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37 terms

HIV

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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
fungal

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

tx = Fluconazole (diflucan)
2' Infection: Cryptococcosis
fungal

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
contact
droplet
airborne
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
Acinetobacter
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