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medsurg exam 3
HIV/AIDS and the immune system
| Question | Answer |
|---|---|
| AIDS quilt | the world’s largest community arts project, created in 1987 to commemorate lives lost to the AIDS epidemic and raise awareness |
| in 1981 | “healthy” homosexual males dx with Pneumocystic carinii pneumonia & Kaposi’s sarcoma |
| in 1984 | HIV isolated |
| in 1985 | serologic test HIV |
| in 1996 | introduction of HAART |
| HAART | Highly Aggressive Antiretroviral Therapy |
| introduction of HAART results in | 3 years later, a 60-80% decrease AIDS “pre-HAART” vs “post-HAART” |
| 1987-2008 | increased rate of death in males, evens out more around 1998 |
| HIV dx had a 17% dip in 2020 due most likely to | disruptions in clinical care services, hesitance in accessing healthcare services, and shortages in materials for HIV tests during the COVID 19 pandemic |
| what age group is HIV/AIDS more likely in | people aged 13-34 accounted for more than half (57%) of new HIV dx in 2020 |
| what group of people is HIV/AIDS more likely in | gay, bisexual, and other men who reported male to male sexual contact are the population most affected by HIV |
| what gender of people is HIV/AIDS more likely in | men continue to be heavily affected by HIV, accounting for 80% of new HIV dx in 2020 |
| what races and ethnicities of people is HIV/AIDS more likely in | racial and ethnic differences in new HIV dx persist racism, HIV stigma, discrimination, homophobia, poverty and barriers to health care continue to drive these disparities |
| for every 100 people overall dx with HIV in 45 states and the district of columbia in 2020, | 74 received some HIV care 51 were retained in care 65 were virally suppressed |
| age relationship | those who are younger are less likely dx, linked to care, retained in care, have suppressed viral load |
| people with dx HIV in the US and dependent areas by age | people with dx HIV are living longer, healthier lives because of effective HIV tx |
| national HIV testing day | june 27 get tested. share your story. use the hashtag. #DoingItMyWay |
| what is HIV | Specific type of virus (a retrovirus) that carries genetic information as RNA |
| how does HIV work | Enters body, infects cells CD4 antigen Uses enzyme to convert RNA to DNA DNA is duplicated in cell division |
| HIV can remain | inactive for years |
| HIV creates | antibodies |
| when can HIV be detected | as early as 2-4 weeks |
| stage 1 is | Transmission & Seroconversion |
| stage 1: Transmission & Seroconversion | Short, flu-like illness or no symptoms Highly contagious at this time |
| when is Seroconversion detected | 2-4 weeks |
| stage 2 is | clinical latency period |
| stage 2: clinical latency period | Lasts for average 8-10 years Usually no symptoms May be swollen glands |
| during stage 2: clinical latency period, | Level HIV blood drops to very low levels HIV antibodies are detectable in the blood |
| stage 3 is | AIDS |
| stage 3: AIDS | the immune system weakens, illnesses become more severe leading to an AIDS dx |
| natural history of HIV infection | look at slide 25 |
| nursing care for HIV changes | over course of disease |
| nursing care in early stages | Preventive health measures Health maintenance activities Education Psychosocial support |
| what to educate pt on | transmission, disease process and exposure |
| Psychosocial support for pt with HIV/AIDS | because there is only treatment and no cure |
| nursing care as disease progresses | Physical symptom management Education on infection prevention Continued psychosocial support |
| as disease progresses, | viral load increases, CD4 decreases which leads to immunocompromisation |
| Opportunistic Infections associated with AIDS | Bacterial Cancer Viral Fungal |
| bacterial opportunistic infections | TB |
| cancerous opportunistic infections | Kaposi Sarcoma Lymphoma Cervical cancer |
| TB and HIV | People with HIV are up to 20 times more likely to develop TB than people without HIV |
| TB and HIV = | lethal combination |
| what does CDC recommend | all HIV positive people should be tested for TB |
| symptoms of TB | cough with or without blood, fatigue, weight loss, anorexia, low grade fever, NIGHT SWEATS!!! |
| treatment for TB | begin immediately, anti TB meds for 6 mo |
| preventative tx for TB | airborne isolation! |
| kaposi's sarcoma (KS) | most common cancer with AIDS small, flat, or slightly raised, painless blotches on the skin |
| viral opportunistic infections | Cytomegaloviris (CMV)- herpes virus |
| fungal opportunistic infections | Pneumocystis carinii Candida (Thrush) |
| Pneumocystic carinii pneumonia | Most common opportunistic infection affecting patient with AIDS |
| Pneumocystic carinii pneumonia is | a fatal fungal pneumonia!! |
| symptoms of Pneumocystic carinii pneumonia | fever, cough, dyspnea, chest discomfort, tachypnea, tachycardia, weight loss |
| treatment of Pneumocystic carinii pneumonia | bactrim, steroids |
| other presentations of HIV/AIDS | Long Term Non Progressors Elite Controllers |
| Long Term Non Progressors | HIV infection for at least 10 years No antiretroviral agents Lack of symptoms CD4 count above 500/mm (normal) 4-7% of individuals |
| elite controllers | no progression for >19 years |
| modes of HIV/AIDS transmission | sex mother to baby body fluids sharing IV needles |
| sex | vaginal, oral, anal |
| mother to baby | before, during, after birth |
| body fluids | blood, semen, vaginal fluid, breast milk |
| four ways to protect yourself | abstinence, monogamous relationship, protected sex, sterile needles |
| abstinence | Only 100% effective means |
| monogamous relationship | HIV testing required to prove neither infected |
| protected sex | Condoms Latex barrier during oral sex |
| sterile needles | Fill with undiluted bleach - wait 30 minutes Syringe Service Programs - Prevention Point Pittsburgh |
| CDC estimates | that IV drug use is responsible for >1/3 of all AIDS cases in the United States |
| problem with the 13% of affected HIV pts that are unaware or are not compliant | Do not take meds as advised Do not use safe sex practices Do not use clean needles |
| universal screening | US Preventative Task Force |
| US Preventative Task Force | Screen all 15 to 65 years Screen if high risk < 15 or > 65 years Screen all pregnant women |
| rationale of universal screening | Identification and treatment of HIV is associated with a markedly reduced risk for progression to AIDS |
| Drug therapy substantially decreases | risk for transmission to those not infected |
| Identification of HIV-positive pregnant women dramatically reduces | mother-to-child transmission |
| Pre-Exposure Prophylaxis (PrEP) | Not infected, take daily pill reduce risk |
| When PrEP is used consistently, | Risk of getting HIV through sex up to 99% lower and drug injection up to 74% lower |
| different PrEP drugs | truvada (pill) descovy (pill) apretube (injection) |
| truvada (pill) | for people at risk through sex or injection drug use |
| descovy (pill) | for people at risk through sex but not for people assigned female at birth at risk for HIV through receptive vaginal sex |
| apretube (injection) | for people at risk through sex who weigh at least 77 lbs |
| home testing for HIV | OraQuick In-Home HIV test Home Access HIV-1 home test |
| OraQuick In-Home HIV test is the | first self administered HIV test |
| OraQuick In-Home HIV test entails | Available drug stores ~ $40.00 Results in 20 to 40 minutes Positive test results need to be confirmed |
| Home Access HIV-1 home test is sold either as | "The Home Access Express HIV-1System" or "The Home Access Express HIV-1 Test System." |
| how does Home Access HIV-1 home test work | Blood sample taken at home using a finger stick test strip, mailed to a lab, results are received by phone |
| sensitivity of OraQuick In-Home HIV test | Sensitivity 92%, Specificity 99% |
| sensitivity of Home Access HIV-1 home test | Sensitivity 100% |
| goals of therapy | Suppress viral load to < 50 copies/ml Restore immune function as indicated by CD4 counts Prevent HIV transmission Prevent drug resistance Restore QoL |
| antiretroviral drugs | > 25 drugs; 6 major classes |
| therapy is | highly complex |
| why is therapy highly complex | Need specialist Consider SE, expense, interactions |
| pts are typically prescribed a | Three drug regimen |
| selection of three drug regimen | Base = drug from one classification Backbone = 2 drugs from another classification |
| Once viral load undetectable, | may switch to injections once a month or once every other month |
| HAART regimen is challenging, why?? | Expensive Drugs need to be taken specific times Can cause major adverse reactions Adherence is of central importance Failure to follow regimen risks opportunistic infection, medication resistance |
| use of HAART before | when CD4 counts <200 toxic, only a few options |
| use of HAART now | Offer to all when first diagnosed Including those asymptomatic Once started continue indefinitely |
| harms associated with HAART | All HAART regimens have adverse events |
| adherence with HAART is | problematic |
| why is adherence with HAART problematic | 61% change/discontinue initial regimen by 8 mo 40% to 50% discontinue due to adverse events |
| some side effects of HAART are short term like | GI, Rash, Sleep Disturbances |
| increased risk of the following with HAART | metabolic disturbances (lipodystrophy syndrome, hyperlipidemia, DM) kidney issues or liver damage heart disease |
| What is the risk of HIV transmission? | Greater with high viral load, deep exposure |
| percutaneous route of exposure: factors increasing risk | Hollow bore needle, visibly bloody device, deep injury, and device used in an artery/vein |
| mucous membrane route of exposure: factors increasing risk | Large volume |
| cutaneous route of exposure: factors increasing risk | Must involve non-intact skin |
| what to do 1st when you have an exposure | Cleanse area: Soap and water Alcohol based agent (viricidal HIV) Flush mucous membranes with water |
| what to do 2nd when you have an exposure | document exposure |
| what to do 3rd when you have an exposure | document HIV status of source and Rapid HIV test |
| what to do 4th when you have an exposure | If unknown, PEP (post exposure prophylaxis) |
| goal of PEP is to start within | 1-2 hrs |
| 2013 USPHS Recommendations Updated in 2025 | 8 reccomendations |
| Rec 1 of USPHS Recommendations | Start PEP ASAP and take for 4 weeks |
| Rec 2 of USPHS Recommendations | Regimen should contain 3 (or more) antiretroviral drugs |
| Rec 3 of USPHS Recommendations | Consult expert regarding choice of drugs |
| Rec 4 of USPHS Recommendations | Follow-up should include counseling, baseline and follow-up testing & monitoring for drug toxicity |
| Rec 5 of USPHS Recommendations | Follow-up appointments should begin within 72 hrs of exposure |
| Rec 6 of USPHS Recommendations | If newer 4th generation combination HIV p24 antigen– HIV antibody test is utilized for follow-up testing, testing may be concluded 4 mo after exposure if negative |
| Rec 7 of USPHS Recommendations | If a newer testing platform is not available, HIV testing should be concluded 6 months after an HIV exposure |
| Rec 8 of USPHS Recommendations | Use of precautions to prevent secondary transmission of HIV |
| Ryan White Program | federal funding |
Created by:
leh195