NCM-112-III-Immune-Deficiency-Disorders-1.pdf

HIGH RISKS FOR HIV Immune Deficiency Sharing of infected injection drug use equipment Disorders Sexual relatio...

HIGH RISKS FOR HIV Immune Deficiency Sharing of infected injection drug use equipment Disorders Sexual relations with infected individuals Infant born to mothers with HIV infection and/or NCM 112. Immunology. August 30, 2024 who are breast fed by HIV infected mothers People who received organ transplants, HIV-infected blood, or blood products IMMUNODEFICIENCIES Deficiencies in the proper expression of the HIV LIFE CYCLE immune response system It is classified into two types: 1. Primary Immunodeficiencies 2. Secondary Immunodeficiencies PRIMARY IMMUNODEFICIENCIES Deficiencies resulting from the improper development of the immunosuppressive cells and tissues Mainly genetic disorders seen in children Example: T-Cell Deficiency: Di-Goerge’s Syndrome (Thymic Hypoplasia) Absence of thymus in the neonate SECONDARY IMMUNODEFICIENCIES Any condition that can interfere with the normal growth or expression of the immune response system Ex: HIV/AIDS HIV Life Cycle | HHMI BioInteractive Video HUMAN IMMUNODEFICIENCY https://www.youtube.com/watch?v=PlSvywlLuNw VIRUS (HIV) Weakening of the body’s immune system from opportunistic infections due to an infection that attacks the body’s immune system, specifically the HIV LIFE CYCLE CD4 cells. 1. Attachment Glycoproteins (GP120 and GP41) of HIV bind with the host’s uninfected CD4+ receptor and chemokine coreceptors (CCR5) resulting in fusion of HIV with CD4+ T Cell membrane HIV TRANSMISSION BODY FLUIDS 1. BLOOD 2. Uncoating 2. SEMINAL FLUID HIV’s viral core = two single strands of viral RNA + 3. VAGINAL SECRETIONS three viral enzymes: reverse transcriptase, 4. AMNIOTIC FLUID integrase, and protease are emptied into the CD4+ 5. BREASTMILK T Cell membrane 3. DNA Synthesis STAGES OF HIV DISEASE Through reverse transcriptase, HIV changes its genetic material from RNA to DNA resulting in double stranded DNA that carries instruction for viral replication 4. Integration Through action of integrase, the new viral DNA enters the nucleus of the CD4+ T cell is blended with the DNA of the CD4+ T cell resulting in permanent, lifelong infection 5. Transcription CD4+ T cell is activated and the double-stranded DNA forms singe-stranded messenger RNA (mRNA) and builds new viruses CLINICAL MANIFESTATIONS OF HIV 6. Translation SYSTEM MANIFESTATIONS ASSOCIATED New chains of new proteins and enzymes DISEASES (polyproteins) created by mRNA contain the Respiratory Shortness of Pneumocystis components needed in the construction of new breath, dyspnea, Pneumonia (most viruses cough, chest pain, common infection) and fever Mycobacterium avium Complex Tuberculosis 7. Cleavage The polyprotein chain is cut by the HIV enzyme Gastrointes Loss of appetite, Oral candidiasis resulting into individual proteins that make up the tinal nausea, vomiting, Wasting syndrome new virus oral and esophageal candidiasis, and chronic diarrhea 8. Budding causing profound weight loss The viral RNA and new proteins migrate to the membrane of the infected CD4+ T cell, exit from Oncologic Flat or raised, Kaposi’s sarcoma the cell and restart the process. brownish pink to (most common deep purple skin HIV-related discolorations, malignancy) lymphedema, pain B-Cell Lymphomas Cervical carcinoma Neurologic Motor dysfunction Peripheral neuropathy PATHOPHYSIOLOGY and behavioral HIV encephalopathy change Cryptococcus neoformans Progressive multifocal leukoencephalopathy Integument Rashes, skin Herpes zoster and ary discolorations herpes simplex Molluscum contagiosum Seborrheic dermatitis Eczema or Psoriasis Gynecologi Persistent, recurrent Ulcerative sexually c vaginal candidiasis transmitted diseases (STDs are more severe in women with HIV) DIAGNOSTIC TESTS 5. OraQuick 1. CIA/ELISA In-home HIV Self Test Antibodies are detected, resulting in positive Works by looking body’s responses (antibodies) results, and marking the end of the window period to fighting the HIV Virus + result is preliminary and ff up confirmatory test is needed 2. WESTERN BLOT Also detects antibodies to HIV; used to confirm EIA TREATMENT HAART (Highly Active Antiretroviral Therapy) For reduction in replication of HIV and reductions in morbidity and mortality also a rise in CD4+ T Cell count Reduce the viral load 3. VIRAL LOAD Measures HIV RNA in the plasma 4. CD4/CD8 These are markers found on lymphocytes. HIV kills CD4+ cells, which results in a significantly impaired immune system  IMPLEMENTATION AMONG CLIENTS Client education and counseling. Disease transmission: blood and body fluids Advice client to practice safe sex as follows: ○ Abstinence ○ Mutual, monogamous sexual relationship ○ Avoid multiple partners ○ Use of soluble lubricants and condoms Prevention of Infections Promote Self-care Safety Provide psychosocial care. Pharmacotherapy: AZT (Retrovir/Zidovudine) ○ Slows progress of opportunistic infections and dementia Side effects Malaise Nausea Headache Fever Insomnia Myalgia Toxic effects Bone Marrow Suppression (serum level determination should be done at regular basis); weekly CBC should be monitored Precaution HIV PREVENTION Avoid pregnancy Abstinence Do not donate blood, sperm, organs Be faithful Consistent & Correct Condom Use Do not use Drugs and Alcohol Education Pre- & Post-Exposure Prophylaxis ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) IMPLEMENTATION AMONG HEALTH A disorder caused by the human CAREGIVERS immunodeficiency virus (HIV) Practice strict handwashing It is characterized by generalized dysfunction of Wear gloves when coming in contact with body the immune system secretions The syndrome is manifested clinically by Avoid recapping of needles opportunistic infections and unusual neoplasms Use heavy plastic bags to be used for articles The disease has long incubation period, contaminated with body fluids (biohazard sometimes up to 10 years or more bag/red bag) Use of 1:10 Bleach/Water Solution Boiling equipment (20 minutes) TRANSMISSION OF THE DISEASE Dishwashing (hot water, air drying) Sexual exposure to genital secretions of an Laundry (use bleach) infected person Do not share razors, toothbrush. These are Parenteral exposure to infected blood and contaminated with body secretions tissue  Perinatal exposure of an infant to infected Kaposi’s Sarcoma maternal secretions through birth or breastfeeding Candidiasis HIGH RISK GROUPS FOR AIDS Male homosexuals or bisexuals Intravenous drug abusers Cytomegalovirus Persons receiving blood transfusions E.g. hemophiliacs, those with Thalassemia, hemodialysis, and surgical clients Frequent exposure to blood and body fluids Heterosexual contact with high-risk individuals Babies born to infected mothers CLINICAL MANIFESTATIONS OF AIDS Malaise, weight loss Lymphadenopathy for at least 3 months Leukopenia Diarrhea Fatigue Night Sweats Presence of opportunistic infections DIAGNOSTIC TESTS Pneumocystis jirovecii pneumonia 1. Enzyme-linked immunosorbent assay Kaposi’s sarcoma (ELISA) Fungal infections It determines the response of antibodies to the HIV Candidiasis virus Cytomegalovirus 2. Western Blot Lymphadenopathy for It confirms the presence of HIV antibodies at least 3 months 3. p24 antigen Two or more positive results are diagnostic for HIV Pneumocystis jirovecii infection pneumonia 4. CD4+ INTERPROFESSIONAL COLLABORATIVE It is used to assess immune system status, risk MANAGEMENT FOR PATIENTS WITH AIDS for disease progression Implement standard precautions Adults normally have 800 to 1,200 CD4+ T cells Promote respiratory function per microliter of blood. The normal lifespan of Provide adequate nutritional support CD4+ T cells is about 100 days, but Maintain fluid and electrolyte balance HIV-infected CD4+ T cells will die after an Promote comfort average of 2 days Monitor for signs of infection A decline in CD4+ T cells count leads to Best practice: Proper handwashing when caring impaired immune function for clients with HIV infection and AIDS MEDICATION FOR HIV AND AIDS 1. NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS Ziagen (Abacavir), Videx (Didanosine), Epivir (Lamivudine), Ritrovir, AZT (Zidovudine) Can cause nausea, vomiting, diarrhea Didanosine, Stavudine, Zalcitabine (HIVID) Can cause neuropathy, hepatoxicity, and pancreatitis DIAGNOSTIC CRITERIA FOR AIDS 2. ANTIVIRAL MEDICATIONS AIDS is diagnosed when an individual with HIV Cytovene (Ganciclovir) infection develops at least one of these conditions: Used to treat cytomegalovirus retinitis. It CD4+ T cells count drops below 200 causes bone marrow depression. cells/microliter Development of one of the following Zovirax (Acyclovir) opportunistic infections: fungal, viral, protozoal Used to treat herpes simplex, herpes zoster or bacterial or varicella zoster. Development of one of the following It is nephrotoxic opportunistic cancers: ○ Invasive Cervical Cancer Foscavir (Metronidazole) ○ Kaposi’s sarcoma (KS) Used to treat cytomegalovirus retinitis. ○ Burkitt’s lymphoma It is nephrotoxic. ○ Immunoblastic lymphoma ○ Primary lymphoma of the brain Wasting syndrome occurs. 3. ANTI-INFECTIVE MEDICATIONS ○ Wasting is defined as a loss of 10% or more Pentam 300 (Pentamidine) ideal body mass Used to treat pneumocystis carinii pneumonia. It is nephrotoxic, hepatotoxic, and AIDS dementia complex (ADC) can also be immunosuppressive. developed It may cause hypotension and hypoglycemia Flagyl (Metronidazole) Used to treat cryptosporidiosis and giardiasis Avoid alcohol during treatment to prevent disulfiram-like manifestations 4. ANTIFUNGAL MEDICATIONS Nizoral (Ketoconazole) Used to trat candidiasis, coccidiodomycosis or histoplasmosis It is hepatotoxic and may cause photosensitivity Avoid alcohol during treatment to prevent liver damage Diflucan (Fluconazole) Used to treat candidiasis It is hepatotoxic Fungizone (Amphotericin B) Used to treat candidiasis and other fungal infections It is nephrotoxic, can cause thrombophlebitis and bone marrow depression 5. PROTEASE INHIBITORS Agenerase (Amprenavir) It is nephrotoxic Crixivan (Indinavir) It causes hyperbilirubinemia, nephritis, and kidney stones Kaletra (Lopinavir and Ritonavir) It is hepatotoxic Viracept (Nelfinavir) It can cause nausea, flatulence, and diarrhea Norvir (Ritonavir) It is hepatotoxic and increases triglyceride levels