HIV PDF - Human Immunodeficiency Virus

Human Immunodeficiency Virus (HIV) Retrovirus Slowly progressive disease...

Human Immunodeficiency Virus (HIV) Retrovirus Slowly progressive disease 2 major strains: HIV-1 – most commonly seen in US HIV-2 – limited to West Africa Transmission routes: Human Blood Semen Immunodeficiency Virus Vaginal fluids Transplacenta Shermel Edwards-Maddox, PhD, RN,(HIV) Breast milk CNE, RN-BC Saliva (into open mouth wounds) HIV Pathophysiology HIV Pathophysiology HIV attacks CD4 cells and macrophages Enzyme driven illness CD4 cells are involved in both humoral and cell-mediated HIV attaches to the CD4 receptor cell immune reactions. Reverse transcriptase changes viral RNA into viral DNA HIV slowly debilitates body immune systems, both T cell Integrase allows viral DNA to be in integrated into host and B cell immunity. DNA Macrophages serve as reservoir for the virus Protease helps assemble protein component to build Allows virus to go undetected new viruses Also help disseminate/spread the virus Host becomes a “factory” for manufacturing more viruses Macrophages are found at mucous membranes After using the host cell, the virus destroys the CD4 cell causing a weakened immune response. Risk Factors for Stages of HIV Infection Contracting HIV Acute infection Unprotected sexual activity Heterosexual females at higher risk than heterosexual males MSM (men who have sex with men) Chronic infection Receptive partner is at higher risk than the insertive partner IV drug abusers African American males AIDS Hispanic male History of sexually transmitted diseases (STD) Frequent blood transfusions Offspring of infected mothers Clinical Manifestations: Clinical Manifestations: Acute Phase Chronic Phase Presents like a flu-like virus Known as the latent stage similar to mononucleosis Can last from 6 months to 10 years Fever, headache, fatigue, pharyngitis, Symptoms can range from mild to severe: lymphadenopathy, myalgia Cough Shortness of breath Occurs within 28 days of contracting the virus Weight loss Diarrhea Lasts a couple of weeks and then resolves Fatigue Symptoms are often disregarded Viral load is slowly increasing After this stage resolves the patient CD4 count is decreasing becomes asymptomatic Clinical Manifestations: AIDS Laboratory Studies & Diagnostics Screening for HIV is highly recommended AIDS= acquired immune deficiency syndrome Presence of HIV virus in the bloodstream CD4 count diminishes to 200 or less HIV RNA blood test Symptoms: Virus is detectable between 4 – 11 days after infection Rapid weight loss Presence of HIV antibodies: Recurring fever or profuse night sweats It can take between 2 weeks and 6 months for immune A red rash that doesn't itch, usually on your torso. system to make antibodies Prolonged swelling of the lymph glands in the armpits, groin, or neck CD4 count is used to monitor the course of the disease Complications: Normal CD4 count: 800- 1,200 cells/mm3 Kaposi sarcoma Impaired immunity: below 500 cells /mm3 Pneumocystis jirovecii Pneumonia (PJP) If CD4 count drops below 200 cells/mm3 AND there is an Other opportunistic infections opportunistic infection, then the diagnosis of AIDS is made. Treatment and Management of HIV Complications of HIV/AIDS Treatment can be challenging: Antiretroviral therapy (ART) is the only long- Latency of disease term successful treatment Opportunistic Infections Medications work by attacking the virus Tuberculosis Immunocompromise Candida (thrush) at various stages Highly mutable virus Pneumocystis jiroveci pneumonia (PJP) Candida Infection Histoplasmosis Examples: protease inhibitors, transcriptase inhibitors, integrase Toxoplasmosis inhibitors, fusion inhibitors Histoplasmosis Hepatitis A, B, C Treatment be started as soon as possible Can live a long life if compliant with Malignancies medications Kaposi sarcoma Non-Hodgkin’s lymphoma Cervical cancer Anal cancer Kaposi sarcoma lesions Lymphadenopathy from lymphoma Preventative Treatment of HIV Practice Question #1 PREP- pre-exposure prophylaxis PEP- post exposure prophylaxis In each of the following situations, identify which option has the highest Uses antiviral medications in highly Uses antiviral medications after a single risk for human immunodeficiency virus (HIV) transmission? susceptible, uninfected individuals high-risk event to prevent contraction of Examples: Truvada, Descovy HIV Must be started within 72 hours to be A. Transmission to women OR to men during sexual intercourse Strategy used when one partner is HIV positive, and the other is HIV negative effective B. First 2 to 6 months of infection OR 1 year after infection Must take the medication every single day Includes a 28-day course of triple ART C. Perinatal transmission from HIV-infected mothers taking antiretroviral Continue to use condoms Only to be used in emergency situations therapy OR HIV-infected mothers using no therapy Follow up with their health care provider D. A splash exposure of HIV-infected blood on skin with an open lesion every 3 months OR a needle-stick exposure to HIV-infected blood Answer to Practice Question #1 Practice Question #2 In each of the following situations, identify which option has the highest risk for human immunodeficiency virus (HIV) transmission? What is a primary reason that the normal immune response fails to contain the HIV infection? A. Transmission to women OR to men during sexual intercourse B. First 2 to 6 months of infection OR 1 year after infection A. CD4+ T cells become infected with HIV and are destroyed. C. Perinatal transmission from HIV-infected mothers taking antiretroviral B. The virus inactivates B cells, preventing the production of HIV antibodies. therapy OR HIV-infected mothers using no therapy C. Natural killer cells are destroyed by the virus before the immune system can D. A splash exposure of HIV-infected blood on skin with an open lesion be activated OR a needle-stick exposure to HIV-infected blood D. Monocytes ingest infected cells, differentiate into macrophages, and shed viruses in body tissues Answer to Practice Question #2 What is a primary reason that the normal immune response fails to contain the HIV infection? A. CD4+ T cells become infected with HIV and are destroyed. B. The virus inactivates B cells, preventing the production of HIV antibodies. C. Natural killer cells are destroyed by the virus before the immune system can be activated D. Monocytes ingest infected cells, differentiate into macrophages, and shed viruses in body tissues Rationale: Activated CD4+ T cells are an ideal target for HIV because these cells are attracted to the site of concentrated HIV in the lymph nodes, where they become infected through viral contact with CD4 receptors. CD4+ T cells normally are a major component of the immune system and their infection renders the immune system ineffective against HIV and other agents. The virus does not affect natural killer cells and B lymphocytes are functional early in the disease, as evidenced by positive antibody titers against HIV. Monocytes do ingest infected cells and may become sites of HIV replication and spread the virus to other tissue but this does not make the immune response ineffective.