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Where is HIV most prevalent via transmission

Blood & Seminal fluids

How does HIV infect?

- Enters the host blood stream
- Infects the CD4 cells
- Replication of the HIV virus within the CD4 cell

How is HIV transmitted?

- Sexual transmission
- IV drug abuse
- Perinatal transmission
- Blood transfusion
- Occupation exposure

How is HIV testing done?

- Blood (rapid, ELISA, western blot)
- Saliva
- Home test

Nucleoside Reverse Transcriptase Inhibitors

Competitive inhibitors of the HIV enzyme that convert viral RNA into DNA and act as DNA chain terminators.

Non-nucleoside Reverse Transcriptase Inhibitors

Binds to and denatures reverse transcriptase

Protease Inhibitors

impede the HIV protease that trims viral proteins in capsid construction

Fusion Inhibitors

blocks entry of virus into the cell by binding to viral gp41 glycoprotein. Inhibit the fusion of HIV to CD4 cells.

Entry Inhibitors

new class of drugs; prevents HIV from entering cells; bind either gp120 interaction with CD4 OR CCR5

Integrase Inhibitors

Antiretroviral drugs that block integrase thus preventing the incorporation of HIV DNA into the T-cell's DNA

How is HIV classified?

- Based on symptoms and CD4 count

How many HIV categories are there?

Three (A, B, C)

How many HIV subcategories are there that are dependent on CD4 count?

1 = CD4 > 500
2 = CD4 200 - 499
3 = CD4 < 200

Diagnosis of AIDS

Progression of the HIV virus into various conditions

Herpes, Kaposi sarcoma, TB, Lymphoma
CD4 < 200

2' Infection: PCP

Pneumocystis jiroveci (fungal)

S/S = DOE, crackles, wt loss

tx = IV solumedrol, Dapsone, Bactrim (po prevention and IV acute infection)

2' Infection: Candida albicans


S/S = white/yellow plaque formation of mouth, pain

tx = Fluconazole (diflucan)

2' Infection: Cryptococcosis


S/S = fever, nuchal rigidity, blurred vision

tx = Fluconazole (diflucan), symptom management

2' Infection: Histoplasmosis

- fungal
- from bird and bat droppings
- causes respiratory symptoms

tx: fluconazole (diflucan)

2' Infection: Toxoplasmosis

pathogenic infection

S/S: CNS changes, headaches, fever

tx = refrain from eating undercooked meat, do not clean litter boxes

2' Infection: Cryptosporidiosis

pathogenic infection

S/S: severe diarrhea

tx: fluid balance, electrolyte replacement, HAART, anti-diarrheal agents, Nitazoxinide (Alinia) & Azithromycin (Zithromax)

2' Infections: Mycobacterium avium

bacterial infections

S/S: fever, night sweats, weight loss, abdom pain, diarrhea, cough

tx: clarithryomycin (admin w/ caution)

2' Infections: Tuberculosis

bacterial infections

S/S: fever, night sweats, productive cough, dyspnea, chest pain, may have extra pulmonary sites in (CNS, liver, bone, spleen)

*if CD4 < 200, PPD will not be positive*

tx: respiratory iso until (-) sputum culture, Rifampim

2' Infections: Cytomegalovirus

viral infections

commonly infected through eye, GI, resp or CNS

tx: retroviral therapy, symptom mangement

2' Infections: Herpes Simplex

- HSV1 & HSV2
- Small fluid filled vesicles

S/S: fever, pain, open sore following rupture

tx: acyclovir, famciclovir, valcyclovir

2' Infections: Varicella-Zoster Virus

"shingles" - follows sensory nerve tract

S/S: pain & burning occur 1st, rash (fluid filled blisters

Malignancies: Lymphoma

S/S: wt loss, fever, night sweats

tx: chemotherapy

Malignancies: Kaposi's sarcoma

- small purplish lesions raised lesions
- normally develop on skin and may be present on intestinal tract, lungs, or lymph nodes

tx: chemo/radiation, keep area clean dry, prn pain meds

AIDS Dementia: CNS involvement

- may be mild to severe limitations of cognition, behavior, and motor symptoms
- peripheral neuropathies

tx: symptom management, safe environment

Wasting Syndrome

- due to multiple factors of HIV/AIDS disease process

- V/D, anorexia, pain

tx: symptom mangement, high calorie/high protein diet, mouth care

Obesity & HIV

- due to increased caloric intake/high fat diets and low levels of physical activity
-HAART therapy may contribute

tx: dietary teaching, exercise programs

Renal failure & HIV

- may be due to disease or HAART
- acute/chronic
- prevention, tx of ARF, tx of CRF

Psychiatric concerns & HIV

- depression, bi-polar
- exacerbate existing psychiatric disease

tx: HAART, psychiatric meds

Drug resistant organisms

standard precautions

methicillin-resistant staphylococcus aureus

MRSA: community or hospital acquired

- transmitted through direct contact w/ individual colonized with disease

tx: vancomycin

vancomycin-resistant enterococci

VRE: hospital acquired

- transmitted through direct contact with stool, urine, blood

tx: Zyvox


Hospital acquired in immunocompromised pt

- transmitted through direct skin to skin contact

tx: pt specific very hard to treat due to drug resistance

Clostridium difficile

C-diff: immunocompromised or received long-term anitbiotic therapy

- transmitted through direct contact with feces or contaminated surfaces

tx: vancomysin, flagyl po

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