Care of Patients with HIV Disease and Other Immune Deficiencies

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Chp. 21 Ignatavicious

HIV Define

Acquired immune deficiency syndrome is the most common secondary immune deficiency disease in the world

Clinical catergory A for CDC

HIV positive, persistent generalized lymphadenopathy, or acute primary infection with HIV

Clinical category B for CDC

Bacterial endocarditis, meningitis, sepsis, pneumonia, vulvovaginal candidiasis that is persistent more than 1 month, severe cervical dysplasia or carcinoma, diarrhea or fevere lasting longer than 1 month, oral hairy leukoplakia, herpes zoster (shingle) ITP, listeriosis, TB, nocardiosis, PID and peripheral neuropathy.

Long term non progressors

These people have been infected with HIV for at least 10 years and have remained asymptomatic, with CD4+ %-cell counts within normal range. Genetic component found with this

Faster growing group with HIV infection and AIDS?

Women

First signs of HIV infection in woman

Gynecologic problems, especially persistent or recurrent vaginal candidiasis

Absolute safe methods of preventing infection with sexual contact

Abtinence or monogamous sex with noninfected partners

Most risky sexual contact for HIV transmission

Anal intercourse

Drugs to decrease neuropathic pain from peripheral neuropathy

May respond best to TCA such as amitriptyline (elavil) or to anticonvulsant drugs such as phenytoin (dilantin) or carbamezepine (tegretol). Drugs may take several weeks to work, during this time an opiod may be given for pain.

Drug therapy for arthralgia and Myalgia

NSAIDS. Motrin (ibuprofen), Toradol, Lodine, Indocin, Relafen, Daypro, Feldene, Celebrex, Naproxen (aleve), Ketoprofen, Voltaren

Which medication would you expect to be to a patient with Candidiasis?

Fluconazole (Diflucan)

Monotherapy

promotes drug resistance and does not improve the duration or quality of life for the patient with HIV/AIDS.

HAART

Highly active antiretroviral therapy and is showing good results as measured by reduced viral load and improved CD4+ T cell counts

Lab work with Zidovudine (retrovir)

Monitor CBC, hepatic, and renal function

NARTI's action

Suppress viral replication in infected cells by inhibiting the activity of revere transcriptase.

NNRTI's

Suppress viral replication in infected cells by inhibiting the activity of revere transcriptase.

Protease inhibitors

Prevent viral replication and relase of viral particles by inhibiting viral protease

CDC recommendations for HIV testing

People with STDs, injection drug users, women of childbearing age, recieved transfusion between 1978-1985, planning to get married, people admited to hospitals, people in correctional institutions, prostitutes and customers. HIV epidemic began in 1970.

Entry Inhibitors action

Prevents HIV infection by blocking the CCR5 receptor on CD4 + T lymphocytes. Prevents binding of gp41 to CCR5 receptor

NARTI's and NNRTI's action

Inhibit HIV revere transcriptase. Prevents HIV concerting of DNA

Integrase inhibitors action

Prevents this enzyme from allowing the viral ds-DNA to be inserted into the host ds DNA, which completes the infection of the CD4-T cell

Protease Inhibitors action

Prevents viral replication and release of viral particles by inhibiting viral protease.

A healthy adult has at least this many of CD4-Tcells

800 - 1000 cells/mm3

First manifestations of HIV

Fevere, night sweats, chills, headache, and muscles aches. Common to influenza

Classifaction of A1

CD4 t cell counts at least 500

Classification A2

CD4 t cells counts 200-499

Classifaction of A3

CD4 t cells counts at least 200 u/l

HIV has been cound in most body fluids including

Semen, blood, vaginal secretions, breast milk, amniotic fluid, urine, feces, saliva, tears, cerebrospinal fluid, lymph nodes, cervical cells, corneal tissue, and brain tissue.

Syrince cleanign

First fill with clear water, next fill with bleach and shake for 30 - 60 seconds

Perinatal transmission risk

25% who are not using drug therapy, and 8% who are on drug therapy

Seroconversion

the phase of an infection when antibodies against the infecting agent are first detectable in the blood.

Drug therapy for P. jiroveci pneumonia (PCP)

Trimethropim/sulamethoxazole (Apo-sulfatrim, bactrim, cotrim, septra). Many patients have adverse reactions to this drug including nausea, vomiting, hyponatremia, rashes, fever, leukopenia, thrombocytopenia, and hepatitis.

Immune enhancements

Including bone marrow trasnplantation, lympocyte transufsion, and infusion of lympokines.

Drug therapy for an imbalanced nutrition

Ketoconazole (nizorol) or fluconazole (fiflucan) orally, or IV amphotericin B (fungizone). Treatment for esophagitis.

Drug therapy for diarrhea

Diphenoxylate hydrochloride (diaresd, lomotil) or loperamide (imodium.

Drug therapy for promoting healing

Modified burrows solution (domebro)

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