with an ARV drug for those at high risk of contracting HIV (99% effective).
Routine testing knowing one's status is crucial, especially for ages 15-65, pregnant women, and victims of sexual assault.
Post-test counseling for positive individuals (education and treatment).
Undetectable viral load for more than 6 months indicates that the virus is practically undetectable and cannot be transmitted.
Education about safe sex like abstinence, limiting partners, and using condoms.
Legal requirement for individuals to disclose their HIV infection status to sexual partners.

Prevention (continued)

Parenteral transmission via injection:
- Avoiding injecting drugs, using clean supplies, and having safe injection techniques.
- Not sharing or reusing needles.
- Pharmacies participating in syringe exchange programs.
Parenteral transmission via transfusion
- Rigorous testing and screening of blood products before transfusion to minimize risk of infection.
- Low chance of infection if blood has not had sufficient time to develop detectable antibodies.

Prevention – Health Care Workers

Occupational transmission is rare.
Standard precautions must be followed.
Hand hygiene is crucial.
Safety devices on needles (never recapping).
If exposed, seek immediate emergency care and prophylactic treatment with ARVs.

HIV Signs and Symptoms

Initial infection can be asymptomatic.
Stage 1 (Acute retroviral syndrome): fatigue, headache, fever, enlarged lymph nodes, diarrhea, and sore throat.
Stage 2 (Chronic HIV infection): asymptomatic or mild symptoms with treatment
Stage 3 (AIDS): opportunistic infections or cancers, increased weakness, pain, weight loss, and wasting.

Complications

Fewer complications are seen due to advances in treatment.
AIDS wasting syndrome: unintentional weight loss, weakness, fever, or diarrhea lasting more than 30 days.
Malnutrition needs attention.
HIV-associated neurocognitive disorder: infection in the brain and central nervous system, leading to memory problems, personality changes, hallucinations, leg weakness, balance loss, and slow responses.
Cancer: weakened immune system permits uncontrolled cell growth.
Opportunistic infections: fungi, viruses, bacteria utilize weakened immune system, like Candida albicans, Pneumocystis jirovecii pneumonia, Cytomegalovirus (CMV), Mycobacterium avium complex (MAC), and Tuberculosis (TB)

Diagnosis

Finger stick, oral swab, or serum tests are methods used for diagnosis.
Urine tests (rare).
Health care and home test kits detect antigens within 2 weeks of exposure and antibodies within a range of 3 weeks to 3 months.

Lab Testing

Antigen and antibody testing.
CD4 T lymphocyte counts (332-1642 cells/mm³).
Viral load testing (quantitative RNA assay) to measure HIV RNA in plasma.
Goal of treatment is to achieve an undetectable viral load.
Genotyping for resistance to available ARV medications.
Screening for concurrent STIs or hepatitis.
Enzyme-linked immunosorbent assay (EIA) and Western blot assay for confirmation of HIV diagnosis.

Treatment

All patients should be treated with antiretroviral therapy (ART) regardless of CD4 count.
Prophylactic treatment for opportunistic infections.
ART inhibits viral reproduction, but does not kill the virus.
Combination therapy using various medications that act on different phases of the HIV life cycle.
Achieve undetectable viral load within 6 months of treatment.
"Undetectable = untransmissible"

Medication Adherence

Medication resistance can occur if drugs are not taken as prescribed.
Resistant strains can be transmitted.
Promoting adherence through patient education is crucial.
If not taken correctly, HIV can reemerge and become detectable again.
Encourage reporting side effects for regimen adjustments and improved adherence.

Nursing Implications

Non-judgmental approach, empathy, and psychosocial support.
Maintain confidentiality (HIPAA).
Infection prevention (table 20.5).
Education about transmission, prevention, safety, and treatment.
Maintaining nutrition and weight.

Patient Education

Wash dishes in hot soapy water to destroy bacteria and soak cleaning sponges in bleach.
Clean spills with bleach solutions.
Avoid items that carry toxoplasmosis risk (changing litter boxes).
Daily use of antimicrobial cleansers.
Monitor body temperature to identify fever or infections early.

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Description

This quiz explores the nursing care required for patients with HIV and AIDS, covering essential topics such as the disease's history, pathophysiology, treatment options, and prevention strategies. Focus on understanding the life cycle of HIV and its impact on the immune system to provide effective care and support.