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Management of Patients with HIV infection
Terms in this set (58)
What types of cells does HIV infect?
cells which express CD4
(lymphocytes, macrophages, monocytes)
tranmission occurs through contact with infectious body fluids including
less chance of HIV transmission if one has a....
lower viral load
can people with HIV go asymptomatic for years?
CDC guidlines for HIV
-test patients 13-64 in all health care settings
-test high risk patients annually
-no required prevention counseling
-test ALL pregnant women
What does HIV do to the cells?
takes over CD4 or T-cell and makes the cell produce million of HIV viruses
- destroyed CD4 cells, causing deterioration of immune system (lymph, macro, monocytes)
- liberates other chemicals which adversely effect immune system
AIDS (CD4 <200 or Indicator disease)
what is a good indicator of transition to AIDS?
CD4 below 200
bacterial/viral/fungal infection that people are at risk with if they have aids?
other conditions people are at risk for when they have aids
PML (progressive multifocal leukoencephalopathy)
Acute retroviral syndrome...how long until remission? seroconversion?
3 months to remission
1-4 weeks to seroconversion after acute infection
the initial infection phase when one contracts HIV
the time that it takes for an antibody to develop in the blood and become detectable
detection of acute retroviral syndrome
may have a positive ELISA and indeterminate western blot
in which states is AIDS reportable?
antibodies to HIV take how long to appear?
-- newer tests can detect sooner
screening for aids
no longer relying on western blot
what is the aids confirmatory test?
ELISA vs western blot
ELISA test for HIV 1 and 2
Western blot only HIV1
false positives for ELISA may come from...
autoimmune diseases recent immunizations, multiple prior pregnancies
antibody screen ELISA
detects presence of antibodies in serum which is indicative of exposure to the virus
the confirmation test (multi-spot) also detects antibodies but...
is more specific than screening test (elisa)
blood put on multiple dots and states whether one is reactive to HIV 2 or HIV 1 or HIV (undifferentiated)
new patient evaluation for HIV
-prior HIV testing
-history of STD
- constitutional symptoms
- weight, oral cavity, lymph nodes, genital/rectal area
A hallmark of the progression of HIV
decrease int he number of CD4 cells
-also a marker for immune strength (found in monocytes, lymphocytes, macrophages)
viral load test (RNA Assay)
test for the presence of the actual RNA of the virus, in contrast to other tests which just predict the amount of antibodies
a low viral load is seen in...
patients who are being successfully treated
high viral load means...
indicate viral mutration or resistance to treatment
what is a low CD4 count?high?
less than 200
more than 500
what is a high viral load?low?
high over 100,000
low less than 50
what types of testing is used to assess for resistant mutations int heir patients?
- very expensive
routine monitoring for one with HIV
CBC with diff
IPV (IV polio) not oral
avoid measles vaccine
evidence of success of treatment of HIV
viral load below 50
cd4 above 500
WBC between 4 to 11
goal of therapy with HIV
-maximal suppression of viral replication
-maintain immune function
-preserve quality of life
tool to achieve goals of therapy
-combination antiretroviral therapy
- opportunist disease chemoprophylaxis
-promotion of maximum adherence
- use of drug resistance testing
definition of success of goal therapy
HIV RNA below 50 copies/ml
factors to consider whens tarting antiretroviral therapy
HIV-1 RNA level
toxicities and risk factors for development
commitment to therapy
antiretroviral therapy is recommended for who?
all HIV positive patients including patients with CD4 count above 500 cells
large trials demonstrated a marked reduction in HIV transmission with early...
other indications for antiretroviral therapy
-post exposure prophylaxis
-preexposure prophylaxis in discordant couples
5 classes for antiretroviral medications
NRTI Nucleoside/Nucleotide Analog Reverse Transcriptase Inhibitors
Non-nucleoside Reverse Transcriptase Inhibitors
what are PI's often used with?
in varying doses
- increases concentrations of other PI's
-allows for smaller doses and less frequent dosing intervals and improve outcomes
using different antivirals from different classes results in...
predictors of inadequate adherence
-active drug/alcohol illness
- active mental illness
-lack of patient education
-lack of access to care
-lack of trust
long-term success depends on ability to take...
medications as directed atlas 95% of the time
what is a drug that often interferes with PI's?
lipid lowering agents
oral contraceptives and PI
not effective when a patient is taking certain protease inhibitors and NNRTI's
toxicities induced by HIV drugs
renal tubular dysfunction
dry skin, alopecia, nail dystrophy, bone loss
nutrition therapy goals
preserve lean body mass
provide adequate levels of all nutrients
minimize nutrition related complications that interfere with either the intake or absorption
complimentary and alternative medicine
population is very prone to the use of CAM
role of HCP in CAM
distinguish legitimate vs quackery therapy
assess for harmful substances, toxic amounts and possible health consequences
foster communication and openness about CAM
viral infection cause eye disease and can lead to blindness
mycobacterium avid complex (MAC)
bacterial infections hat can cause recurring fevers, general sickness, problems with digestion and serious weight loss (CD4 under 75)
fugal infection that can cause a fatal pneumonia
CD4 under 200
protozoal infection of the brain
CD4 under 100
CD4 under 200, what type of prophylaxis should be started?
start pneumocystis carinii pneumonia (PCP)
CD4 under 50 start
mycobacterium avid complex prophylaxis
annual eye exam to screen for CMV
what drugs are used for PCP prophylaxis?
TMP/SMX 3x week
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