HIV & AIDS Nursing Notes PDF

NUR 211 Unit 1 HIV & AIDS Erin Ludlum, MSN, RN History  Incidence/Prevalence Estimated HIV Prevalence among Persons Aged ≥13 years, by Area of Residence 2019—United States and Puerto Rico Pathophysiology Retrovirus...

NUR 211 Unit 1 HIV & AIDS Erin Ludlum, MSN, RN History  Incidence/Prevalence Estimated HIV Prevalence among Persons Aged ≥13 years, by Area of Residence 2019—United States and Puerto Rico Pathophysiology Retrovirus CD4 T helper cells Virus replication Retrovirus Hijacks CD4 T lymphocytes (Helper T cells) Leads to severe immunodeficiency Virus replication Pathophysiology Adams 6th ed pp. 553 Fusion Reverse transcriptase Integrase RNA Transcribes Integrates Cleaves the into DNA into host DNA proteins Protease Entry &Fusion Pathophysiology Ie VIRAL LOAD  Transmission Who can spread? Most common routes of transmission: Sexual Parenteral Perinatal Sexual Transmission Parenteral Transmission Perinatal Transmission  Assessment Three identified stages of HIV: Phase 1: Acute phase: Early flu-like symptoms Phase 2: Chronic phase:  Assessment Phase 3: AIDS AIDS = HIV + Opportunistic infection/CA OR CD4 count drops below 200 Opportunistic Infections ○ Pneumocystis Pneumonia (PCP) ○ TB ○ Candidiasis ○ HSV or zoster ○ Cytomegalovirus ○ Wasting Syndrome Opportunistic Cancers ○ Next slide Opportunistic Infections Candidiasis: Herpes simplex virus (HSV ) or varicella-zoster virus (VZV) Pneumocystis jiroveci pneumonia (PCP) TB CMV Wasting syndrome Opportunistic Infections Malignancy: ○ Kaposi’s Sarcoma Most common Late stage Brownish purplish spots ○ Lymphoma Hodgkin & Non-Hodgkin’s & primary brain Lymphomas Affect lymphoid tissues, lymph nodes, lymphocytes, and lymphoid organs Systemic and local s/s Lymphomas Kaposi sarcoma (KS) Opportunistic Cancers ○ Cervical cancer Screening & Diagnostic Testing Rapid diagnostic tests Screening recommended for everyone ages 13-64 at least once ELISA Higher risk should be screened q6mo to annually Western blot testing Rapid diagnostic tests Enzyme-linked immunosorbent assay (ELISA) Western Blot Viral load Specific Markers CD4 ○ Viral Load – measures amount of actively replicating virus ○ CD4 count Nonspecific markers Nonspecific Markers ○ CBC ○ ESR ○ LFTs ○ Resistance testing Diagnostic Testing- HIV  Diagnostic Testing Results What does a negative HIV test result mean? During window period: ? After window period: ? What does a positive HIV test result mean?  If community program or self test: ?  If health care setting or a lab: the lab will conduct the follow-up testing If the follow-up test is also positive, it means ?? Drug Therapy – labs before HIV testing starting STIs Kidney function tests Liver functions tests Because drugs can be toxic to kidney and liver Hepatitis A, B, and C PrEP has black box warning for those with Hep B Treatment: Drug Therapy Adams 6th ed pp. 553 Fusion Entry Inhibitors Reverse transcriptase RT Inhibitors Integrase Integrase Inhibitor Protease Protease Inhibitor Drug Therapy - ART Guided by CD4T cell count and viral load Combination drug regimen Strict adherence required Classifications: ○ Non-nucleoside reverse transcriptase inhibitors (NNRTI) ○ Nucleoside reverse transcriptase inhibitors (NRTI) ○ Protease inhibitors (PI) ○ Entry inhibitors ○ Integrase inhibitors Boosters: ○ Cobicistat ○ Ritonavir Drug Therapy - ART Classifications: ○ Entry inhibitors Rocks and water prevents entry ○ Maraviroc and Enfuvirtide Adv effects: Enfuvirtide is subq- pain at injection site Non-nucleoside reverse transcriptase inhibitors (NNRTI) Nucleoside reverse transcriptase inhibitors (NRTI) Adv effects: Hepatotoxicity, rash, CNS effects (dizzy, sleep d/o, fatigue) ○ Nucleoside reverse transcriptase inhibitors (NRTI) Zidovudine, Tenofovir, emtricitabine Adv effects: inhibit mitochondrial function, blood d/o, lipodystrophy ○ Integrase inhibitors *newer class Bictegravir, Dolutegravir, Elvitegravir, Raltegravir, etc Adv effects: weight gain and increased Creatine Kinase (CK) ○ Protease inhibitors (PI) Never (-navir) tease a pro-tease! Atazanavir, Darunavir, Fosamprenavir, Indinavir, etc Adv effects, GI complications (n/v), hyperglycemia and high cholesterol  Drug Therapy - PrEP PrEp is pre-exposure prophylaxis  Drug Therapy - PEP PEP is post-exposure prophylactic meds Drug Therapy - Pregnancy Begin ASAP (or continue taking) Pharmacotherapy of pregnant  Initiation of ART woman similar to nonpregnant  Preferred ART Regimens woman  Monitoring PrEP and PEP  Delivery Considerations  Postpartum Care Zidovudine to prevent spread to  Breastfeeding newborn  Counseling and Support Breastfeeding Treatment: Drug Therapy Goals & Evaluation ○ Lab tests to guide pharmacotherapy: Absolute CD4 T- cell count Viral load Drug Therapy – Adjunct Agents used in combination with antiretroviral therapy ○ Interferons ○ Other agents to prevent/treat OIs ○ Vaccines ○ Antibiotics ○ Symptom management Nursing BIGGEST ROLE: Education Prevention: ABC Medication Adherence Management/monitoring Avoid infections Nutrition Maintain skin Integrity Assessments: Psychosocial support/Advocacy Standard Precautions Exposure?? Avoid bias Maintain confidentiality Thanks !